Clinical Parasitology

Introduction • Spurious Parasite- free-living that passes

through the digestive tract without
infecting the host.
• Parasitology- area of biology concerned
with the phenomenon of dependence of Types of Hosts
one organism to another.
• Medical Parasitology- study of parasites to
• Definitive or Final Host- where parasite
humans and their medical significance.
attains sexual maturity.
Many tropical diseases are parasitic
• Intermediate Host- asexual or larval stage
diseases.
of the parasite.
Biological Relationships • Paratenic Host- parasite does not develop
further to later stages and widen the
parasite distribution and bridge the
• Symbiosis- living together of different
ecological gap between definitive and
organisms that may involve protection o
intermediate hosts.
other advantages to one or both
• Incidental Host- promotes the spread of
organisms
parasites.
• Commensalism- two species that live
• Reservoir Host- allows parasite’s life cycle
together in which one organism benefits
to continue and become additional
from the other without harming or
sources of human infection.
benefiting the other.
• Mutualism- both organisms benefit from Types of Vectors
each other.
• Parasitism- one organism, a parasite lives
in another host or organisms for its • Vector- responsible for transmitting the
survival. parasite from one host to another.
• Biologic Vector- transmits the parasite
Types of Parasites only after the latter has completed its
development within the host and an
• Endoparasite- parasite that lives inside essential part of the parasite’s life cycle.
the body. Infection is the name when • Mechanical (Phoretic) Vector- only
there is a presence of endoparasite. transports the parasite.
• Ectoparasite- parasite that lives outside Exposure and Infection
the body. Infestation is the name when
there is a presence of ectoparasite.
• Obligate Parasite- requires host at some • Carrier- harbors pathogen without
stage of their life cycle to complete their manifesting signs and symptoms.
development. • Exposure- process of inoculating an
• Facultative Parasite- either free-living or infecting agent.
parasitic when needed. • Infection- establishment/presence of the
• Accidental or Incidental Parasite- parasite infective agent in the host.
establishes itself in a host where it does • Incubation- period from infection to
not ordinarily live. appearance of symptoms.
• Permanent Parasite- parasite remains on • Clinical Incubation Period- infection to
or in the body of the host for its entire life. symptoms
• Temporary Parasite- parasite that lives for • Pre-patent Period- period between
a short period of time. infection or acquisition of the parasite and
evidence or demonstration of infection.

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 1

Clinical Parasitology
Sources of Infection Parasite Evasion Mechanisms

• Soil and water- most common • Resistance to Immune Responses-

• Food parasites are usually resistant to
• Arthropods complement; the cuticle and integument of
• Animals helminths are resistant to cytotoxic effects
• Inanimate objects- beddings, clothings of PMNs and macrophages.
• Human • Immune Suppression- antigenic
competition, suppressor factor, blocking
Modes of Transmission antibodies.
• Antigenic Variation- change in antigenic
• Oral- foodborne, drinking water profile (variant surface glycoproteins).
• Skin penetration • Host Mimicry- acquire antigen similar or
• Arthropod Vectors- biologic vs. from the host, Ab fail as non-self vs self.
mechanical • Intracellular Sequestration- removal of
• Congenital transmission parasites that are found intracellularly.
• Inhalation Parasite Classification
Treatment
Classification Parasite
Protozoa Atrial Flagellates
• Selective treatment- individual-level • Chilomastix mesnili
deworming based on diagnosis or • Dientamoeba
assessment on the severity of infection. fragilis
• Targeted Treatment- group-level for a • Giardia lambia
defined risk group (without prior • Trichomonas
diagnosis) according to age, sex, and hominis
Subphylum • Trichomonas tenax
other social groups.
Mastigophora • Trichomonas
• Universal Treatment- population-level for
a community irrespective of social groups. vaginalis
Hemoflagellates
• Preventive Chemotherapy- regular,
• Leishmania spp.
systematic, large-scale intervention (using
• Trypanosoma spp.
one or more drugs) to reduce morbidity
• Acanthamoeba
and transmission of helminth infection.
castellanii
• Coverage- proportion of the target
• Endolimax nana
population reached by an intervention. • Entamoeba dispar
• Efficacy- the effect of a drug against an • Entamoeba
infective agent in ideal experimental gingivalis
conditions and isolated from any context. Subphylum • Entamoeba
• Effectiveness- a measure of the effect of a Sarcodina histolytica
drug against an infective agent in a • Iodamoeba
particular host, living in a particular butschlii
environment with specific ecological, • Naegleria fowleri
immunological, and epidemiological Phylum Ciliophora • Balantidium coli
determinants. • Babesia spp.
• Cryptosporidium
hominis

