SUPER PARASITOLOGY TABLE

Maria Yña Eluisia T. Pereyra RPh, MD, MBA

Parasite Morphology & Infective & Transmission, Diagnosis & Pathogenesis

Epidemiology Diagnostic Treatment
stage ; Host

1. Intestinal Amoeba
a. Entamoeba has pseduopodia for Infective: fecal-oral, via enema equipment ; majority is Asx ; Amebic dysenstery: bloody diarrhea,
Histolytica locomotion, lacks Cyst , trophozoite and cyst in the stool, fish odor stool, (+) Charcot-Leyden crystals ; amoebic
mitochondria, no RER Diagnostic: saline and methylene blue stain, PCR colitis: abdominal pain and diarrhea +/- blood and
and GA ; prevalent in the Trophozoite ; and ELISA (for differenetiation from mucus, Amoebic liver abscess (ALA) is the most common
tropics, infects at least Intermediate other Entamoeba sp., serum extra-intestinal form of amebiasis (fever, RUQ pain) ; 3
50M people worldwide, : None ; antibodies (DxOC for ALA), UTZ virulence factors: Lectin (for adherence to cells) ,
about 100,000 die each Definitive: (round or oval hypoechoic area with Amebapore (form pores on host cell memb) and
year placing second to human wall echoes, usually in the R lobe), Cysteine proteinases (cytopathic for host cell) ;
malaria in terms of CT Scan, MRI ; DOC is Metronidazole mechanism of immunity: cell-mediated immunity, ADCC
mortality caused by for invasive amebiasis, Diloxanide doe not work for amoeba ; Flask-shaped ulcer (usually in
protozoans, equal furoate for asymptomatic cyst the cecum, asceding colon and sigmoid) ; complications:
prvalence among men carriers, Percutaneous drainage of perforation, secondary bacterial peritonitis, rupture of
and women but ALA is 3- liver abscess if not responding to the pericardium, intraperitoneal
10x more commmon in metronidazole or for prompt relief rupturesecondaryamoebic meningoencephalitis ;
men of pain or for left lobe abscess that
may rupture into the pericardium

2. The Commensal Amoeba: are non-invasive and do not cause disease ; reproduce by binary fission ; cysts pass through the acidic stomach unscathed, protected by their cyst wall, excystation
a. Entamoeba dispar: morpholigacally similar to E. histolytica but their DNA and ribosomal RNA are different
b. Entamoeba hartmanni: similar to E. histolytica but is much smaller and does not ingest RBC, sluggish
c. Entamoeba coli: cosmopolitan in distribution, harmless inhabitant of colon, has a larger cyst and greater number of nuclei than E. histolytica
d. Entamoeba polecki: parasite of pigs and monkey, cyst is uninucleated
e. Entamoeba gingivalis: has no cyst stage and does not inhabit the intestines, found in the mouth, moves quickly and has numerous blunt pseudopodia, transmission is via kissing or droplet spr
f. Endolimax nana: small size, sluggish movement
g. Iodamoeba butschlii: no peripheral chromatin granules on the nuclear membrane
3. Free-living Pathogenic amoeba
 a. Acanthamoeba has acanthopodia for active route of invasion of CNS is via causes Granulomatous Amoebic Encephalitis (GAE)
locomotion, sluggish and trophozoite blood ; trophozoite or cyst in tissues usually in Px who are immunocompromised, manifests
polydirectional stage and and CSF ; 5-Fluorocytosine, as destructive encephalopathy and meningeal irritation
movement, ubiquitous, dormant cyst Ketoconazole, Itraconazole, (confusion, somnolence, hallucinations, seizures, cranial
cysts are double-walled ; stage Pentamidine, Amphotericin B, nerve palsies, visual disturbances, increased ICP) ;
high incidence among surgical excision of infected cornea causes amoebic keratitis (corneal ulceration, infiltration
AIDS Px and contact lens with corneal transplantation ; Avoid and clouding, iritis, slceritis, loss of vision) ; fpund in
wearers use of topical corticosteroids ; nasal cavity, throat and intestines
Boiling water is the best possible
way of killin trophozoitez and cysts

b. Naegleria : N. Naegleria trophozoites I: Cyst, D: oral and intranasal routes whie causes primary amebic meningoencephalitis (PAM)
gruberi (non- readily forms a pair of trophozoite ; swimming in contaminated pools, manifested as fever, headache, signs of meningeal
pathogenic), N. flagella originating from N. fowleri is lakes and rivers, inhalataion of the irritation, vomiting and encephalitis with progression to
fowleri the tip of a pear-shaped only dust-borne cyst could lead to coma and death, has degenerative or cytopathic effects
(pathogenic) cell body (transforms pathogenic infection, most ofte isolated from in mammalian cell cultures
from an ameba intoa to humans, thermal effluents, hot springs and
biflagellated organism) ; others are water with elevated temp ;
soil is the preferred opportunisti trophozoites in the brain and CSF,
habitat, run-off from c pathogens. PCR, ELISA ; DOC is Amphotericin B,
heavy rains result in Clotrimazole, Azithromycin, Iodine,
introduction of ameba Chlorine
from soil into lakes and
ponds

4. Ciliates and Flagellates

a. Balantidium has a cytosome through I: Cyst, D: ingestion of food/water capable of attacking the intestinal epithelium resulting in
coli which it acquires food both cyst and contaminated with fecal material ulcer with a rounded base and wide neck which in turn
and a cytopyge through trophozoite ; containing cysts ; trophozoites and causes bloody diarrhea, ulceration is caused by
which it excretes waste, primarily cysts in feces ; Tetracycline, hyaluronidase , bloody and mucoid stoool prund 6-15x a
has a macro and associated Metronidazole, Iodoquinol day, complicatiosn include intestinal perforation and
micronucleus and two with pigs ; acute appendicitis ; ingested cysts excyst in the SI and
contractile vacuoles ; become trophozoites. Trophozoites inhabit the lumen,
common in pigs mucosa and submucosa of the large intestines primarily
throughout the tropics the cecal region, also blood vessels and lymphatics
 b. Giardia binucleated flagellated I: Cyst, D: ingestion of food/water lives in the duodenum, jejunum and upper ileum of
lamblia trophozoite and trophozoite contaminated with fecal material humans, excyst in the duodenum and develops into
quadrinucleated cyst, and cyst containing cysts ; trophozoites and trophozoites which rapidly multiply and attach to the
pyriform or tear-drop cysts in feces, aspiration biopsy, intestinal villi causing pathologic changes (villous
shaped, pointed Enterotest, antigen detection tests, flattening & crypt hypertrophy) that leads to a decrease
posteriorly with a pair of immunofluorescence test, direct in eletrolyte, glucose and fluid absorption, causes
ovoidal nuclei, dorsal fluorescent antibody is considered mechanical irritation in the affected tissues, secretes
side of the organism is to be the Gold standard in Lectin which enables attachment to intestinal
convex while vetral side diagnosis ; Metronidazole, epithelium, causes rearrangement of cytoskeleton in
is concave with a large Tinidazole, Furazolidone, human colonic and duodenal monolayers --> structural
adhesive disc used for Alternatives: Paromomycin & disintegration --> enterocyte apoptosis ; also causes
attachment, bilaterally Quinacrine increased epithelial permeability leading to loss of
symmetrical with epithelial barrier function ; 50% of cases may be
distinct medial line asymptomatic, abdominal pain described as cramping
called axostyle ; with with diarrhea, excessive flatus with an odor of hydrogen
erratic tumbling motion sulfide "rotten egg" odor ; chronic infection is
by four pairs of flagella ; chracterized by steatorrhea (passage of greasy, frothy
high prevalence among stools that float on toilet water) ; spontaneous recovery
homosexuals due to oro- occurs within 6weeks
anal practices

5. Coccidians: characterized by an alternation of generations - 1 sexual & 1 asexual - occuring in the same host. Asexual reproduction is schizogony while the Sexual cycle is sporogony
a. Isospora belli oocyst has two I: oocyt, D: ingestion of food/water sporocytes excyst in the small intestines and the
sporocysts with each oocyst contaminated with fecal material released sporozoites enter the epithelial cells of the
containing four containing cysts ; oocysts in feces by distal duodenum and proximal ileum; often
sporozoites ; more direct microscopy or after formalin- Asymptomatic, diarrhea occurs intermittently for
common in children and ethyl acetate concentration, Acid- months, fever, flatulence, malabsorption syndome ;
male homosexuals esp fast stain, Iodine staining, Entero- mucosal lesions of shortened villi, hypertrophied crypts
those with AIDS test, duodenal aspirate ; bed rest and infiltration of the lamina propria with
and bland diet for asymptomatic polymorphonuclear leukocytes esp eosinophils
patients, Co-trimoxazole or
Pyrimethamine-Sulfadiazine for
symptomatic Px
 b. oocyst will appear as a I: oocyst, ingestion of food/water sporozoites which attach to the surface of epithelial cells
Cryptosporidium red-pink doughnut- oocyst; C. contaminated with fecal material of the GIT --> sporozoites develop into trophozoites and
hominis shaped circular parvum is containing oocysts ; diagnosed using become intracellular but extracytoplasmic and attach to
organisms in a blue- now Sheather's sugar flotation or the brush borders ; manifest as self-limiting diarrhea of
background in Kinyoun considered a formalin-ethyl-acetate 2-3weeks in the immunocompetent host, In the
acid fast stain parasite of concentration technique or acid fast immunocompromised Px the diarrhea becomes more
bovines staining (cheapest and quickest), severe, progressively worse and life-threatening ; there
which can Indirect fluorescent antibody, may also be acute and gangrenous cholecystitis due to
infect enzyme immunoassay and DNA heavy infection of bile duct and gallbladder, respiratory
humans probes ; There is presently no infections lead to chronic coughing, dyspnea,
while C. acceptable treatment for bronchiolitis and pneumonia ; the villi of the intetines
hominis will Cryptosporidiosis, Nitazoxanide become blunted and there is infiltration of inflammatory
infect only however has been reported cells into the lamina propria and elongated crypts
humans effective, Bovine colostrum,
paromomycin, claritromycin and
azithromycin have shown promise
as treatment

