An introduction to Medical

Partners in Global Health Education

Parasitology
1. How to use this
module
2. Learning
outcomes
3. Key definitions
4. Epidemiology
5. Burden of
parasitic infections
6. Classification of
protozoa
7. Classification of
helminths
8. Schistosomiasis
9. Hookworm
10. Lymphatic
filariasis
11. Sources of
information

For more information about the authors and reviewers of this module, click here
 How should you study this module?
Partners in Global Health Education

1. How to use this

module
• We suggest that start with the learning
2. Learning objectives and try to keep these in mind as
3.
outcomes
Key definitions
you go through the module slide by slide, in
4. Epidemiology order.
5. Burden of
parasitic infections • You should research any issues that you
6. Classification of
protozoa are unsure about. Look in your textbooks,
7. Classification of
helminths
access the on-line resources indicated at
8. Schistosomiasis the end of the module and discuss with your
9. Hookworm
10. Lymphatic
peers and teachers.
filariasis
11. Sources of
• Finally, enjoy your learning! We hope that
information
this module will be enjoyable to study and
complement your learning about TB from
other sources.
 Learning Outcomes
Partners in Global Health Education

1. How to use this After completing this SDL, you should be able to:
module
• Discuss how important parasites can be classified according
2. Learning
outcomes to kingdom and phylum
3. Key definitions • State the meaning of commonly-used terms
4. Epidemiology • Describe how parasitic infections affect communities in poor
5. Burden of
parasitic infections
countries and that knowledge of their life cycle is necessary
for effective prevention and control
6. Classification of
protozoa • Discuss the epidemiology, basic life cycle, clinical
7. Classification of presentation, management and control of some important
helminths
parasitic infections
8. Schistosomiasis
9. Hookworm
10. Lymphatic
Note: This SDL will contain many unfamiliar terms. You are NOT
filariasis expected to remember the classifications and names of all of
11. Sources of the different parasite species. The emphasis is on
information understanding basic concepts and being able to illustrate
these with some important examples.
After completing this SDL, try the associated quiz to assess your
learning.
 Key definitions: What is ….?
Partners in Global Health Education

1. How to use this • Medical parasitology: “the study and medical implications of parasites
module
that infect humans”
2. Learning
outcomes
3. Key definitions
• A parasite: “a living organism that acquires some of its basic
4. Epidemiology
nutritional requirements through its intimate contact with another living
organism”. Parasites may be simple unicellular protozoa or complex
5. Burden of
parasitic infections
multicellular metazoa
6. Classification of
• Eukaryote: a cell with a well-defined chromosome in a membrane-
protozoa bound nucleus. All parasitic organisms are eukaryotes
7. Classification of
helminths • Protozoa: unicellular organisms, e.g. Plasmodium (malaria)
8. Schistosomiasis
9. Hookworm
• Metazoa: multicellular organisms, e.g. helminths (worms) and
10. Lymphatic
filariasis
arthropods (ticks, lice)
11. Sources of
information • An endoparasite: “a parasite that lives within another living organism”
– e.g. malaria, Giardia

• An ectoparasite: “a parasite that lives on the external surface of

another living organism” – e.g. lice, ticks
 Key definitions: What is ….?
Partners in Global Health Education

1. How to use this • Host: “the organism in, or on, which the parasite lives and causes
module
harm”
2. Learning
outcomes
3. Key definitions • Definitive host: “the organism in which the adult or sexually mature
4. Epidemiology stage of the parasite lives”
5. Burden of
parasitic infections
• Intermediate host: “the organism in which the parasite lives during
6. Classification of
protozoa
a period of its development only”
7. Classification of
helminths • Zoonosis: “a parasitic disease in which an animal is normally the
8. Schistosomiasis host - but which also infects man”
9. Hookworm
10. Lymphatic • Vector: “a living carrier (e.g.an arthropod) that transports a
filariasis
pathogenic organism from an infected to a non-infected host”. A
11. Sources of typical example is the female Anopheles mosquito that transmits
information
malaria
 Epidemiology
Partners in Global Health Education