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 2

Clinical Parasitology
Phylum • Cyclospora • Paragonimus
Apicomplexa cayetanensis westermani
• Cyclospora belli • Schistosoma spp.
• Plasmodium spp. • Archnida- mites,
• Toxoplasma gondii scorpions, spiders,
• Enterocytozoon ticks
bieneusi • Chilopoda-
• Encephalitozoon centipedes
spp. • Crustacea-
• Vittaforma cornae Phylum copepods, crabs
Phylum • Trachipleistophora Arthropoda • Diplopoda-
Microspora hominis millipedes
• Pleistophora spp. • Insecta- flies, flea,
• Anncaliia beetles, bees, lice,
vesicularum wasps, bugs,
• Microsporidia spp. mosquitos
Metazoa • Ascaris • Pentastomida-
lumbricoides tongue worms
• Capillaria
philippinensis Protozoan Infections
• Enterobius
vermicularis Entamoeba histolytica (Intestinal
• Hookworm
Phylum Nematoda Amoeba)
• Strongyloides
stercoralis Infective Stage Diagnostic Stage
• Trichuris trichiura Mature/Infective Cyst Trophozoites/Cysts
• Lymphatic filarial Hosts Infected Vector
Humans NA
• Parastrongylus
cantonensis Pathogenesis Treatment
• Trichinella spiralis Amebiasis Metronidazole
MOT Diagnosis
• Dipylidium
Fecal-Oral DFS
caninum
• Echinococcus spp.
• Hymenolepis spp. Characteristics of Parasite
• Raillietina garrisoni
Phylum Cestoda • Taenia spp. -Cyst-
• Diphyllobothrium • Spherical in shape and has 2 nuclei’s
latum • Has highly refractile hyaline cyst wall
• Spirometra spp.
• Has 4 rod-shaped chromatoidal bars
• Artyfechinostomum
• Undergoes 2 nuclear divisions to become
malayanum
• Clonorchis Quadrinucleated cyst
sinensis -Quadrinucleated Cyst-
Phylum • Echinostoma
Trematoda ilocanum • Same feature with the cyst but has 4
• Fasciola hepatica nuclei’s.
• Fasciolopsis buski -Trophozoite-
• Heteryphyids
• Opisthorchis • Highly motile with pseudopodia
viverrini (pseudopodia is an arm-like projections
used for locomotion).

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 3

Clinical Parasitology
• Progressive directional movement Pictures of Parasite
• Has clear, glass-like cytoplasm and is
characterized with ingested RBC found in Cyst
cytoplasm
• Multiplies by binary fission
Pathogenesis and Clinical Manifestations

Mechanism of Virulence of the Parasite

1. Production of enzymes or other cytotoxic
substances
2. Contact-dependent cell killing
3. Cytophagocytosis

Diagnosis

• Stool Microscopy- minimum of 3 samples

and immediately examined before it Trophozoite
reaches 30 minutes after it was claimed.
• Direct Fecal Smear (DFS) with saline
solution.
Prevention and Control

• Improve environmental sanitation

• Safe drinking of food and water
• Proper hygiene and sanitation
• Vaccines
Life Cycle

Commensal Amoeba
Infective Stage Diagnostic Stage
Mature/Infective Cyst Trophozoites/Cysts
Hosts Infected Vector
Humans NA
Pathogenesis Treatment
Amebiasis NA
MOT Diagnosis
Fecal-Oral FECT

General Introduction

• Differentiated from E. his because of: 1.