c. Cyclospora has cyanobacteria-like I: oocyst, D: ingestion of food (leafy chronic and intermittent watery diarrhea (6-7 weeks)
cayatensis body, oocysts are oocyst ; host: vegetables) /water contaminated with >6 stools per day, infections are usually self-
autofluorescent and human only with fecal material containing limiting and immunity may result with repeated
under fluorescent oocysts ; Direct microscopic infections
microscopy, would examination of fecal smears under
appear as blue or green high magnification (400x), acid fast
circles staining, safranin staining,
microwave heating, PCR ; disease is
self-limiting and treament is not
necessary, if pharmacologic
treatment is warranted, Co-
trimoxozole may be given
 d. Toxoplasma trophozoite is crescent- I: tachyzoite, ingestion of food/water is an intracellular parasite which infects different kinds
gondii shaped with a pointed bradyzoite contaminated with cat fecal material of nucleated cells including macrophages ; usually
anterior and a rounded and oocyst, containing oocysts, eating of meat of asymptomatic as long as the immune system of the Px is
posterior D: tachyzoite infected animals, blood transfusion, well functioning ; once stimulated the immune system
/ placental transfer (1st trimester), quickly responds to the parasites which, in turn, adapt
bradyzoite ; organ transplantation esp bone by transforming into bradyzoites that are proctected by
I: human and marrow ; examination of tissue a cyst wall, cyst can be found in the brain, skeletal and
other imprints stained with Giemsa, cardiac muscles and retina ; Clinical manifestations
animals hematoxylin or eosin, serum become apparent when immune system is suppressed
(rodents, antibodies, Sabin-Feldman (old age, drug-induced, AIDS etc): encephalitis,
pigs), D: cat methylene blue dye test, indirect myocarditis, focal pneumonia, retinochorioditis,
hemmaglutination, indirect lymphoreticular hyperplasia with enlargement of the
fluorescent antibody test, ELISA, posterior cervical lymph node, hepatitis, splenomegaly,
latex agglutination, PCR ; failure to gain weight ; In pediatric Px it may be
pyrimethamine-sulfadiazine (rescue manifested as stillbirth, abortion, chorioretinitis,
agent for pyrimethamine: epileptic seizure, jaundice, hydrocephalus, microcephaly,
Leucovorin), if with sulfa allergy, use anemia, pneumonia ;
Clindamycin, alternative drugs:
spiramycin, azithromycin,
clarithromycin, dapsone,
atovaquone ; Prophylaxis for
immunocompromised: Co-
trimoxazole

e. Sarcocystis simplest form is called a I: oocyst D: ingestion of uncooked or 2 types: Macrocysts (seen by naked eye), Microcysts
hominis, S. zoite, which is banana- oocyst ; I: undercooked meat of an (seen under the microscope), penetrate intestinal
suihominis shaped, sporocysts are cattle, pig D: intermediate host ; Western Blot, epithelial tissue and spead hematogenously to various
composed of 4zoites Human & IFA, ELISA ; NO EFFECTIVE areas of the body, including the brain ; SSx include
other TREATMENT IS KNOWN, diarrhea, eosinophilic enteritis, myalgia, weakness and
primates, Corticosteroids for muscular mild increase of creatine kinase
dogs, cats inflammation, Co-Trimoxazole for
intestinal infections

6. Other Intestinal Protozoans

 a. Blastocystic lacks cell wall but has a I: cyst D: cyst fecal-oral route ; direct fecal smear, abdominal cramps, IBS, bloating, flatulence, diarrhea
hominis mitochondrion with (vacuolated hematoxylin, trichrome stain, Boeck withou fecal leukocytes or blood, nausea, vomiting, low
protozoan morphology, form) ; D: and Drbohlay's media, Nelson and grade fever, malaise ; Blastocystis is hard to eradicate
capable of pseudopodial human, dogs, Jones media ; DOC is metronidazole, because it hides in the inteestinal mucus, sticks and
extension and chicken, iodoquinol, if metronidazole- holds on to intestinal membranes
retraction ; has 4 ostrich, resistant, give co-trimoxazole
morphological forms - macaques
vacuolated, amoeba-like,
granular and mutliple
fission ; more common
in children and
immunocompromised
individuals

b. Dientamoeba rossette-shaped nuclei ; I: fecal-oral route, transmission of lives in the mucosal crypts of the cecum and upper colon,
fragilis resembles Trichomonas trophozoites helminth eggs particularly does not invade tissues but produces irritation of the
except for the absence of D: Enterobius vermicularis ; fecal mucosa with secretion of excess mucus and
flagellum ; together with trophozoites smear ; Iodoquinol, tetracycline, hypermotility ; infections are usually asymptomatic, if
Enterobius, has high ; D: human, metronidazole symptomatic: colicky abdominal pain, loss of appetite,
prevalence aming pre- pigs diarrhea with excess mucus, andominal tenderness,
school children and bloating and flatulence, anal pruritus (due to co-infection
mental institutions with Enterobius), may be found in the egg or lumen of E.
vermicularis

7. Plasmodium
Plasmodium pigment producers, I: bite of a female Anopheles Asexual life cycle in human: Schizogony which produces
falciparum, amoeboid in shape, sporozoites mosquito ; Giemsa or Wright stain merozoite and gametocyte, Sexual life cycle in mosquito:
Plasmodium gametocyte is banana from remains to be the Gold Standard Sporogony which produces sporozoites ; Inside humans,
vivax, shaped, microgamete mosquito D: (obtian smeras evry 6-8hrs), sporozoites are injected into the blood via a mosquito
Plasmodium cytoplasm is light blue in trophozoites Quantitative Buffy Coat, Malaria blood meal --> goes to liver and enter parenchymal cells
ovale, color while ; I: human D: rapid diagnostic tests such as (exoerythrocytic schizogony which produces
Plasmodium macrogamete is darker mosquito Histidine-rich protein, Plasmodium merozoites) --> merozoites proceed to peripheral blood
malariae blue, trophozoite is ring- LDH (can distinguish between to enter RBCs --> some merozoites reinvade the liver
shaped with a red falciparum and non-falciparum ; forming hypnozoites (remain dormant for years), others
chromatin dot and a Chloroquine (DOC for P. vivax, P. develop into trophozoites in RBCs --> trophozoites has
small blue cytoplams in ovale, and uncomplicated P. an extended cytoplasm and a large chromatin mass
Giemsa or Wright stain, ; falciparum in areas where there is which further divides to form more merozoites --> RBC
1.5 to 2.7M deaths no resistance, Sulfadoxine- rupture and the merozoites are released into the blood
annually, 2.3B are at risk Pyrimethamine for areas with ready to invade other RBCs--> some merozoites develop
of being infected, Chloroquine resistance, Quinine + into micro-macrogametes which are picked by feeding
falciparum and vivax are Sulfadoxine-Pyrimethamine or female anopheles mosquito --> the gametes form a
responsible for 90% of Quinine + Tetracycline or zygote which transforms into an oocyst and then
cases of human malaria ; Clindamycin for resistant cases, produces sporozoites which enter the salivary gland of
most important parasitic Quinine is the DOC for pregnancy, mosquitos --> another blood meal will inject a
disease affecting man, Primaquine and Tetracycline are sporozoite into another human host ; feed on Hgb
considered to be one of contraindicated, Artemisinin, and resulting in production of pigment ; Symptoms include
the three major Artesunate and Artemether are paroxysms of fever with asymptomatic intervals,
infectious disease presently the best suited therapy for weakness, desire to stretch and yawn, aching bones and
threats along with HIV severe malaria, Quinine or Quinidine limbs, loss of appetite, nausea, vomiting, chills ;
and TB, it kills more is the DOC for severe falciparum Symptoms composed of cold stage (shivering, peripheral
people than any other malaria, Primaquine is for radical vasoconstriction) and hot stage (fever, headache,
coomunicable disease treatment of relapsing vivax or ovale palpitations, tachypnea, epigastric discomfort, thirst,
except TB, kills 1.5-2.7M malaria and is a gametocide, nausea vomiting), Cerebral malaria is manifested at
people each year ; In the Artemotil is also for severe malaria, symmetrical encephalopathy, retina hemorrhages ,
Philippines, 65 out of 78 For MDR malaria, give Mefloquine, bruxism, neck stiffness. and (+) pout reflex, the ff SSx
provinces are endemic to sulfadoxine-pyrimethamine, happen to severe malaria: Acute renal failure, ARDS,
malaria, 70% of malaria halofantrine, artemisinin and family hyperkalemia, hyperuricemia
in the Philippines is can be given (Mefloquine +
caused by P. falciparum Artesunate is the DOC for SE Asian
while <30% is P. vivax, countries),
<1% is due to P.
malariae