1. How to use this • Although parasitic infections occur

module
globally, the majority occur in tropical
2. Learning regions, where there is poverty, poor
outcomes
sanitation and personal hygiene
3. Key definitions
• Often entire communities may be infected
4. Epidemiology
with multiple, different organisms which
5. Burden of
parasitic infections
remain untreated because treatment is
neither accessible nor affordable
6. Classification of
protozoa • Effective prevention and control requires
7. Classification of
"mass intervention strategies” and intense
helminths community education. Examples include:
8. Schistosomiasis – General improved sanitation: pit
9. Hookworm latrines, fresh water wells, piped water
10. Lymphatic – Vector control: insecticide
filariasis impregnated bed nets, spraying of
11. Sources of houses with residual insecticides,
information drainage, landfill
– Mass screening and drug
administration programmes which
may need to be repeated at regular
intervals
 The burden of some major parasitic
Partners in Global Health Education
infections
1. How to use this Parasite Diseases No. people infected Deaths/yr
module Plasmodium malaria 273 million 1.12 million
2. Learning
outcomes Soil transmitted helminths: 2 billion 200,000
3. Key definitions
• Roundworm (Ascaris) Pnemonitis, intestinal
4. Epidemiology obstruction
5. Burden of • Whipworm (Trichuris)
parasitic infections • Bloody diarrhoea, rectal
• Hookworm prolapse
6. Classification of
protozoa (Ancylostoma and
Necator) Coughing, wheezing,
7. Classification of abdominal pain and anaemia
helminths
Schistosoma Renal tract and intestinal 200 million 15,000
8. Schistosomiasis
disease
9. Hookworm
10. Lymphatic Filariae Lymphatic filariasis and 120 million Not fatal but 40
filariasis elephantiasis million
11. Sources of disfigured or
information incapacitated
Trypanasoma cruzi Chagas disease 13 million 14,000
(cardiovascular)
African trypanosomes African sleeping sickness 0.3 – 0.5 million 48,000
Leishamania Cutaneous, mucocutaneous 12 million; 2 million 50,000
and visceral leishmaniasis new cases/yr
 Taxonomic classification of parasitic organisms
Partners in Global Health Education

1. How to use this • The classification of parasites is controversial - there is no

module universally accepted system
2. Learning • Parasites form part of the animal kingdom which comprises some
outcomes
800,000 identified species categorised into 33 phyla (but it is
3. Key definitions estimated that there may be ~10m species in total)
4. Epidemiology • The parasitic organisms that are of importance for human health
5. Burden of are eukaryotes - they have a well defined chromosome in a nuclear
parasitic infections
membrane (as opposed to prokaryotes which have no nuclear
6. Classification of
protozoa
membrane, e.g. bacteria)
7. Classification of
• Parasites are classified into 2 sub-kingdoms: protozoa (unicellular)
helminths and metazoa (multicellular)
8. Schistosomiasis • Protozoan (unicellular) parasites are classified according to
9. Hookworm morphology and means of locomotion. There are 45,000 protozoa
10. Lymphatic
species. Most species that cause human disease belong to the
filariasis phylums sarcomastigophora and apicomplexa
11. Sources of • Metazoa (multicellular) include the worms (helminths) and
information arthropoda (posses an external skeleton) e.g. ticks, lice
• Note that the genus starts with a capital letter and the species is
always written in italics, e.g. Plasmodium falciparum, Giardia
lamblia
 Taxonomic classification of protozoa
Partners in Global Health Education

1. How to use this

module Sub Phylum Sub-phylum Genus- Species-
2. Learning kingdom examples examples
outcomes
3. Key definitions
Protozoa Sarcomastig- Sarcodina-- - Entamoeba E. histolytica
4. Epidemiology ophora move by
pseudopodia
5. Burden of further divided into
parasitic infections
6. Classification of
protozoa
Mastigophora Giardia G. lamblia
move by flagella
7. Classification of
helminths
8. Schistosomiasis Apicomplexa Plasmodium P. falciparum,
9. Hookworm no organelle of P. vivax,
locomotion
10. Lymphatic P. malariae,
filariasis
P. ovale
11. Sources of
information
Ciliophora Balantidium B. coli
move by cillia

Microspora Enterocyto- E. bienusi

Spore-forming zoa
 Examples of important intestinal protozoa
Partners in Global Health Education