May mistaken as entamoeba histolytica,

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 4

Clinical Parasitology
and 2. It is an identification of fecal • More vacuolated but
contamination of food and water. does not ingest RBC.
• Excystation occurs in alkaline • More narrower
environment in small intestine. • Broader and blunter
• Reproduction is through binary fission. pseudopodia
• More sluggish,
Diagnosis undirected
movements
• Thicker
• Stool Examination
Cysts (compared to E. his):
• Formalin Ethyl/Ether Concentration • Larger in size
Technique (FECT)- use to differentiate the • More nuclei (8 vs. 4)
species. • More granular
• Iodine Stain- use to differentiate the cytoplasm
species. • Splinter-like
chromatoidal bodies.
Prevention and Control Entamoeba • Parasite found in
polecki intestines of monkeys
• Proper disposal of human waste and pigs
• Good personal hygiene • Motility is sluggish like
the coli
Comparison of Commensal Amoeba • Angular or pointed
chromatoidal bars
Parasite Description Entamoeba • Found in apes and
Entamoeba • Morphologically chattoni monkeys
dispar similar to E. • Morphologically
histolytica but the only identical to E. polecki
difference is the DNA Entamoeba • Found only in gums
and ribosomal DNA. gingivalis and teeth
Entamoeba • It is osmotolerant • Blunt pseudopodia
moshkovskii where it can grow at • Contains food
room temperature of vacuoles contains
25C and survives at cellular debris
temperature of 0-41C. (leukocytes) and
• It was first detected in bacteria.
sewage in some parts • Has no cyst
of North America. • Infective & Diagnostic
• Morphologically are both Trophozoite
indistinguishable to E. • MOT: kissing, sharing
histolytica and E. of utensils, droplet
dispar. spray
Entamoeba • Relatively similar to E. Endolimax • Morphologically
hartmanni histolytica. nana similar to E. coli
• Has rod-shaped • Motility is sluggish
chromatoidal bars • Has blunt hyaline
• Does not ingest RBC pseudopodia
in trophozoite form. • Food vacuoles
Entamoeba coli • More common than contains bacteria
other amoeba Iodamoeba • Trophs are large,
Trophozoite (compared to E. butschlii vesicular nucleus
his):

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 5

Clinical Parasitology
• No peripheral
chromatin
• Cysts are
uninucleated and has
a large glycogen
vacuole.

Pictures of Parasite

Life Cycle

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 6

Clinical Parasitology
Other Intestinal Protozoans -Multiple Fission-
• Arises from vacuolated forms
Blastocystis hominis • It is believed that these multiple fission
Infective Stage Diagnostic Stage forms may produce many vacuolated
Not yet known Not yet known forms.
Hosts Infected Vector
Humans NA Pathogenesis and Clinical Manifestations
Pathogenesis Treatment
Blastocytosis Metronidazole
• Causes a wide variety of intestinal
MOT Diagnosis
Fecal-Oral DFS disorders
• Absence of any organelle for locomotion • Symptoms usually last about 3-10 days
• Life cycle is still unclear Diagnosis
• Has 4 morphological forms: Vacuolated,
Ameba-like, Granular, and Multiple
Fission • Direct Fecal Smear (DFS)
• Hematoxylin or Trichrome Staining- to
Characteristics of Parasite differentiate various stages of B. hominis.

-Cysts- Epidemiology
• Has one or two nuclei
• Mostly oval or circular in shape and is • Blastocystis hominis has been reported
surrounded by loose outer membranous virtually worldwide, with infections
layer occurring most commonly in tropical,
• The outer membranous layer is the subtropical, and developing countries.
easiest diagnostic feature to identify. Prevention and Control
-Vacuolated Form-
• Most predominant forms of fecal • Consuming safe water
specimens • Sanitary preparations
• Spherical in shape with large central Life Cycle
vacuole
• Considered as the main type of
blastocystis that cause diarrhea
-Ameba-like-
• Occasionally observed in stool samples
• The amebic form appears to be an
intermediate stage between the vacuolar
form and the precystic form, as this stage
allows the parasite to ingest bacteria in
order to enhance encystment.
-Granular-
• Are multinucleated
• Keeps the daughter cells of amoeba-form
when the cell ruptures

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 7

Clinical Parasitology
Pictures of Parasite Dientamoeba fragilis
Infective Stage Diagnostic Stage
B. hominis Vacuolated Form Trophozoites Trophozoites
Hosts Infected Vector
Humans NA
Pathogenesis Treatment
Dientamoeba fragilis Metronidazole
infection
MOT Diagnosis
Fecal-Oral Schaudinn’s fixative
Ingestion of
contaminated food
and water
• A flagellate with only trophozoite stage
B. hominis Ameba-like Form: known
• No cyst stage like the trichomonas
Characteristics of Parasite

-Trophozoite-
• Has 1 or 2 rosette-shaped nuclei
• Cytoplasm has vacuoles that ingests
debris
• Does not have peripheral chromatin
Pathogenesis and Clinical Manifestations

B. hominis Granular Form: • Usually asymptomatic

• Does not invade tissues but its presence
causes irritation to mucosa
• Chronic infection can mimic the symptoms
of diarrhea-predominant irritable bowel
syndrome
Epidemiology