P. falciparum pre-patent period: 11-14 days ; Incubation period: 8-15

days ; infect RBC of all ages
P. vivax pre-patent period: 11-15 days ; Incubation period: 12-20
days ; infect young RBC ; has relapse
P. ovale pre-patent period: 14-26 days ; Incubation period: 11-16
days ; infect only young RBC ; has relapse
P. malariae pre-patent period: 3-4 weeks ; Incubation period: 18-40
days ; infect only aging RBC
8. Babesia cause malaria like infection
a. B. divergens cattle parasite
b. B. microti single or paired, I: sporozoite bite from and infected black-legged The larval form of the tick attaches to the white-footed
amoeboid, D: tick, Ixodes scapularis (also known mouse for a blood meal and picks up the parasite from
oval/spherical/bizaare- trophozoite ; to carry Borrelia burgdoferi), the host. After feeding, the larva molts to an infective
shaped bodies ; I: tick vertical transmission from an nymphal stage which attaches to grass leaves and other
intraerythrocytic D:dogs, infected mother to fetus, blood vegetation, waiting to bite a bigger vertebrate host
parasites look "teardrop- cattles, transfusion ; Immunofluorescent (usually deer or human). The infected nymph takes a
shaped" horses, rats assay (IFA), PCR is the DxOC ; blood meal in the new vertebrate host then emerges as
Clindamycin +/- Quinine an infective adult which will need another blood meal to
lay eggs, now infected with Babesia ; causes an increase
in the release of TNF, SSx incude headache, fever, chills,
altered mental status, DIC, anemia with
dyserythropoiesis, respiratory distress and renal
insufficiency

9. Blood and Tissue Flagellates

 a. Trypanosoma trypomastigotes are I: metacyclic enters human host through trypomastigotes are engulfed by macrophages and
cruzi characteristically C or U- trypomastigo scratched skin or through mucous multiply through binary fission as amastigotes ; cells
shaped ; 16-18M are te D: membranes that are rubbed with frequently invaded are the reticuloendothelial cells of
infected, chronic disease trypanosome fingers contaminated with the bug's the spleen, liver, cardiac, smooth and skeletal muscles ;
is more common than s ; I: rodents feces at the site of inoculation, a local inflammatio is produced
acute disease, highest and (Triatoma/Rhodnius/Panstrongylus which is called a Chagoma (small painful reddish
incidence occurs in the burrowing better known as reduviid, kissing or nodule), other SSx include fever, generalized
fifth decade of life, animals D: assasin bug), may also enter lymphadenopathy ; chronic infection may manifest as
Male>Female humans through the conjunctiva of the eye cardiomyopathy, megaesophagus, megacolon
and cause edema of the eyelids and
conjunctiva (Romañ a's sign) ;
Trypanosomes in blood, CSF, fixed
tissue or lymph via thick blood
smears (only in the first 2months),
blood culture, Xenodiagnosis,
Immunofluorescent antibody test,
complement fixation test, indirect
hemagglutination assay, ELISA, Dot-
immunobinding assay, PCR ; NO
ENTIRELY SUITABLE DRUG -
Nifurtimox and Benznidazole are
only partially effective in acute
disease

b. flattened and fusiform, I: metacyclic transmitted via a bite of the vector In humans, the paraiste live in the blood, in the reticular
Trypanosomoa body tapes anteriorly trypomastigo Glossina sp (tsetse fly) where the tissues of the lymph and spleen and the CSF, multiply by
brucei gambiense and is blunt posteriorly, te D: parasite trypomastigote form longitudinal binary fission, invade the CNS in chronic
pale bue cytoplasm is trypanosome develop into epimastigotes (in the infection ; earliest SSx is a chancre (local, hard, painful
granular and may be s ; I: rodents salivary gland), multiply and lesion at the site of inoculation), acute stage is
vacuolated, red-staining and transform into the infective stage, characterized by irregular fever, headache, joint and
falgellum runs alon the burrowing Congenital transmission is possible ; muscle pains, dizziness, debility, rash, posterior cervical
edge of the undulating animals D: Giemsa stain, buffy coat lymphadenopathy with a consistency of ripe plums
membrane and becomes humans concentration method, indirect (Winterbottom's sign) ; With CNS invasion, headcahes
free anteriorly ; Affects hemagglutination, ELISA, become more and more severe with increasing mental
over a third of Africa, Immunofluorescence ; Pentamidine, dullness and apathy, Tremors, hyperesthesia (Kerandel's
20,000 new cases are Suramin (both does not reach CSF), sign) and inversion of sleep cycle may be observed ;
reported each year, Melarsoprol or Tryparsamide (if Tryapnosomes are able to evade the immuse response of
prominent in areas near with CNS involvement), Eflornithine the host through a process called antigenic variation.
river banks and streams has been found to be effective in late This refers to the ability of the Trypomastigote to change
stages of Gambian Trypanosomiasis its surface coat, which is a variant surface glycoprotein,
so that the antobodies previously produced by the host
cannot act on it, resulting in recurrent waves of
parasitemia
 membrane and becomes humans concentration method, indirect (Winterbottom's sign) ; With CNS invasion, headcahes
free anteriorly ; Affects hemagglutination, ELISA, become more and more severe with increasing mental
over a third of Africa, Immunofluorescence ; Pentamidine, dullness and apathy, Tremors, hyperesthesia (Kerandel's
20,000 new cases are Suramin (both does not reach CSF), sign) and inversion of sleep cycle may be observed ;
reported each year, Melarsoprol or Tryparsamide (if Tryapnosomes are able to evade the immuse response of
prominent in areas near with CNS involvement), Eflornithine the host through a process called antigenic variation.
river banks and streams has been found to be effective in late This refers to the ability of the Trypomastigote to change
c. Trypanosoma stages of Gambian Trypanosomiasis its surface coat, which is a variant surface glycoprotein,
brucei so that the antobodies previously produced by the host
rhodesiense cannot act on it, resulting in recurrent waves of
parasitemia

d. Leishmania Promastigotes have a I: transmitted via bite of sandfly Amastigotes live intracellularly in monocytes, PMNs or
tropica, L. single free flagellum Promastigote (Phlebotomus spp), congenitally, by endothelial cells, multiply by binary fission ; L. tropica is
braziliensis, L. arising from the s D: blood transfusion, by contamination manifested as skin ulcer with elevated and indurated
donovani Kinetoplast at the Amastigotes ; of bite wounds and by contact ; margins, painless and do not result in lymphadenopathy,
anterior end ; 12M cases D: humans demonstration of Leishmania in systemic SSx are absent , diffuse cutaneous
are affected worldwide tissue biopsies (skin for cutaneous Leishmaniasis causes widespread thickening of the skin
Leishmaniasis, bone marrow with lesions resembling that of lepromatous leprosy ; In
spleenor lymph nodes for Kala- mucocutaneous Leishmaniasis, lesions resemble that of
Azar), aldehyde & complement- cutaneous Leishmaniasis , however, there is metastatic
fixation tests, immunofluorescent spread to the oronasal and pharyngeal mucosa
antibody test, counter-current (Espundia), which is highly-disfiguring (leprosy-like
electrophoresis technique ; Sodium tissue destruction and swelling - Tapir Nose), also with
stibogluconate, N-methyl-glucamine chiclero ulcer (erosion of the pinna) ; In visceral
antimonite, 2nd line agents include Leishmaniasis, there is twice-daily fever, splenomegaly,
amphotericin B, pentamidine, cachexia, hepatomegaly, lymphadenopathy and anemia.
metronidazole and nifurtimox parasites are numerous in the reticuloendothelial cells of
(Pentamidine and Amphotericin B in the spleen, liver, lymph nodes, bone marrow, intestinal
resistant cases), Miltefosine is the mucosa and other organs
first line drug for Kala-azar in India