1. How to use this Transmitted by the faecal-oral route

module and cause diarrhoea
2. Learning • Giardia lamblia: world-wide
outcomes distribution, lives in the small intestine
3. Key definitions and results in malabsorption
4. Epidemiology • Entamoeba histolytica: may invade
5. Burden of
the colon and cause bloody diarrhoea
parasitic infections – amoebic dysentery. Also causes
ameobic liver abscess.
6. Classification of
protozoa • Cryptosporidium parvum: more
prevalent in the immunocompromised Electron micrograph of G. lamblia
7. Classification of
• Cyclospora cyatenensis - parasitises trophozoites (feeding stage)
helminths
8. Schistosomiasis the small intestinal mucosa and may
cause diarrhoea for several weeks
9. Hookworm
• Balantidium coli: a large motile
10. Lymphatic ciliated parasite that lives in the colon
filariasis
of pigs, humans and rodents and can
11. Sources of lead to colonic ulceration
information
• Enterocytozoon bienusi: a
microsporidian that parasitises the
small intestine. Also more common in
the immunocompromised.
Typical flask-shaped ulcer due to E.
histolytica in the colonic mucosa
 Examples of important systemic
Partners in Global Health Education
protozoa
1. How to use this Detected in the blood
module
2. Learning • Plasmodium: the cause of malaria. There
outcomes are 4 species that infect man: P.
3. Key definitions falciparum, P. vivax, P. ovale and P.
4. Epidemiology
malariae
5. Burden of
parasitic infections • Toxoplasma gondi: transmitted by the
6. Classification of ingestion of oocysts from cat faeces.
protozoa Infection can lead to ocular problems and
7. Classification of
is also a cause of neonatal
helminths Typical lesion of
toxoplasmosis
8. Schistosomiasis cutaneous leishmaniasis
9. Hookworm • Leishmania: transmitted by sand flies,
10. Lymphatic
can lead to visceral, cutaneous and
filariasis mucocutaneous leishmaniasis
Tsetse fly – the
11. Sources of
vector of African
information • Trypanosoma: haemoflagellates which
trypanosomiasis
cause
It has a painful
– In Africa - sleeping sickness (transmitted
bite! by the Tsetse fly)
– In South America - Chagas disease
(transmitted by the Reduviid bug)
 Taxonomic classification of helminths
Partners in Global Health Education

1. How to use this Sub Phylum Class Genus –

module kingdom examples
2. Learning Metazoa Nematodes Ascaris (roundworm)
outcomes Round worms; appear round Trichuris (whipworm)
in cross section, they have Ancylostoma (hookworm)
3. Key definitions
body cavities, a straight Necator (hookworm)
4. Epidemiology alimentary canal and an
Enterobius (pinworm or
anus
5. Burden of threadworm)
parasitic infections Strongyloides