• High prevalence rates of D. fragilis have

been reported from developed countries
B. hominis Multiple Fission Form: with high sanitation standards.
Prevention and Control

• Proper sanitation and disposal of human

wastes

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 8

Clinical Parasitology
Life Cycle Diagnosis

• Giemsa-stained Blood Smears

• Immunofluorescent Assay (IFA ) &
Immunochromatographic Tests (ICT)- for
epidemiologic studies
• Polymerase Chain Reaction (PCR)- gold
standard for babesia detection.2
Epidemiology

• Babesiosis is essentially a zoonotic

infection, regarded of major economic
Babesia spp. importance of livestock, paticulary in the
Infective Stage Diagnostic Stage cattle and horse industry.
Sporozoites Trophozoites
Hosts Infected Vector
Prevention and Control
Humans and Mouse Ixodidae or Hard Ticks
Pathogenesis Treatment • Avoid ticking infected areas
Babesiosis Clindamycin • Remain covered with clothing
MOT Diagnosis • Application of bug repellants
Bites of Ixodidae Giemsa-stained Blood
• Rodent Control
Blood Transfusion Smears
Organ Transplant Life Cycle
• Requires mammals as primary hosts, and
ticks as intermediate hosts.
• Has 3 developmental phases; Merogony,
Stages of Gamogony, & Sporogony.
• Few hours after blood ingestion,
merozoites undergoes morphologic
changes that grows into gametocytes.
• When gametocytes fertilizes, it forms
sporokinetes.
• Sporokinetes (sporozoites) are released
again to infect multiple tissues and organs
Pathogenesis and Clinical Manifestations
Pictures of Parasite
• Smaller forms (B. bovis & B. equi) are
more pathogenic.
• Bigger forms (B. bigemina & B. caballi)
are less virulent.
• Usually asymptomatic but may also result
in severe cases.
• Severe cases can cause hemolytic
anemia and hemoglobinuria with jaundice.
• Usually the infected ones are the elderly.

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 9

Clinical Parasitology
Plasmodium spp. conditio
Infective Stage Diagnostic Stage ns
Sporozoites Trophozoites
(immature and Trophozoit • Maurer’ • Seldom
mature), Schizont, & e s cleft cytoplas
Gametocytes are m
Hosts Infected Vector seen • Dark
Humans Anopheles Mosquito under pigment
Pathogenesis Treatment certain
Malaria Artemisinin and conditio
Chloroquine ns
MOT Diagnosis Schizont • Maurer’ • Small
Mosquito Bites Blood Smears s cleft merozoit
• Obligate parasite that are able to infect are es
and replicate within RBC. seen • Dark
• They are 4 species recognized (P. under pigments
falciparum, P. malariae, P. ovale, P. vivax) certain
but the recent known is P. knowlesi conditio
• Requires completion of life cycle in 2 ns
alternative hosts: humans and mosquito Gametocyt • Distorte • Crescent
• Liver is the number one target once e d by or
plasmodium gets inside the host parasite sausage
• P. vivax and P. ovale are only parasite in shape
that has hypnozoites. • Chromati
n in a
Characteristics of Parasite single
mass
-Plasmodium falciparum-
• Found worldwide in tropical and
subtropical areas.
• Can cause severe malaria because it
multiplies rapidly in blood.
• Infected parasites can clog small blood
vessels.
Stages Appearance Appearance of
found in of Erythrocyte Parasite
Blood
Ring • Multiple • Delicate
infection cytoplas
of RBC m that
are has 1-2
commo small
n chromati
• Maurer’ n dots
s cleft
are
seen
under
certain

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 10

Clinical Parasitology
-Plasmodium vivax-
• Found mostly in Asia, Latin America, and
some parts in Africa.
• Most prevalent human malaria parasite
• Has dormant liver stages (hypnozoites)
that can activate and invade blood
(relapse) in several months or years.
Stages in Appearance of Appearance of
Blood Erythrocyte Parasite
Ring • Multiple • Large
infection cytoplas
of RBC is m with a
not large
common. chromati
• Schuffner n dot
’s dots
may
seen
occasion
ally
Trophozoi • Fine • Yellowis
te Schuffner h-brown
’s dots pigment
may be
seen
distortedl
-Plasmodium ovale-
y
Schizont • Fine • Large • Found mostly in Africa
Schuffner that may • Biologically and morphologically similar to
’s dots almost P. vivax
may be fill RBC
• Can infect individuals who are negative for
seen • Mature
the Duffy blood group
distortedl contains
y 12-24 • Greater prevalence compared to vivax in
merozoit Africa
es Stages in Appearance of Appearance
Gametocy • Fine • Round Blood Erythrocyte of Parasite
te Schuffner to oval Ring • Multiple • Sturdy
’s dots in shape infection cytopla
may be • Scattere of RBC is sm
seen d brown not • Large
distortedl pigment common chroma
y • Schuffner’ tin
s dots are
seen
occasiona
lly
• Ocassion
ally
fimbriated