10. important parasites of fishes, birds, insects

Microsporidia
 a. coiled within the spore is usual hosts: diagnosed using fecal samples or Microsporidia family is obligatory, intracellular, multiply
Encephalitozoon a unique structure called birds esp. biopsy specimens under the light via binary fission or multiple fission ; considered to be
the polar filament which parrots microscope, hematoxylin stain, among the most primitive of eukaryotic cells as they
functions to insert in the eosin stain, Warthin-Starry stain, posses characteristics similar to prokaryotic organisms -
host cell the spore's Giemsa stain, Chromotope 2R lack mitochondria, has 70s ribosomes, all have resistant
nucleus and cytoplam (stains spore and spore wall), using spores and multiply within the host cell ;
(sporoplasm) in order to the electron microscope is the gold
initiate infection standard for diagnosis,
Immunofluroescence is used to
distinguish between species, PCR ;
Albendazole and other
Benzmidazole derivatives, 5-FU, and
sparfloxacin

b.
Enterocytozoon

c. Pleistophora
d. Nosema
e. Brachiola

f. Vittaforma

g.
Trachipleistophor
a
h.
Microsporidium

NEMATODE INFECTION
1. Intestinal Nematodes
 when eggs are ingested, the larvae hatch in the lumen of
the small intestines and the penetrate the intestinal wall.
They enter the venules to go to the liver through the portal
has polymyarian type of vein, on to the heart then to pulmonary vessels where they
somatic muscle break out of capillaries to enter air sacs. In the lungs they
arrangement, has a undergo motling before migrating to the larynx and
terminal mouth with 3 lips Transmission is by ingestion of food oropharynx o be swallowed into the GIT. adult worms
and sensory papillae ; I: fully or while playing with soil reside in but do not attach to the mucosa of the small
affects around 1Billion embryonated contaminated with embryonated eggs ; intestines ; may have allergic manifestations such as
people, 70% of whom are eggs D: Direct Fecal smear, Kato technique or asthmatic attacks and edema of the lips, most frequent
from Asia, at least 20,000 unembryonat cellophane thick smear method, Kato- compaint is abdominal pain, may be regurgitated and
die annually, mostly ed or Katz technique ; Albendazole is the vomited or escape through the nostrils, may enter the liver
a. Ascaris young children, has a fertilized egg; DOC, Mebendazole, Pyrantel or gallbladder and be lodged in the appendix or pancreas,
lumbricoides cosmopolitan distrubution D: humans pamoate, Ivermectin may cause intestinal obstruction

cylindrical, fusiform,
grayish-white, the head is
curved opposite to the infection is by penetration through are blood-sucking nematodes that attach to the mucosa of
curvature of the body, exposed skin, for Ancylostoma, it can the small intestine, life cycle begins with adult worms
which is like a hook at the also be transmitted via ora route copulating while attached to the mucosa of the small
anterior end, Ancylostoma (eating raw vegetables contaminated intestines, female worms deposit eggs which are then
is slightly larger than with larvae or by ingestion of raw passed out with human feces, In the soil eggs hatches into a
Necator,eggs have bluntly infected meat, transmammary rhabtidiform larva which is then transformed into filariform
rounded ends and a single transmission ; Direct Fecal Smear, larva, lara penetrates the skin, enter venules and migrate to
thin transparent hyaline Kato technique or Kato-Katz, the heart and into the alveoli of the lungs, larva then
b. Hookworms: shell; usually in tropical or Concentration methods like ZnSO4 ascends to the trachea where it is swallowed passing down
Necator subtropical countries, centrifugal flotation and formalin- to the small intestine ; penetration through the skin
americanus, over 900M people I: filariform ether concentration method, culture produces maculopapular lesions and localized erythema,
Ancylostome affected with 50,000 larva D: eggs ; methods lie Harada-Mori ; Itching is often severe, there may be pneumonitis,
duodenale deaths annually D: human Mebendazole, Albendazole (DOC) bronchitis, abdominal pain, steatorrhea, bloody diarrhea,
 have an attenuated
anterior 3/5 traversed by
a narrow esophagus
resembling a string of
beads, egg is lemon-
shaped with plug-like inhabit the large intestines, deeply embedded in the cecum,
translucent polar Fecal-Oral route ; Direct Fecal Smear, the infective eggs go to the small intestine and undergo
prominences, "barrel- I: Kato thick smear, Kato-Katz technique four larval stages to become adult worms ; cause petechial
shaped" eggs with bipolar embryonated (for egg counting and egg reduction hemorrhages which may predispose to amebic dysentery
plugs ; occur in both eggs D: rate), concentrations methods such as because ulcers provide a site for E. histolytica invasion,
temperate (20-30%) and unembryonat acid-ether and formalin-ether ; there may be rectal prolapse, severe diarrhea in heavy
c. Trichuris tropical countries (60- ed egg ; D: Mebendazole (DOC), Albendazole, infection that may be blood-streaked, abdominal pain,
trichiura 85%) human Ivermectin +/- Albendazole nausea, vomiting, anemia, weight loss

route of infection is through the

mouth, the respiratory system males are rarely seen because they usually die after
(inhalation of dust containing copulation, adult worms found in the lower ileum and
meromyarian, adult Enterobius eggs) and through the anus cecum, gravid female worms migrate down the intestinal
worms hasve cuticular (retroinfection when they go back to tract and exit through the anus to deposit eggs on the
alar expansions at the the large intestines ; adult worm or perianal skin, after deposition, the female dies ; mild
anterior end and a egg on microscopic examinations, may catarrhal inflammation of the intestinal mucosa, mechanical
prominent posterior be seen in the feces or perianal irritation and secondary bacterial invasion, intense itching,
esophageal bulb, eggs are regions, Graham's scotch adhesive insomnia due to pruritus ; complications include
asymmetrical with one I: egg D:adult tape swab (greatest number of eggs appendicitis, vagintis, endometritis, salpingitis and
side flattened and the worm or egg seen) ; Pyrantel Pamoate (DOC), peritonitis ; eggs can be collected from the fingertips and
other side convex ; in perianal Albenadazole, Mebendazole, cure under the fingernails of schoolchildren, female worms
d. Enterobius 208.8M infected, folds ; D: may be considered only after seven migrate to the perianal area even during daytime but more
vermicularis female>male human perineal smears are negative migration occurs in the evening hours
 infection is by penetration of skin ;
repeated concentratio techniques free-living forms are found in the soil ; from the skin, it
such as Harada-Mori culture and enters the circulation, pass through the lungs and migrate
Baermann funnel, Beale's string test, to the larynx where they are sunsequently swallowed ;
duodenal aspiration, small bowel greatest numbers are found in the duodenal and jejunal
biopsy, larvae in sputum or urine ; regions ; autoinfection occurs when rhabditiform larva pass
I: filariform Albendazole (egg reduction rate down the large intestine and develop into filariform larva ;
larva D: cannot be determined because eggs erythema and pruritic elevated hemorrhagic papules, lobar
short buccal cavity has Rhabtidiform are not passed out in the feces but are pneumonia with hemorrhage, intractable painless
e. Strongyloides four indistinct lips ; affects larvae ; D: ovideposited in the intestine and intermittent diarrhea (Cochin Chna diarrhea) ; Autoinfection
stercoralis 50-100M people human other tissue of the host is possible

characterized with abdominal pain, chronic diarrhea,

gurgling stomach (borborygmus), weight loss, anorexia,
severe protein-losing enteropathy, malabsorption of fats
I: larvae D: ingestion of uncooked small and sugars, decreased excretio of xylose, Hypokalemia and
the esophagus has rows of adult worm freshwater/brackish water fish high levels of IgE ; resides in the small intestines ; must
secretory cells called or "Bagsit" ; Direct Fecal Smear, stool reach the water in order to be ingested by small species of
stichocytes and the entire unembryonat concentrations methods, duodenal freshwater or brackish water fish, when the fish is eaten
esophageal stucture is ed egg ; I: aspiration ; Mebendazole, uncooked, the larvae escape from the fish intestines and
called a stichosome, eggs migratory Albendazole (DOC) because it can develop into adult worms in human intestine ; flattened
are peanut-shaped with fish-eating destroy larval stage more than and denuded villi and dilated muscoal glands, lamina
f. Capillaria striated shells and birds D: mebendazole, electrolyte propria is infiltrated with plama cells, lymphocytes,
philippinensis flattened bipolat plugs ; human replacement and high-protein diet macrophages and neutrophils
2. Blood and Tissue Nematodes
 bite of mosquito (Aedes, Culex,
Anopheles sp. for Wuchereria ;
Mansonia sp. for Brugia ; all are night
biters) infected with microfilariae ;
wet smears, thick blood smears taken
between 8pm-4am (due to nocturnal
periodicity), DEC provocative test to
allow blood smear collection even in
daytime, antigen detection techniques
creamy, white, long, (circulating filarial antigens) such as worms are found tightly coiled in nodular dilatations in
filiform in shape , simpel card test, PCR, UTZ may lymph vessels and in sinuses of lymph glands (usually in the
microfilariae appear as demonstrate live worms in the lower extremities, inguinal lymph nodes, epididymis of the
minute snake-like lymphatics, contrast males, labial glands of females), female worms produce
organisms constanty lymphangiography, lymphscintigraohy microfilariae which gain entrance to the blood where they
moving around the RBCs, using radiolabeled albumin or are picked up by a mosquito during a blood meal ;
when stained, the central I: dextran ; Diethylcarbamazine (DOC), selectively induce CD4+ lymphocyte apoptosis, which may
axis shows dark staining microfilariae Ivermectin, DEC +/- Ivermectin or contribute to immune unresponsiveness to filariasis ; SSx
nuclei which serves as an D: Albendazole, for acute attacks, the include fever, lymphadenitis, funiculitis, swelling of arms
important identifying microfilariae; initial step is to relieve the pain (clean and legs, edema ; there is also a chronic proliferative
a. Wuchereria feature ; affects 120M D: human, cat cloth soaked in cools water, elevate overgrowth of fibrous tissue around the dead worms, ADL /
bancrofti, Brugia worldwide, adult > is a reservoir and rest legs), surgical drainage of adenolymphangitis or DLA / dermatolymphangioadenitis
malayi children, male > female host hydrocoele (sensitization to the products of living or dead worms)
 transmitted via ingestion (eating
mollusks, leafy vegetables
contaminated with mucus secretion of
the mollusk, freshwater crabs or
prawns, contaminated water) or active
penetration, when rats or humans
ingest infected mollusks ; Diagnosed
by CSF eosinophilia of greater than
10%, CSF protein mildly elevated but
CSF glucose is normal, CT Scan (to causes eosinic meningoencephalitis in man ; adult worms
exclude neurocysticercosis) ; NO live in two main branches of the pulmonary arteries of the
ANTHELMINTIC TREATMENT IS rat, lay eggs in the smaller vessels of the lungs, hatch larvae
RECOMMENDED AT PRESENT but and then enter the respiratory tract and migrate up to the
Mebendazole, Albendazole, trachea where the are swallowed and eventually expelled
pale and filiform, well- Thiabendazole and Ivermectin were in the feces of the rat ; larvae pass through the stomach
developed caudal bursa successful in anima studies, analgesics into the intestine and then enter the circulatory system and
which is kidney-shaped I: third larval for pain, removal of 10ml CSF at migrate to the brain or spinal cord, they may also migrate
and single-lobed, uterine stage D: frequent intervals to relieve to the eye ; SSx include severe intermittent occipital or
tubules of female worms larvae ; I: headache, Prednisone 30mg daily, bitemporal headaches, stiffness of the neck, weakness of
b. wound spirally around the slugs and surgical removal of the worm when it the extremities, abdominal pain, facial paralysis, low-grade
Angiostrongylus intestine "Barber's pole" snails D: is lodged in the anterior chamber of fever ; may cause intraocular hemorrhage, retinal
cantonensis pattern human the eye detachment
 ingestion of undercooked meat ; larva
in muscle biopsy (usually in pectoral,
glutues, deltoid, biceps and
gastrocnemius) , elevated creatine
phosphokinase, lactate
dehydrogenase and myokinase levels,
blood eosinophilia, antibody titers, infective larvae are usually encysted in the muscle fibers of
I: larvae D: Bentonite flocculation test (BFT), Latex the host ; larvae upon ingestion excyst in the stomach or
larvae ; I: & D: flicculation test (LFT), IFAT, ELISA, small intestine, then they burrow into the subepithelium of
human, rats, Beck's xenodiagnosis ; SUPPORTIVE the villi where they mature, adult worms mate and after
dogs, cats, TREATMENT (analgesics, antipyretics, fertilization, will produce eggs that grow into larvae, larvae
pigs, bears, bed rest), prednisone for severe cases, penetrate the mucosa through the lymphatics into the
foxes, other Thiabendazole during the 1st week of circulation and finally into striated muscles ; SSx include
whitish in color ; occurs acarnivores infection expels adult worm (but no diarrhea / constipation, vomiting, abdominal cramps,
c. Trichinella wherever meat is a part of and effect on larvae), Mebendazole is malaise, high remittent fever ; may cause splenomegaly,
spiralis the diet omnivores larvicidal pericardial effusion, CHF, meningitis and cerebral lesions