6. Classification of
protozoa Platyhelminthes Cestodes Taenia (tapeworm)

7. Classification of Flat worms; dorsoventrally Adult tapeworms are found in

helminths flattened, no body cavity the intestine of their host
and, if present, the They have a head (scolex) with
8. Schistosomiasis alimentary canal is blind sucking organs, a segmented
ending body but no alimentary canal
9. Hookworm
Each body segment is
10. Lymphatic hermaphrodite
filariasis
11. Sources of
Trematodes Fasciolopsis (liver fluke)
information
Non-segmented, usually leaf- Schistosoma (not leaf
shaped, with two suckers but shaped!)
no distinct head
They have an alimentary canal
and are usually hermaphrodite
and leaf shaped
Schistosomes are the
exception. They are thread-
like, and have separate sexes
 Examples of important metazoa –
Partners in Global Health Education
intestinal nematodes
• Trichuris (whipworm)
1. How to use this • Ascaris (roundworm)
module – A soil transmitted helminth – Found world-wide in conditions of
2. Learning
– prevalent in warm, humid poor hygiene, transmitted by the
outcomes conditions faecal- oral route
– Can cause diarrhoea, rectal – Adult worms lives in the small
3. Key definitions intestine
prolapse and anaemia in heavily-
4. Epidemiology
infected people – Causes eosinophilia
5. Burden of
parasitic infections
6. Classification of
• Ancylostoma and Necator
protozoa (hookworms)
7. Classification of
– A major cause of anaemia in the
helminths tropics
8. Schistosomiasis
9. Hookworm • Strongyloides
10. Lymphatic – inhabits the small bowel
filariasis – infection more severe in
11. Sources of immunospressed people (e.g.
information HIV/AIDS, malnutrition,
intercurrent disease)
Heavy intestinal infections may
• occur with Ascaris. Adult worms
Enterobius (pinworm or threadworm)
can be several cms long.
– prevalent in cold and temperate
climates but rare in the tropics
– found mainly in children
 Examples of important metazoa –
Partners in Global Health Education
systemic nematodes
1. How to use this
module Filaria including: • Toxocara
2. Learning
outcomes • Onchocerca volvulus –
– A world-wide infection of
3. Key definitions
Transmitted by the simulium dogs and cats
4. Epidemiology
5. Burden of
black fly, this microfilarial – Human infection occurs
parasitic infections
parasite can cause visual when embryonated eggs
6. Classification of
protozoa impairment, blindness and are ingested from dog or
7. Classification of severe itching of the skin in cat faeces
helminths
8. Schistosomiasis those infected – It is common in children
9. Hookworm
• Wuchereria bancrofti – The and can cause visceral
10. Lymphatic
filariasis major causative agent of larva migrans (VLM)
11. Sources of
information
lymphatic filariasis
• Brugia malayi – Another
microfilarial parasite that
causes lymphatic filariasis
 Examples of important flatworms -
Partners in Global Health Education
cestodes
1. How to use this 1. Intestinal - (“tapeworms”) 2. Systemic
module
• Taenia saginata
2. Learning • Echinococcus granulosus (dog
outcomes
– worldwide tapeworm) and Echinicoccus
3. Key definitions
– acquired by ingestion of multilocularis (rodent
4. Epidemiology contaminated, uncooked
beef tapeworm)
5. Burden of
parasitic infections – a common infection but
6. Classification of causes minimal symptoms – Hydatid disease occurs
protozoa
• Taenia solium
7. Classification of when the larval stages of
helminths
– worldwide these organisms are
8. Schistosomiasis
– acquired by ingestion of ingested
9. Hookworm
contaminated, uncooked
10. Lymphatic
pork that contains
filariasis cystercerci – The larvae may develop in
11. Sources of
– Less common, but causes the human host and cause
information cystercicosis – a systemic
disease where cysticerci space-occupying lesions in
encyst in muscles and in the several organs, e.g. liver,
brain – may lead to epilepsy brain
 Examples of important metazoa –
Partners in Global Health Education
trematodes (flukes)
1. How to use this Intestinal • Fasciola hepatica (liver fluke)-
Primarily, a parasite of sheep,
module
Fasciolopsis buski - A common humans become infected when they
2. Learning parasite of humans and pigs ingest metacercariae that have
outcomes
in South- east Asia. This encysted on watercress. The adult
3. Key definitions parasite is one of the largest trematode lives in the intra-hepatic
4. Epidemiology trematodes to infect man bile ducts of the liver. “Fascioliasis”
5. Burden of (8cm in length) and lives in can lead to severe anaemia in
parasitic infections the upper intestine. Chronic humans
6. Classification of infection leads to
protozoa inflammation, ulceration and • Clonorchis sinensis (liver fluke)-
7. Classification of haemorrhage of the small Widespread in China, Japan, Korea
helminths intestine and Taiwan, this parasite is acquired
8. Schistosomiasis by ingestion of infective
metacercariae in raw or pickled fish
9. Hookworm
10. Lymphatic
filariasis • Paragonimus westermani ( lung
fluke)- Widespread in the Far East
11. Sources of
information
and South east Asia, the parasite is
acquired by ingestion of infective
metacercariae in raw or pickled
crustaceans
Adult Fasciolopsis buski trematode
© Dr. Peter Darben, Queensland • Schistosoma haematobium, S.
University of Technology mansoni and S. japonicum – see
below
 Schistosomiasis (bilharzia)
Partners in Global Health Education

1. How to use this

module
2. Learning
outcomes
3. Key definitions
4. Epidemiology
5. Burden of
parasitic infections
6. Classification of
protozoa
7. Classification of
helminths
8. Schistosomiasis
9. Hookworm
10. Lymphatic
filariasis
11. Sources of
information
 Schistosomiasis (1)
Partners in Global Health Education

1. How to use this Epidemiology

module • 200m people in 74 countries
2. Learning infected, 85% of whom live in
outcomes sub-Saharan Africa
3. Key definitions • S. haematobium - Africa and
4. Epidemiology
middle east (most prevalent)
• S. Mansoni - Africa and Latin
5. Burden of
parasitic infections America
6. Classification of
• S. japonicum – Pacific region
protozoa
7. Classification of Life cycle Bulinus globosus, the intermediate host snail for
helminths • Transmission occurs in fresh water S. haematobium (source: WHO/TDR/Stammers)
8. Schistosomiasis • Infective cercariae released from snails of
the genera Bulinus, Biomphalaria
9. Hookworm
Oncomelania
10. Lymphatic • Cercariae penetrate the skin of people who
filariasis drink, swim or bathe in infected water
11. Sources of • Adult worm live in the veins that drain the
information urinary system (S. haematobium) or
mesentric blood vessels intestines (S.
mansoni, S. japonicum) and release eggs
into water in urine or faeces S. haematobium cercaria (differential
• Eggs develop into miracidia which then interference contrast microscopy; source:
infect snails WHO/TDR/Stammers)
 Schistosomiasis (2)
Partners in Global Health Education