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 11

Clinical Parasitology
Trophozoi • Some • Large -Plasmodium malariae-
te fimbriated chroma
• Found worldwide
and tin
Schuffner’ • Dark- • Only malaria parasite that has a three-day
s dots brown cycle. (quartan cycle)
pigmen • Can cause serious complication such as
t the nephrotic syndrome
Schizont • Some • Large
Stages in Appearance of Appearance of
fimbriated nuclei Blood Erythrocyte Parasite
and • Dark-
Ring • Normal • Sturdy
Schuffner’ brown
s dots to 0.75x cytoplas
pigmen
m
t
• Large
Gametocy • Some • Round
chromati
te fimbriated to oval
n
and in
Same w Ovale
Schuffner’ shape
Trophozoit • Normal • Compact
s dots • May
e to 0.75x cytoplas
almost
• Zieman m
fill RBC
n’s • Large
• Scatter
stippling chromati
ed
is rarely n
brown
seen • Dark-
pigmen
t brown
pigment
Schizont • Normal • Large
to 0.75x nuclei
• Zieman • Mature:
n’s 6-12
stippling merozoit
is rarely es
seen • Dark-
brown
pigment
Gametocyt • Normal • Round to
e to 0.75x oval in
• Zieman shape
n’s • May
stippling almost
is rarely fill RBC
seen • Scattere
d brown
pigment
Same w Ovale

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 12

Clinical Parasitology
seen • Dark-
rarely brown
pigment
Schizont • Normal • Large
to 0.75x nuclei
• Sinton • Mature:
and up to 16
Mullinga merozoit
n’s es
stippling • Dark-
s are brown
seen pigment
rarely • Occasio
nal
rosettes
• mature
merozoit
es
appear
segment
ed
Gametocy • Normal • Round
-Plasmodium knowlesi- te to 0.75x to oval in
• Sinton shape
• Found mostly in Southeast Asia
and • May
• Recently shown to be a significant cause Mullinga almost
of malaria in Malaysia n’s fill RBC
• Has 24-hour replication cycle stippling • Compact
Stages in Appearance of Appearance of s are chromati
Blood Erythrocyte Parasite seen n
rarely • Scattere
Ring • Normal • Delicate
to 0.75x cytoplas d-brown
m pigment
• Multiple
infection • 1-2
of RBC promine Diagnosis
is not nt
common chromati -Immunoserologic Tests-
n dots
• Occasio • Indirect Fluorescent Antibody (IFA) test-
nal antibody detection.
applique • Rapid Diagnostic Tests (RDTs)- antigen
forms detection
Trophozoit • Normal • Compact
e to 0.75x cytoplas -Molecular Testing-
• Sinton m • Polymerase Chain Reaction
and • Large
Mullinga chromati -Symptoms-
n’s n
• Splenomegaly
stippling • Occasio
s are nal band • Anemia
forms • Renal dysfunction

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 13

Clinical Parasitology
• Hypoglycemia Ciliates and Flagellates
• Neurologic changes
-Physical Findings- Balantidium coli
Infective Stage Diagnostic Stage
• Fever and chills Cysts Cysts
• Headache Hosts Infected Vector
• Myalgia Humans NA
• Weakness Pathogenesis Treatment
• Vomiting Balantidiasis Metronidazole
• Diarrhea MOT Diagnosis
Fecal-Oral Microscopic
-History of Travel- Ingestion of Examinations
contaminated food
Life Cycle and water
• Largest protozoan parasite
• Only ciliate to cause human disease
• Motility is Spiraling.
Characteristics of Parasite

-Cysts-
• Spherical or slightly ovoid in shape
• Covered with thick double cell wall for
survival
-Trophozoite-