CESTODE INFECTION
1. Intestinal Cestodes

inhabits the upper jejunum, gravid proglottids undergo

apolysis and are either passed out with the feces or actively
crawl out of the bowel to the external environment, eggs
are released and remain viable in the soil for weeks, when
cattles ingest Taenia eggs, the oncosphere is released,
oncosphere actively penetrates the intestinal mucosa and
ingestion of encysted larva from raw enter venule to get to systmeic circulation, it then enters a
mature proglottids are or improperly cooked beef ; muscle fiber and develops into Cysticercus bovis ; most
square in shape and I: Cysticercus proglottids / eggs in feces, India Ink, common CC is passage of proglottids or segments in the
contain mature male and bovis (larvae) formalin-ether technique, perianal stool, SSx include weight loss, epigastric pain, pruritus ani,
female reproductive D: eggs in the swab ; Praziquantel (DOC) , criteria for loss of appetite , proglottids are actively motile and they
organs ; Cysticercus is stool ; D: cure: recovery of scolex or a (-) stool may cause obstruction in the bile, pancreatic ducts and
a. Taenia saginata ovoid and milky white human exam 3months after treatment appendix
 eggs are ingested by hogs and oncospheres are released,
inhabits upper small intestines, proglottids are less active
than T saginata , the oncosphere penetrates the intestinal
shorter than, has less mucosa to typically encyst in muscles as Cysticercus
proglottids than and has cellulosae , commonly infected are the muscles, tongue,
smaller and more heart, diaphragm, liver, spleen, mesentery ; SSx include
spherical acetabula than ingestion of improperly cooked non-specific abdominal pain but obstruction is not likely
T. saginata, has 4 infected meat, the larva is ingested (because proglottids are not that active) ; Cysticerci are
acetabula , scolex carries I: Cysticercus and the scolex attached to the multiple and can develop in any organ or tissue, usually in
a cushin-like rostellum bovis (larvae) intestinal mucosa ; Dx is by identifying the striated muscles , brain, eye heart, lungs and
with a double crown and D: eggs in the proglottids eggs or scolex in the feces, peritoneum, cysts may survive up to 5yrs, most serious
large & small hooks which stool ; I & D: CT scan, ophthalmoscopy, ELISA, manifestation is neurocysticercosis (focal neurologic
are absent in T. saginata , human, pig, Electro-immuno transfer blot, western deficits, generalized seizures, obstructive hydrocephalus,
eggs are indistinguishable cattle, goat, blot for antibodies, DOT ELISA ; nausea, vomiting) , (+) increased opening pressure,
from T. saginata , mature wild boar & Praziquantel (DOC), Niclosamide, elevated protein, decreased glucose and increase in
cysticercus has scolex with moonkeys,is Albendazole, Predinosolone, mannitol mononuclear cells ; ophthalmic SSx include intraorbital
4 suckers and a circlet of intermediate (for increaed intracranial pressure due pain, photopsia, loss of vision, may float freely in the
b. Taenia solium hooks, host to "tumor") , surgical removal, vitreous and aqeous humore

has a dual pathway, direct (host ingests eggs which hatch in

the oncosphere has a thin the duodenum) and indirect development (accidental
outer membrane and a ingestion of infected arthopod intermediate hosts like the
thic inner membrane with direct or indirect tranmission ; wet rice and flour beetles) ; light worm burden is usually
conspicuous bipoar I: Cysticercoid smears, concentration methods, asymptomatic , SSx include headcahe, dizziness, anorexia,
thickenings, from each of larvae D: eggs proglottids are not recovered because pruritus of nose and and anus, diarrhea, abdominal pain,
which arise 4-8 hair-like in the stool ; they undergo degeneration prior to pallor , heavy infections may cause enteritis due to necrosis
polar filaments embedded I : rice and passage with stools ; Praziquante and desquamation of the intestinal epitheliam cells , in
c. Hymenolepsis in the inner membrane ; flour beetles, (dose is higher because cysticercoids time, immunity may limit or eventually clear the H. nana
nana about 20M is infected D: human are more resistant) population spontaneously

I: Cysticercoid
eggs are bile-stained, NO larvae D: eggs via accidental ingestion of grain
BIPOLAR FILAMENTS, with in the stool ; beetles infesting dried grians, dried eggs when ingested by a wide range of adult and larval
d. Hymenolepsis hooklets with fan-like I : insects, D: fruits flour and cereals ; wet smear ; insects like fleas, beetles, cockroaches, mealworms ad
diminuta arrangement human Praziquantel earwigs develop into cysticercoid larvae
 pale reddish adult worm
with proglottids are
narrow with two sets of
male and female
reproductie organs and
bilatera genital pores I:
"Double-pored worm", Cysticercoid larval fleas ingest the ova as they feed on epidermal debris ;
egg is spherical, thin- D: proglottids when the insect is ingested by mammalian host (dog, cat,
shaped with a hexacanth in the stool ; human), the cystocercoid is liberated and becomes an adult
e. Dipylidium embryo ; human infection I : flea D: dog ingestion of infected insects ; wet ; very minimal SSx (slight intestinal discomfort, eoigastric
caninum is rare & cats smear of stool ; Praziquantel pain, diarrhea, anal pruritus and allergic reactions)

I: Cysticercoid
larvae D: ova
pr proglottids accidental ingestion of flour beetles ;
in the stool ; wet smear of stool ; sometimes, the cysticeroid larva attaches to the intestinal villi to develop
I : Tribolium worm may be expelled by child into adults ; Direct infection does not occur if eggs are
segments are motile, confusum sponatenously without treatment ; ingested by the mammalian host, therefore these is no
f. Raillietina white, appears like grain (flour beetle), Praziquantel may be given to expel autoinfection in H. diminuta infection ; Px are usually
garrisoni of rice ; D: human the worm asymptomatic
 The ova complete their development in water and release
has two sucking grooves the free-swimming coracidium, a ciliated embryo, which is
or bothria located dorsally I: procercoid ingested by freshwater copepods of the genera Cyclops and
and ventrally ; Ova are larvae D: eggs ingestion of fish infected with Diaptomus, the copepod is in turn ingested by fish, the
yellowish-brown with an in the stool ; plerocercoid larvae by man, dog, cat procercoid larva migrates through fish tissue and develop
inconspicuous operculum, I : fish (perch, or other mammals ; direct fecal into a plerocercoid larva or "sparaganum" in themuscle and
g. opposite the operculum is trout, salmon, smears suffice, Kato technique for viscera ; Infected Px may show no signs of disease, SSx
Diphyllobothrium a small knob-like pike) D: demonstrating eggs ; Praziquantel include nervous disturbances, digestive disorders,
latum thickening human (DOC) abdominal discomfort, weight loss, weakness, anemia
2. Extraintestinal Cestodes