1. How to use this

module Pathology
2. Learning • Shistosoma eggs become trapped in the tissues of the urinary tract (S. haematobium)
outcomes and intestines (S. mansoni, S. japonicum)
3. Key definitions • This results in inflammatory response and tissue damage
4. Epidemiology
5. Burden of
parasitic infections
6. Classification of
protozoa
7. Classification of
helminths
8. Schistosomiasis
9. Hookworm
10. Lymphatic
filariasis
11. Sources of
information

S. haematobium eggs measure 140 x 50 μm

Adult worms of S. haematobium are 1-2 (differential interference contrast microscopy;
cm long (source: WHO/TDR/Stammers) source: WHO/TDR/Stammers)
 Schistosomiasis (3)
Partners in Global Health Education

1. How to use this Symptoms and signs Treatment

module • Urinary Schistosomiasis: • Praziquantel: effective against all
2. Learning – S. hamatobium species
outcomes – Gross haematuria • S. haematobium: single dose (40
3. Key definitions – Dysuria mg/kg)
4. Epidemiology – Bladder, ureters and kidneys damaged
• S. mansoni, S. japonicum: 2-3 doses of
5. Burden of Cancer of the bladder is common
30mg/kg
parasitic infections
6. Classification of • Intestinal schistosomiasis
protozoa – S. mansoni, S. japonicum
7. Classification of – Gradual enlargement of liver and spleen
helminths intestines
8. Schistosomiasis – hypertension of the abdominal blood
vessels which begin to bleed
9. Hookworm
– Blood in the stools
10. Lymphatic • Diagnosis
filariasis
• Microscopy for eggs:
11. Sources of
– urine sediment for S. haematobium
information
– concentrated stool samples for S.
mansoni, S. japonicum
• Serology – all species
• Rectal biopsy - S. mansoni, S. japonicum Haematuria due to S. haematobium
(source: WHO/TDR)
 Schistosomiasis (4)
Partners in Global Health Education

1. How to use this

module
Prevention and control
2. Learning
outcomes • Educate people to not urinate or defecate in
3. Key definitions
fresh water supplies
• Eliminate snail vectors by making the water
4. Epidemiology
habitat unsuitable (increase water flow,
5. Burden of
parasitic infections
remove vegetation)
6. Classification of
• Provide piped water to avoid direct contact
protozoa with cercariae
7. Classification of • Mass drug treatment of communities to
helminths reduce reservoir of infection
8. Schistosomiasis
9. Hookworm
10. Lymphatic
filariasis
11. Sources of
information

Concrete irrigation ditches do not allow

breeding of Oncomelania snails (source:
WHO/TDR/Crump)
 Hookworm (1)
Partners in Global Health Education

1. How to use this

module
Epidemiology
2. Learning
outcomes • >1200m infections each year of which
3. Key definitions
100m are symptomatic
4. Epidemiology
5. Burden of
• It is due to 2 parasites both of which
parasitic infections occur worldwide:
6. Classification of
protozoa – Necator americanus - predominant
7. Classification of species in sub-Saharan Africa,
helminths
south Asia and the Pacific
8. Schistosomiasis
9. Hookworm – Ancylostoma duodenale –
10. Lymphatic predominant in S. Europe, N.
filariasis
Africa, western Asia, northern
11. Sources of
information China, Japan and the west coast of
America
Hookworm is a major cause
of anaemia
 Hookworm (2)
Partners in Global Health Education