Vector • Are covered in cilia

• Has cytosome (oral apparatus) and
Anopheles Mosquito cytopyge (excretion of wastes)
• Has 2 dissimilar nuclei: Macronucleus
• Males sips on nectar
and Micronucleus
• Females require blood meal for egg
• Has 2 contractile vacuoles that act as an
development
osmoregulatory organelles
• Head- for sensory information
• Inhabits in the lumen, mucosa, and
• Thorax- for locomotion submucosa of the intestines.
• Abdomen- for digestion and egg
development Pathogenesis and Clinical Manifestations
• Has 4 life cycle stages: Egg, Larva,
Pupa, Adult • Are capable of attacking intestinal
epithelium and creating a ulcer-like
characteristics
• Ulceration is caused by the secretion of
lytic hyaluronidase by trophozoites

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 14

Clinical Parasitology
Epidemiology B. coli Trophozoite:

• Distribution of B. coli is prevalent in areas

with poor sanitation, close contact with
pigs, and overcrowded areas.
Prevention and Control

• Proper sanitation
• Good personal hygiene
• Protection of food from contaminations
Giardia duodenalis or Giardia
Life Cycle lamblia
Infective Stage Diagnostic Stage
Cysts Cysts or Trophozoites
Hosts Infected Vector
Humans NA
Pathogenesis Treatment
Giardiasis Metronidazole
MOT Diagnosis
Fecal-Oral Stool Microscopy
Ingestion of Enterotest
contaminated food
and water
• It was first discovered by Antoinne van
Leeuwenhoek in his own tools
• Flagellates that lives in duodenum,
jejunum and upper ileum
• Motility is Falling Leaf
Characteristics of Parasite

-Cysts-
Pictures of Parasite
• Ovoid in shape
B. coli Cysts: • Young cysts has 2 nuclei’s and mature
has 4.
-Trophozoite-
• Pyriform or Teardrop in shape
• Has undulating membrane that extends its
whole organisms length
• Has pair of ovoidal nuclei in each side of
mideline which called as axostyle (with 2
axonemes).
• Has large adhesive disc used for
attachment.
• Divide through longitudinal binary fission.

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 15

Clinical Parasitology
Pathogenesis and Clinical Manifestations Pictures of Parasite

G. lamblia Cysts:
• Infections occur if the hosts ingests as few
as 10 cysts
• Attaches to intestinal cells via sucking
disc’s which can cause mechanical
irritation.
• Attachment is caused by a substance
called lectin which is released by giardia.
G. lamblia Trophozoite:
Epidemiology

• Abundant in areas with poor sanitation

and hygiene practices.
Prevention and Control

• Proper human waste disposal

• Avoid use of night soil as fertilizer Trichomonas vaginalis
• Usual water treatment Infective Stage Diagnostic Stage
Trophozoites Trophozoites
Life Cycle Hosts Infected Vector
Humans NA
Pathogenesis Treatment
Trichomoniasis Metronidazole
MOT Diagnosis
Sexual Intercourse Saline Preparation of
Vaginal Fluid
Culture- gold standard

• A sexually transmitted disease

• Exists only in trophozoite stage
• Motility is rapid jerky (all trichomonas)
Characteristics of Parasite

-Trophozoite-
• Its pyriform in shape
• Has 4 free anterior flagella and the fifth
one is embedded in the undulating
membrane.
• Undulating membrane extends about half
of the organisms length
• Has median axostyle and single nucleus
• Multiplies through binary fission
• Lives in vagina for females and urethra in
males (rarely).

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 16

Clinical Parasitology
Pathogenesis and Clinical Manifestations Non-Pathogenic Flagellates

• Parasite causes desquamations of the

Trichomonas hominis
vaginal epithelium followed by leukocytic Infective Stage Diagnostic Stage
inflammation Trophozoites Trophozoites
Hosts Infected Vector
• Infection in males is usually asymptomatic
Humans NA
• Prostatitis is most common complication
Pathogenesis Treatment
of trichomoniasis of males. Trichomoniasis Not mentioned
Epidemiology MOT Diagnosis
Ingestion of Not mentioned
contaminated food
• In the Philippines, it is prevalent in and water
commercial sex workers. • Pyriform in shape
• Inhabits in the cecal area of large
Prevention and Control
intestines
• Has 5 anterior flagella and a posterior
• Reducing the risk of exposure flagellum
• Avoid multiple sex partners
• Use protective devices such as condoms
Pictures of Parasite
• Health and Sex Education
Life Cycle