accidental ingestion of eggs, eggs may adult worms inhabit the small intestines of dogs, eggs are
come from soil or fur of dogs ; UTZ swallowed by intermediate host and hatch in the
and history is highly suggestive, duodenum, oncosphere penetrate the intestinal wall and
serologic tests such as indirect migrate into mesenteric venules which lead them to lodge
hemagglutination (IHA), indirect in various organs and tissues, the larval stage is called
fluorescent assay (IFA), enzyme Hydatid cyst, once inside the definitive host the
immunoassay (EIA), Echinococcus protoscolices evaginate, attach to the intestinal wall and
antigens, ELISA ; surgical resection is develop into adults which reside in the small intestines of
adut worm posseses a still the Tx of choice for the host (where they release eggs) ; organs most commonly
pyriform scolex, short echinococcosis, instilling scolicidal involved are the liver, lungs, brain and orbit ; causes down
neck and three agent such as hibitane, 95% ethanol or regulation of the inflammatory cytokine leading to local
proglottids, For E. 30% hypertonic saline solution, immunosuppression ; hepatic cyst are mostly found in the
multilocularis, foxes are endoscopic sphincteretomy is Tx of Inferior right lobe and may cause obstructive jaundice, cyst
the natural definitive host choice for hydatid cysts that have may rupture from coughing, muscle strain etc and may
and small rodenst are the I: egg D: eggs ruptured into the biliary tract and metastasize and reach other tissues to develop into
intermediate hosts, in the stool, causes obstructive jaundice ; For secondary cysts ; SSx include intermittent jaundice, fever,
humans may be infected hydatid cyst ; inoperabel cases and post surgery, eosinophilia, inc ICP and Jacksonian epilepsy, hematuria,
a. Echinococcus by eating raw plants I : goat, horse Albendazole, PAIR technique kidney dysfunction ; may lead to pyogenic abscess
sp - E. granulosus, contaminated with feces camel, sheep, (Puncture, Aspirate, Injection, formation, intrabiliary rupture of the cyst is the most
E. multilocularis of infected dogs or rats man D: dog Reaspiration), Cyclosporin A common complication
 drinking water containing Cyclops or
copepods infected with procercoid
larvae, eating infected intermediate
hosts such as frogs, toads or snakes
containing plerocercoid larvae,
I: applying plerocercoid infected flesh of
Plerocercoid frogs and snakes as poultices in sores
larvae D: eggs of the eyes, vagina or skin leading to
in the stool ; penetration of cutaneous tissue,
b. Sparganosis - I : frogsm consumption of infected flesh of
Spirometra toads, snakes, paratenic hosts like wild pigs ; Dx is by most are found in the eyes, subcutaneous and muscular
mansoni, S. D: dogs, cats finding white larvae in the lesion ; Tx tissues of the thorax, abdomen, thigh, inguinal region and in
erinacei, S. larvae are opaque, and other of choice is surgica removal of the viscera ; SSx may be painful edema due to migrating
ranarum glistenig white carnivores plerocercoid larvae

TREMATODE INFECTION
1. Blood Flukes
 eggs can be ovoidal,
rounded or pear-shaped,
are pale yellow with a life cycle involves alternating parasitic stages in mammalian
curved hook or spine near and gastropod hosts and free-living stages ; adult worms
one of the polar ends ; are primarily parasites of the portal vein and its branches,
unlike other trematodes, Eggs deposited in mucosal or sub-mucosal terminal veins or
schistosomes have capillaries escape through ulcerations into the intestinal
separate sexes, with large lumen and subsequently exported with feces, once
sucker anteriorly, a embryonated, egg ocmes in contact with freshwater,
ventral sucker and a hatches and liberates a free-swimming ciliated larva called
gonophore (suckers aid in a miracidium, the miracidium infect the snail Oncomelania
movement and help hupensis quadrasi and develop into sporocysts which will
flukes maintain their later develop into cercariae, the cercariae leave the snail
position inside the veins ; skin penetration by free-swimming host and become free-swimming in the water, cercariae are
has incomplete digestive I: cercariae D: cercariae ; rectal or liver biopsy, transformed into schistosomula after skin penetration and
system ad excretory eggs in the Merthiolate-iodine-formalin find entry into superficial lymphatic vessels or
system made up of flame stool ; I : concentration technique, Kato-Katz subcutaneous veins to reach the lungs, from the lungs the
cells ; In the Philippines, Oncomelania technique, ELISA, intradermal test for schistosomule migrates intravascularly to reach the portal
the total exposed snails, man immediate hypersensitivity using vein where they mature ; worms ingest RBCs and possess a
population is D: dog, pig, worm extracts, indirect protease (hemoglobinase) that breaks down globulin and
approximately 6.8M, cat, carabaos, hemagglutination using worm hemoglobin ; SSx include dermatitis, superficial lung
highest prevalence is cows, antigens, circumoval precipitin test petechiae, fulminating meningoencephalitis with fever,
a. Schistosoma among 5-15y.o., mean rodents, (COPT) - method of choice in the headache, coma, confusion ; may cause pneumonitis,
japonicum prevalence is 4.4% monkey Philippines ; Praziquantel hepatosplenic disease, cor pulmonale

ingestion or raw or insufficiently

cooked crabs with metacercariae ;
Solitary nodular lesions may mimic CA SSx include cough, hemoptysis consistent with PTB,
and fungal diseases on CXR, (+) ring- bloodstained or rust-colored sputum with foul fish odor,
Other species include P. shadowed opacity comprising several low-grade fever, fatigue, mayalgia ; they escape into the
philippinensis and P. I: contiguous cavities that give the respiratory tract where they are moved out by the ciliary
siamensis ; reddish brown metacercaria appearance of a bunch of grapes, epithelium and move along witg ung exudates, they are
worm which resembles a e D: intradermal test with antigen (does either coughed out or swallowed into the alimentary canal
coffee bean ; egg is oval, unembryonat not differentiate between present and to be passed out with feces ; traverses the intestinal wall
yellowish-brown, thick- ed eggs in the past infections), serology such as into the peritoneal cavity, migrates through the diaphragm
shelled ; adult worms are sputum or complement fixation, enzyme to the lungs where it matures, provoke a granulomatous
found in pairs or in threes stool; I : 1st- immunoassay (EIA), immunoblot (IB) ; reaction that gradually proceeds to the development of
in fibrotic capsules or snail, 2nd- Praziquantel, corticosteroids in Px fibrotic encapsulation ; cerebral involvement is the most
b. Paragonimus cysts in the lungs of the crab D: with cerebral involvement, Bithionol, serious complication (Jacksonian eoilepsy, cerebral
westermani host ; 20.7M are infected, human Triclabendazole hemorrhage, meningitis)
2. Intestinal Flukes

adult worm lives in the duodenum attached to the

intestinal mucosa by its suckers, eggs are released together
with feces into the water, it embryonates in water, gives
rise to a miracidium ; inside the snail, the miracidium
transforms into a sporocyst, which subsequently produces
I: rediae and then to a cercarie, cercariae emerge from the
metacercarie snails into water the attaches and encyst a metacercarie on
D: eggs in the the surfaces of seed pods, bulbs, stems or roots of various
stool ; I : 1st- ingestion of encysted metacercaria on aquatic plants ; inflammation and ulceration occur at the
snail 2nd- aquatic plants or when the hull or skin site worm attachment leading to increased mucus
endemic in countries in SE aquatic plants of fruits of these plants is peeled off secretion, bleeding, gland abscesses and intestinal
a. Fascilopsis asia, China, Korea and D: pigs and between the teeth ; fecal smear ; obstruction ; SSx include generalized toxic and allergic
buski India human Praziquantel symptoms

adult worm lives in the small intestines of the definitive

host ; immature eggs are released by the parasite and
I: transported to the environment through the feces, the eggs
metacercaria mature in water and a miracidium hatches from the egg to
E. ilocanum worm is e D: eggs in infect the 1st snail intermediate host,it then develops into a
reddish-gray while its egg the stool ; I : rediae and then into a cercariae, after escaping the snails,
b. Echinostoma is straw-colored, A. 1st- 2nd- ingestion of metacercariae encysted the cercariae swims in water to infect the second snail
ilocanum, malayanum egg is larger snails D: dog, snails ; fecal smear ; Praziquantel ; the intermediate and transforms into a metacercariae ; causes
Artyfechinostomu and is golden brown in human, rat, rat is an important reservoir host for ulceration and consequently diarrhea (sometimes bloody)
m malayanum color cat, pig echinostomes and abdominal pain
 eggs are produced and passed out into the environment
together with feces, miracidium hatches when the egg is
c. Heterophyid egg is light-brown in ingested by the first snail intermediate host and transforms
flukes - color ; worldwide into a sporocyst which the develops into cercariae,
Heterophyes distribution may be due to I: cercariae encyst as metacercariae on or under the scales,
heterophyes, the fact that heterophyids metacercarie usscles, fins, tails, or gills of the fish ; there is inflammation
Metagonimus have adapted to snails a D: eggs in at the site where the worm is attached or burrowed in the
yokogawai, belonging to various the stool ; I : mucosa, excessive mucus production and sloughing off of
Haplorchis taichui, families and are not 1st-snail, 2nd- ingestion of metacercariae encysted in the superficial layers may occur, PUD or APD (upper
Haplorchis specific to their secondary fish D: fish ; Kato-katz technique, abdominal discomfort, gurgling abdomen, colicky
yokogawai intermediate host human Praziquantel abdominal pain, mucoid diarrhea)
2. Liver Flukes