1. How to use this Life cycle

module • Adult worms live in the intestine and excrete eggs in the faeces
• In the absence of latrines, eggs contaminate soil and develop in warm, damp conditions
2. Learning
outcomes • eggs hatch and infective filariform larvae develop in about one week and remain infective in soil
for many weeks
3. Key definitions • filariform larvae penetrate the skin when a person walks barefoot in the soil
4. Epidemiology • larva migrate from the skin to the lungs via the lymphatic and blood systems
• larvae penetrate the capillary wall to enter the alveolus
5. Burden of
parasitic infections • Larvae are propelled up the respiratory tree to the epiglottis where they are swallowed
• Develops to adult stage in upper intestine; adult worms are fully mature after about 5 weeks
6. Classification of • Eggs are excreted in the faeces
protozoa
7. Classification of • Note: eating soil (pica) is a common practice. Ingested filariform larvae of A. duodenale can pass
helminths directly to the gut mucosa
8. Schistosomiasis
9. Hookworm
10. Lymphatic
filariasis
11. Sources of
information

Egg of A. duodenale in faecal smear

(size 57-76 µm by 35-47 µm) Filariform larvae
© Dr. Peter Darben, Queensland © Dr. Peter Darben, Queensland
University of Technology University of Technology
 Hookworm (3)
Partners in Global Health Education

1. How to use this

module Pathology
2. Learning • Hookworms move several times a day to
outcomes
different attachment sites in the upper
3. Key definitions intestinal mucosa to ingest blood
4. Epidemiology • They secrete an anticoagulant which
5. Burden of causes the old attachment sites to
parasitic infections continue to bleed
6. Classification of • Heavy hookworm infection results in
protozoa
chronic haemorrhage from the duodenal
7. Classification of
and jejunal mucosa
helminths
• The combination of constant blood loss
8. Schistosomiasis
due to hookworm infection and poor iron
9. Hookworm
intake in the diet results in iron deficiency
10. Lymphatic anaemia
filariasis
• A. duodenale ingests 4-5 times more
11. Sources of
information
blood each day than N. americanus
• In a child, the continued daily loss of 10ml
of blood can lead to severe anaemia Adult male and female worms of A. duodenale
© Dr. Peter Darben, Queensland University of
Technology
 Hookworm (4)
Partners in Global Health Education

1. How to use this Symptoms and signs Treatment

module
Minor • Mebendazole (cheap) – 100mg, twice
2. Learning
outcomes • Often itchy papules are found at the site daily for 3 days
3. Key definitions where the larva penetrated the skin • Mebendazole is contraindicated in
• There may be cough and wheezing as pregnancy – use Bephenium
4. Epidemiology
the larva migrates through the lungs hydroxynaphthoate “alcopar”
5. Burden of
parasitic infections Major • For anaemia: ferrous sulphate 200-400
mg three times a day for 3 months
6. Classification of • Hookworm anaemia
protozoa (adult regimen)
– Tiredness, aches and pains
7. Classification of
helminths
– Pallor
8. Schistosomiasis – Breathlessness
– Oedema Prevention and control
9. Hookworm
• Health education and improve sanitation
10. Lymphatic Diagnosis
facilities – install pit latrines
filariasis • Microscopic examination of faecal
• Encourage use of protective footwear
11. Sources of smears to demonstrate significant
information numbers of hook worm eggs • Discourage soil eating (pica)
• Measure Hb, serum ferritin, iron • Mass drug treatment of communities
• • Iron supplementation in areas of low iron
Exclude other causes of anaemia
intake
 Lymphatic filariasis (1)
Partners in Global Health Education

1. How to use this

module
Epidemiology
2. Learning
outcomes
• 120m people infected in >80
3. Key definitions countries in Africa, Asia, the
4. Epidemiology
5. Burden of
Pacific islands and South and
parasitic infections
Central America
6. Classification of
protozoa
• 40m of those infected are
7. Classification of
helminths disfigured or severely
8. Schistosomiasis
9. Hookworm
incapacitated
10. Lymphatic
filariasis
• 95% cases due to
11. Sources of Wuchereria bancrofti, other
information
species include Brugia malayi
and Brugia timori A female Anopheles mosquito taking
a blood meal
 Lymphatic filariasis (2)
Partners in Global Health Education