Trichomonas tenax
Infective Stage Diagnostic Stage
Trophozoites Trophozoites
Hosts Infected Vector
Humans NA
Pathogenesis Treatment
Pulmonary Not mentioned
Trichomoniasis
Pictures of Parasite: MOT Diagnosis
Kissing, Swabbing the tartar
Sharing of utensils, between teeth
Droplet spray
• Harmless commensal in mouth that lives
in tartar, teeth, and gums
• Smaller and more tender than T. vaginalis
• Has 4 free equal flagella and 5th one is
T. vaginalis Trophozoite: embedded in undulating membrane

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 17

Clinical Parasitology
• Has a single nucleus and cytostome Free-living Pathogenic Amoeba
• Multiplies through binary fission
Acanthamoeba spp.
Pictures of Parasite
Infective Stage Diagnostic Stage
Trophozoites Cysts/ Trophozoites
Hosts Infected Vector
Humans NA
Pathogenesis Treatment
Acanthamoeba Clotrimazole
Keratitis &
Granulomatous
Amebic Encephalitis
MOT Diagnosis
Eyes Polymerase Chain
Nose Reaction
Chilomastix mesnili
Broken Skin Epithelial Biopsy
Infective Stage Diagnostic Stage
• An aquatic organism that can survive in
Cysts Cysts/ Trophozoites
contact lens solutions
Hosts Infected Vector
• No flagellate stage
Humans NA
Pathogenesis Treatment • Prefers cold water
Not mentioned NA • Has two stages: Cyst and Trophozoites
MOT Diagnosis
Characteristics of Parasite
Ingestion of cysts in Not mentioned
foods and drinks
-Trophozoites-
• Inhabits in the cecal region of large
intestine • Has a characteristics of thorn-like
• Has well-defined cyst and trophozoite appendages (acanthopodia) [ang
• Trophozoites are asymmetrically pear- pseudopodia niya]
shaped • Has a single large nucleus and large
• Cysts are pear or lemon-shaped contractile vacuole
• Replicates through mitosis
Pictures of Parasite
Pathogenesis and Clinical Manifestations
C. mesnili Cyst:
-Acanthamoeba Keratitis-
• Associated with improper use of
disinfected contact lenses
• Symptoms are severe ocular pain and
blurring of vision
C. mesnili Trophozoite:
• Chronic of this diseases causes vision
loss
-Granulomatous Amebic Encephalitis-
• Usually occurs in immunocompromised
hosts
• Symptoms are destruction of brain tissue
and fever
• Incubation period is 10 days

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 18

Clinical Parasitology
Epidemiology Naegleria spp.
Infective Stage Diagnostic Stage
Trophozoites Trophozoites
• First case reported was in General
Hosts Infected Vector
Hospital on 1990
Humans NA
Prevention and Control Pathogenesis Treatment
Primary Amebic Amphotericin B
Meningoencephalitis
• Robust immune system MOT Diagnosis
• Contact lens must be in hygiene Eyes Polymerase Chain
• Boiling of water Nose Reaction (PCR)
Broken Skin Enzyme-link
Life Cycle Immunoassay (ELISA)
• Has three stages of life cycle: Cysts,
Ameba (trophozoite form), & Flagellate
(swimming form).
• Usually lives in hot aquatic environments.
(thermophilic)
• Can survive and reproduce quickly if
temperature is above 30C.
• Acanthamoeba spp. are opportunistic
organisms while Naegleria fowleri is
considered as true pathogen.
Characteristics of Parasite
Pictures of Parasite -Ameba and Flagellate-
Acanthamoeba Cysts: • Cytoplasm contains many vacuoles
• Has large nucleus
• They replicate through promitosis
• Flagellated forms can revert themselves
into trophozoite form
• Can infect humans by penetrating the
nasal mucosa
Pathogenesis and Clinical Manifestations

• Usually occurs in healthy adult that has a

Acanthamoeba Trophozoite:
history of swimming
• Death usually occurs if there is an
increased cranial pressure due to the
infection of the parasite.
Epidemiology

• Is abundant in freshwater lakes and ponds

• N. philippinensis is another species found
in the Philippines due to its abundance of
water sources.