the fluke penetrates the intestinal wall to reach the

peritoneal cavity where it wanders until it reaches the liver
capsule, the parasite then burrows through the liver
parenchyma, and enters the bile ducts where it becomes
sexually mature, inside the snail, the miracidium develops
into a sporocyst to produce a cercariea, it the escapes the
snail and swims freely in water to encyst in surfaces of the
Fasciola worm has a aquatic plants forming a metacercariae ; can be
characteristic cephalic asymptomatic, SSx include RUQ pain, sundden high fever,
cone which has a marked I: ingestion of metacercariae encysted in hepatomegaly ; the acute phase corresponds to the
widening at the base of metacercaria edible aquatic plants or by drinking migration of the juvenile parasite from intestine to the liver
the cone ("shoulder"), F. e D: eggs in water with floating metacercarie ; while the chronic phase is asymptomatic and corresponds
giganitica is longer and its the stool ; I : fecal smear or demonstration of eggs to the period when the parasite has already reached the
shoulders less developed 1st-snail 2nd- in different samples such as duodenal biled ducts, can cause obstruction leading to inflammation
a. Fasciola F. gigantica egg is also aquatic plants contents and bile, PCR-restriction and subsequently fibrosis ; complications include atrophy of
hepatica ; Fasciola bigger affects 2.4M D: sheep, fragment length polymorphism (RFLP) the liver, periductal cirrhosis, abscess formation, hemobilia
gigantica individuals human assay ; Bithionol, Triclabendazole etc
 metacercariae excysts in the duodenum and moves through
ingestion of metacercarie in infected the ampulla of vater to the common bile duct and then to
undercooked or raw fish and in salted distal biliary capillaries where it matures into adult worms,
dried or pickled fresh water fish ; fecal egg escapes into the environment via the feces ; upon enrty
I: smear, Potassium permanganate into the snail host, miracidium transform into a sporocyst
b. Clonorchis metacercaria smear (will show distinct melon-like which then produces cercariae which is released in water to
sinensis, adult worms are leaf-like e D: eggs in ridges in the surface of O. viverrini infect freshwater fishes ; causes wall of the ducts to
Opistorchis in shape with transparent the stool ; I : eggs), Phosphoglycerate kinase (PGK), become thickened and dilate 2-3x its normal diameter,
felineus, tegument ; affects 30M 1st- snail, ELISA, Enzyme immunoassay (EIA), causes periductal fibrosis, cirrhosis and portal hypertension,
Opistorchis people, male > female, 2nd-fish D: determination of IgM antibodies, PCR ; SSx include chills, fever enlargement with tenderness of the
viverrini adults more tha children dog, cat, pig Praziquantel, Albendazole liver

* GA: Golgi Apparatus ; RER: Rough Endoplasmic Reticulum ; Asx: Asymptomatic ; Troph: Trophozoite ; ADCC: antibody dependent cell cytotoxicity ; DxOC: Diagnostic of choice ; SI: Small intestine
IFA: Indirect Fluorescence antibody test

** In general, almost all parasitic infections are associated with poor sanitation and crowded areas
 Remarks

most invasive among the

Entamoeba family and the only
member to cause colitis and liver
abscess, the cyst is resistant to
gastric acidity and dessication
and can curvive in a moist
environment for several weeks ;
lasts for weeks and may return
after remission, infection persist
for years

h unscathed, protected by their cyst wall, excystation occur in the SI

seudopodia, transmission is via kissing or droplet spray

feeds on G(-) bacteria, blue-gree
alage or yeasts ; reproduce by
binary fission , most affeacted
areas of the brain are posterior
fossa, diencephalon, thalamus
and brainstem

a free-iving amebo-flagellate
because it can exist as an
amoeba (trophozoite from) and
as a flagellate (swimming form) ;
is able to survive in elevated
temp up to 46C and in
hyperchlorinated water ; N
fowleri does not tolerate temp
higher than 100C and lower than
65C, its growth is inhibited by
0.2% NaCl and KCl, dehydration
is lethal to trophozoites but cysts
remain viable if rehydrated
within 23 months.

the largest protozoan parasite

and is the only ciliate known to
cause human disease ; unlike
ameba, encystation does not
result in an increase in number
of nuclei ; reproduce by binary
fission ; easily inactivated by
heat and 1% bleach, ordinary
chlorination of water may not be
as effective
 also known as G. intestinalis, G.
duodenalis, Lamblia duodenalis
or L. intestinalis, discovered by
Antoine Van Leeuwenhoek in his
own stool but was described by
Lambl ; attachment to villi was
observed to be maximal at body
temp and stable at a pH of 7.8 to
8.2 ; floating leaf-like motility ;
"Old Man's glasses" ; minimal
infective dose of 1-10 cysts
suggests that it could easily be
transmitted by fecally
contaminated food ; Important
Risk Factors include
overcrowding,
immunodeficiency and
homosexual practices ; shown to
be related to the "gay bowel
syndrome", normal water
chlorination will not affect cyst
but usual water treatment
modalities should be adequate

zogony while the Sexual cycle is sporogony

dissemination of parasite into
other organs happen in AIDS Px,
prognosis is good but infections
may last for months ; cases of
acalculous cholecystitis has been
noted after I. belli infection
There is varying degrees of
malabsorption and excessive
fluid loss ; most epidemics are
associated with water
contaminated with calf feces ;
chlorination does not affect the
parasite, multiple disinfectants
and combined water treatment
processes may reduce C. hominis
oocyst in drinking water

D-xylose malabsorption has been

found to develop in some
patients ; There is no alternate
treatment if patients are unable
to tolerate sulfamethoxazole,
boiling of water seems to be the
best method since chlorination is
not effective
The complete life cycle only
occurs in the members of the cat
family ; Asexual multiplication is
by a variation of binary fission
called endodyogeny
(characterized by formation of
plasma membrane by the two
new daughter parasites, even
before the division of the
nucleus) ; follows a typical
coccidian life cycle consisting of
schizogony, gametogony and
sporogony in the intestinal
epithelium , the extraintestinal
stages are the asexual stages:
tachyzoites and bradyzoites ;
only the tachyzoite and
bradyzoite stages are present in
humans ; Food should be
protected from combination by
cat feces, pregnant women
should avoid contact with cats

causes Sarcosporidiosis or
Sarcosystosis, infectivity is
prolonged during the cooler
months of the year
inhabitant of the lower GIT of
humans and other animals ;
reproduction is asexual by
binary fission or sporulation
under strict anaerobic
conditions, optimal growth is at
37 celsius in the presence of
bacteria does not grow on fungal
medium ; the vacuolar form is
the main type that causes
diarrhea ; is resistant to chlorine
at standard concentrations

flagellate with only the

trophozoite stage known ; no
cyst stage has been identified ; is
not detected by stool
concetration methods, prompt
fixation with polyvinyl alcohol,
Schaudinn's fixative is helpful
asexual life cycle occurs in
human and other vertebrate
while the sexual life cycle in the
mosquito ; total duration of a
typical attack is 8-12hrs ; has GPI
(Glycosylphosphatidyl Inositol)
act like endotoxin of gram-
negative bacteria
Lipopolysaccharide, they
stimulate the monocytes to
release TNF or cachexin which is
implicated as the cause of
Malarial fever ; history of cough
and convulsions are very
common ; Chloroquine has the
best safety profile among all
antimalarials, it is commonly
combined with
Sulfadoxine+Pyrimethamine to
reduce resistance, Tetracycline
and Doxycycline are effective but
cannot be used alone because
the kill parasites slowly ;
Anopheles ia night biter,
breeding in slow flowing partly
shaded streams ; preventio
include wearing of light-colored
clothing which cover most of the
body, use of insect repellants and
insecticides, Chemoprophylaxis
with Chloroquine, Mefloquine,
Doxycycline or Atovaquone-
Proguanil (Take during the
entire duration of stay and up to
4weeks after the last possible
exposure to infection (since
parasites may still emerge from
the liver),

may induce uterine contractions

in pregnant Px
most are asymptomatic

Most human infection occur in

summer of spring (May to July)
because of abundance of grass
and bushes ; prevention include
wearing of light-colored pants,
avoidance of places where ticks
are found, use of insect
repellants
Chaga's disease / American
Trypanosomiasis ; only exists in
the American continent ;
exhibits all four stages of
development: amastigote,
promastigote, epimastigote and
trypomastigote ; is a zoonosis
transmitted from rodents and
burrowing animals

West African Sleeping Sickness

(West and Central Africa) which
is the chronic form
East African Sleeping Sickness
(East and South Africa) which is
the acute form ; Rhodesian is
more rapid and fatal than
Gambian.