1. How to use this

module Life cycle
2. Learning • Wuchereria bancrofti is mainly
outcomes transmitted by
3. Key definitions – Culex mosquitoes in India
4. Epidemiology – Anopheline mosquitoes in Africa
5. Burden of • B. malayi and B. timori are transmitted
parasitic infections mainly by Mansonia mosquitoes
6. Classification of • Larval forms of the parasite
protozoa (microfilariae) are taken up by a female
7. Classification of mosquito when it takes a blood meal Microfilaria of B. malayi in thick
helminths from a human infected with adult worms blood film (H&E stain; source: CDC)
8. Schistosomiasis • The microfilariae develop inside the
9. Hookworm
mosquito
10. Lymphatic
• When the mosquito takes another blood
filariasis meal the infective filariform larvae enter
the bite wound
11. Sources of
information • Filariform larvae migrate to the
lymphatics and lymph glands
• Larvae develop into sexually mature
adult worms over 3-12 months
depending on the species of filarial
worm Adult worms of B. malayi in section in a
lymph node (source: Univ South
Carolina)
 Lymphatic filariasis (3)
Partners in Global Health Education

1. How to use this

module
Pathology
2. Learning • Adult worms live in the afferent
outcomes
lymphatic vessels and cause
3. Key definitions
severe disruption to the
4. Epidemiology
5. Burden of
lymphatic system
parasitic infections • Scrotal damage and massive
6. Classification of
protozoa
swelling may occur when adult
7. Classification of
Wuchereria bancrofti lodge in
helminths the lymphatics of the spermatic
8. Schistosomiasis cord
9. Hookworm
• Late stage disease is typified
10. Lymphatic
filariasis by elephantiasis – painful and
11. Sources of disfiguring swelling of the limbs
information
• Trauma and secondary
bacterial infection of affected
Elephantiasis of the leg
tissues is common (source: WHO/TDR/Crump)
 Lymphatic filariasis (4)
Partners in Global Health Education

1. How to use this Symptoms and signs – 3 stages

module
1. Asymptomatic stage
2. Learning
outcomes • There is internal damage to the lymphatics
3. Key definitions
and kidneys
4. Epidemiology
2. Acute stage – Filarial lymphangitis
5. Burden of
• Characterised by bouts of fever
parasitic infections • heat, redness, pain, swelling and
6. Classification of tenderness of the lymph nodes and ducts
protozoa 3. Chronic stage
7. Classification of • Usually results in elephantiasis as a result
helminths
of chronic lymphoedema
8. Schistosomiasis
• There is a massive overgrowth of tissue
9. Hookworm
resulting in severe deformities
10. Lymphatic
• The legs are often affected and result in
filariasis
inability to walk
11. Sources of
information • The scrotum is often affected in men and
the breasts and vulva in women

Elderly male with massive hydrocoele, and

elephantiasis of the leg. Also has nodules in the groin
due to onchocerciasis (source: WHO/TDR/Crump)
 Lymphatic filariasis (5)
Partners in Global Health Education

1. How to use this Diagnosis Prevention and control

module • Microscopic examination of Giemsa • Rapid diagnosis and treatment
2. Learning stained thick blood films for the presence
outcomes of infected individuals
of microfilariae
3. Key definitions • W. bancrofti shows marked nocturnal
• Mass drug administration to at
4. Epidemiology periodicity, so it’s best to collect blood risk communities
5. Burden of samples between 10pm and 1 am • Vector control: eliminate
parasitic infections • Serology mosquito breeding sites
6. Classification of through improved sanitation
protozoa
Treatment and enviromental
7. Classification of
helminths • Diethylcarbamazine (DEC) rapidly kills management
8. Schistosomiasis microfilariae and will kill adult worms if • Personal protection against
9. Hookworm
given in full dosage over 3 weeks mosquito bites by insecticides,
10. Lymphatic
• Release of antigens from dying microfilaria bednets and repellants
filariasis causes allergic-type reactions – add an
11. Sources of antihistamine and aspirin to treatment
information regimen
• Other treatment options are
– ivermectin
– combination of DEC and albendazole
 Sources of information
Partners in Global Health Education

1. How to use this

2.
module
Learning
• The Special Programme for Research and
outcomes
Training in Tropical Diseases (TDR UNICEF,
3. Key definitions
4. Epidemiology UNDP, World Bank, WHO) website:
5. Burden of
parasitic infections
ww.who.int/tdr/media/image.html
6. Classification of
protozoa
• University of South Carolina School of Medicine:
7. Classification of
helminths
http://pathmicro.med.sc.edu/book/parasit-
8. Schistosomiasis sta.htm
9. Hookworm
10. Lymphatic
• Lecture notes on Tropical Medicine, Dion R Bell,
filariasis
11. Sources of
Fourth edition, 1996, Blackwell Science.
information
• Parasites and human disease, W. Crewe and
D.R.W. Haddock, 1985, First edition, Edward
Arnold.