L. tropica invade the lymphoid

tissue of the skin (cutaneous
Leishmaniasis), L. donovani the
visceral organs (Kala-Azar or
Visceral Leishmaniasis) while L.
braziliensis the skin and mucous
membranes (Mucocutaneous
Leishmaniasis) ; Post Kala-Azar
Dermal Leishmaniasis (PKDL)
begin as small macule or
hypopigmented areas around the
mouth which spread to the face,
arms and trunk ; Delayed
Hypersensitivity reaction to
Leishmania develop in the late
stages of the infection
has three common species: E.
intestinalis formerly called
Septata intestinalis (causes
chronic diarrhea, nephritis
conjunctivitis, bronchitis,
bronchiolitis, disseminated
infection, biliary tract infection,
E. cuniculi (causes
keratoconjunctivitis,
disseminated infection,
bronchiolitis, hepatitis,
adrenalitis, peritonitis, UTI and
Respiratory infections) and E.
hellem (causes Interstitial
nephritis, keratoconjunctivitis,
disseminated infection ; all
species mostly affect
immunocompromised px

E. bineusi causes chronic

diarrhea (in
immunocompromised px CD4
<50 cells/L), wasting syndrome,
gallbladder and biliary tract
infection such as cholecystitis ;
has prevalence of up to 50% in
causes myositis
keratoconjunctivitis
B. vesicularum causes myositis

V. cornea (formerly known as

Nosema corneum) causes
keratoconjunctivitis
T. hominis causes myositis

causes keratoconjunctivitis,
corneal stroma infection
most commonintestinal nematode
of man, "Giant round worm", Soil-
transmitted helminth (disease of
poverty), reinfection is usually
observed 4months post-treatment
and full reinfection appears at 6-
7months after treatment. This
situation may be remedied by
giving treatment at least 2x a year
at an interval of 4-6months among
school children ; Loeffler's
syndrome (hypersensitivity
pneumonitis, malabsorpton
syndrome)

Itch is known as "ground itch" or

"dew itch" ; patients may suffer
from IDA due to continuous blood
loss ; here in the Philippines, 97%
of hookworm infection is Necator
while Ancylostoma would account
for 1%. The remaining 2% is
composed of mixed infections ;
Ancylostoma ca also affect other
species: Ancylostoma braziliense
(cat hookworm), Ancylostoma
caninum (dog hookworm)
Whipworm, frequently observed
to occur together with Ascaris,
distribution and prevalence are co-
extensive with that of A.
lumbricoides, unlike ascaris, there
is NO heart-lung-migration ; mass
treatment may be indicated if
infection rates is higher than
50%,periodic mass treatment may
be necessary due to reinfection

human Pinworm / Enterobiasis /

Oxyuriasis ; characterized by
perianal itching ; termed familial
diasease because it easily spreads
within the family ; second dose
may be may be necessary due to
high reinfection rates ; the only
inetsinal nematode that cannot be
controlled through sanitary
disposal of human feces because
eggs are deposited in the perianal
region
the only species naturally
pathogenic to humans, more of a
fecally transmitted worm rather
than soil-transmitted helminth ;
disseminated infection occurs
among patients with
immunocompromised patients ;
serology may not be useful in
filaria endemic areas since there
are cross-reactions between
Strongyloides and filarial worm

parasites do not invade intestinal

tissue but they are responsible for
micro-ulcers in the epithelium and
the compressive degeneration and
mechanical compression of cells,
the ulcerative and degenerative
lesions in the intestinal mucosa
may account for malabsorption of
fluid, protein and electrolytes
lymphatic filariasis is one of the
most debilitating diseases
(lymphedema, elephantiasis or
hydrocoele) plaguing most of the
tropical countries today, causes
"Tropical pulmonary eosinophilia"
(characterized with paroxysmal
nocturnal cough,
hyoereosinophilia, high IgE titers,
elevated ESR) , may also present
as "Expatriate Syndrome" which is
hyperresponsiveness to the
mature or maturing worms ;
affected extremities should be
elevated at night and exercised
regularly, and washed twice daily
to prevent secondary infection ;
Anopheles minimus var flavirostris
is the prinicpal vector of malaria in
the Philippines
rat lungworm ; infection is self-
limiting ; Charcot-Leyden crystals
have been found in the meninges ;
snail species include the ff:
Achatina fulica (giant African
snail), Hemiplecta sagittifera,
Helicostyla macrostoma, Vaginilus
plebeius, Veronicella altae ;
anthelmintics not usually
neccessary because infection is
self-limiting and killing worms in
the brain can cause greater
inflammatory reaction
full recovery is expected since
trichinosis is a self-limiting
disease ; is primarily a zoonosis,
human is the dead end infection
for the parasite, usually
maintained in a pig-to-pig or pig-
to-rat-to-pig cycle ; meat should
be cooked at 77C temperature, or
frozen to -15C to -30C to kill the
larvae, smoking, salting or drying
meatis not effective

Beef tapeworm, cosmopolitan in

distribution, adult worm seems to
be irritated by alcohol and passage
of proglottids sometimes happen
after a drinking bout
Pork tapeworm, cosmopolitan in
distribution, infected meat is
called "measly pork" ; Taenia eggs
are very resistant ; autoinfection is
common ; neurocysticercosis is
one of the most serious zoonotic
diseases worldwide ; In the
Philippines, T. saginata is more
common than T. solium ; freezing
at -20oC for 10days kills the
cysticercus

dwarf tapeworm, the only human

tapeworm which can complete its
entire life cycle in a single host (no
need for an obligatory
intermediate host) ; a familila and
institutional infection common in
orphanages, day care centers and
mental institutions

rat tapeworm, cosmopolitan in

distribution ; in the Philippines,
prevalence is only about 8%
common intestinal parasite of
dogs and cats ; stool examination
for the presence of egg capsules is
not recommended since the gravid
proglottids do not disintegrate in
the intestines but in the
environment ; 5.19-36% of dogs in
Manila is infected but the
dissection of fleas only showed
2.4% prevalence ; intermediate
hosts: Ctenocephalides canis (dog
flea), Ctenophalides felis (cat flea),
Pulex irritans (human flea),
Trichodectes canis (dog louse)

a common tapeworm of rats ; a

common intestinal cestode of
rodents in the Philippines
one of the 13 species that infect
human; "Fish tapeworm" or the
"Broad tapeworm" ; compete with
VitB12 in the diet which may lead
to megaloblastic anemia (vitamiin
B12 content is approximately
50times that of T. saginata ;
although other mammalian host
exist as reservoir hosts, human is
responsible for the propagation of
the infection in endemic areas

E. granulosus (unilocular cystic

echinococcus), E. multilocularis
(alveolar echinococcus) , E,
multilocularis is less common ;
Hydatid sand refers to
protoscolices and brood capsules
in the cyst ;
Spargana of Pseudophyllidean
taperworms under the genus
spirometra ; Infection is prevented
by drinking boiled or filtered water
and by cooking meat thoroughly
Oriental lung fluke, endemic in
China, Philippines and Indonesia,
has a wide range of definitive
host ; there is evidence that
schistosomule escape from the
lungs into the pleural cavity and
pass through the diaphragm into
the liver to reach the portal vein ;
cercariea are most abundant in the
field during the early part of the
night ; organs usually affected are
the liver, lungs and intestines ;
eggs are not demonstrable in the
feces

lung fluke disease, pulmonary

distiomiasis, endemic hemoptysis
or parasitic hemoptysis, "oriental
lung fluke" ; first intermediate
snail (Antemelania asperata, A.
dactylus formerly known as Brotia
asperata), second intermediate
host is the mountain crab
(Sundathelphusa philippina
formerly known as Parathelphusa
grapsoides) ; worms may persist
for up to 20yrs ; is a zoonotic
disease of carnivorous animals
first intermediate host is the snail
belonging to the genus
Segmentina or Hippeutis, second
intermediate host such as Trapa
bicornis (water caltrop), Eliocharis
tuberosa (water chestnut), Ipomea
obscura (water morning glory) and
Nymphaea lotus (lotus)

Intermediate hosts for E.

ilocanum: first intermediate host is
the snail (Gyraulus convexiusculus,
Hippeutis umbilicalis), second
intermediate host (Pila luzonica or
kuhol and Vivipara angularis or
susong pampang) ; Intermediate
hosts for A. malayanum: first
intermediate is unknown while
second snail host is Lymnaea
cumingiana or birabid
snail intermediate host of H.
taichui and Procerovum calderoni
are the brackish water snails,
Melania juncea and Thiara riquetti,
second intermediate host atre
fishes (30 different species)

F. hepatica is the temparate liver

fluke or sheep liver fluke while F.
gigantica is the tropical liver fluke ;
In tropical countries, fascioliasis is
considered the ost important
helminth infection of cattle with
reported prevalence of 30-90% ;
lives for 9-13years ; first
intermediate host: snail (from the
Lymnaedia family such as Lymnaea
philippinensis, L. auricularia
rubiginosa), second intermediate
host: aquatic plants (Ipomea
obsucra or kangkong and
Nasturtium officinale or water
cress
 First intermediate host is the snail
of C. sinensis belong to the genera
Parafossarulus (P. manchouricus,
P. anomaliospiralis, P. stratulus),
Bulimus (B. striatulus),
Semisulcospira, Alocinma (A.
longicornis), Thiara (T, granifera)
and Melanoides (M.
tuberculatus) , 1st intermediate
host for Opistotorchis flukes is
under the genus Bithynia snails ;
Second intermediate hosts are
Freshwater fishes under
Cyprinidae family ; infection is
related to the carcinoma of the
liver and adenoCA of the
gallbladder

DxOC: Diagnostic of choice ; SI: Small intestine