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 19

Clinical Parasitology
Prevention and Control Coccidian

• Avoid immersion of head and accidental

Cryptosporidium hominis
inhalation of water Infective Stage Diagnostic Stage
• Chlorination of water Thick-walled Oocyst Thick-walled Oocyst
Hosts Infected Vector
Life Cycle Humans and Cattle NA
Pathogenesis Treatment
Cryptosporidiosis No treatment for now
MOT Diagnosis
Ingestion of Formalin Ethyl/Ether
contaminated water Concentration
Technique
• All stages of development is completed in
gastrointestinal tract of the hosts
Characteristics of Parasite

-Oocyst-
• Round shape that contains 4 sporozoites
that attaches to the epithelial cells
-Small Trophozoites-
• Attaches to the brush borders of epithelial
cells
• Divide further again through schizogony to
produce merozoites that infect other cells
Pictures of Parasite
-Merozoites-
• Produces macro (female) and micro
(male) gametocytes in which the
macrogamete is fertilized by microgamete,
producing a zygote.
• Two types of oocyst resulting from a
zygote: thin-walled and thick-walled
oocyts.
• Thin-walled infect other enterocytes
causing an autoinfection while thick-
walled are passed through feces.
Pathogenesis and Clinical Manifestations

• Bile duct and gallbladder may become

heavily infected
• In the immunocompetent host, the
disease may present as a self-limiting
diarrhea lasting for 2 to 3 weeks.

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 20

Clinical Parasitology
• In immunocompromised persons, the Pictures of Parasite
diarrhea becomes more severe and may
become life-threatening. C. hominis Oocyst:
Diagnosis

• Sheather’s Sugar Floatation & Formalin

Ethyl/Ether Concentration Technique
(FECT)- common used for stool
examination
• Kinyoun’s modified Acid-fast Stain- Cyclospora cayetanensis
routinely used in oocysts which appears Infective Stage Diagnostic Stage
like red-pink doughnut. It is also the Sporulated Oocyst Unsporulated Oocyst
quickest and cheapest method of Hosts Infected Vector
diagnosis. Humans NA
Pathogenesis Treatment
Epidemiology
Cyclosporidiosis Trimethoprim-
sulfamethoxazole
• There are 400,000 cases recorded MOT Diagnosis
worldwide Ingestion of Direct Fecal Smear
contaminated water (DFS)
Prevention and Control Kinyoun’s Stain
• Was thought to be a member of
• Natural water and swimming pool water cyanobacteria because it showed
should not be swallowed. photosynthesizing organelles and auto-
fluorescing particles characteristic of the
• Contamination of drinking water by human
blue-green algae
and animal feces should be prevented.
• Was originally called cyanobacterium-like
Life Cycle body.
Characteristics of Parasite

• It begins its life cycle when the hosts

ingested sporulated oocysts that contains
4 sporozoites
• Sporozoites are released and invade
epithelial cells to produces merozoites (no
trophozoites)
• Merozoites develop macro (female) and
micro (male) gametes and fertilizes to
produced oocysts
• Oocysts are passed out in the feces
• Oocysts undergo complete sporulation
within 7-12 days in warm environment.

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 21

Clinical Parasitology
Pathogenesis and Clinical Manifestations Cystoisospora belli
Infective Stage Diagnostic Stage
Mature Oocyst w Oocyst
• Infections are usually self-limiting
Sporozoites
• Chronic infections may associate with Hosts Infected Vector
watery diarrhea with alternate constipation Humans NA
Epidemiology Pathogenesis Treatment
Cystoisosporiasis Trimethoprim-
sulfamethoxazole
• Cyclosporidiosis has been described in MOT Diagnosis
many countries, with epidemics reported Ingestion of Formalin Ethyl/Ether
in Nepal, Peru, Haiti, and the United contaminated water Concentration
States. Technique (FECT)
Kinyoun’s Stain
Prevention and Control
Characteristics of Parasite
• Good sanitary practices
• Boiling of water • Sporulated oocyst contains 4 sporozoites
• Fruits and vegetables should be washed which are released and penetrate the
intestinal cells
Life Cycle
• They start to multiply through asexual
reproduction through schizogonic phase
producing schizont
• Schizont ruptures intestinal cells and
infects another, producing merozoites
through asexual reproduction
• Merozoites undergo gametogony that
produces micro and macrogametes
(sexual stage)
• Fusing the micro and macro produces a
zygote and when mature, it undergoes
sporulation after 48 hours.
Pathogenesis and Clinical Manifestations

• In immunocompetent individuals, infection

is generally asymptomatic.
• In immunocompromised individuals, it
ranges from a self-limiting enteritis to
Pictures of Parasite severe diarrheal illness resembling that of
cryptosporidiosis, giardiasis or
cyclosporiasis.
• In severe infections, severe diarrhea and
fat malabsorption can occur

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 22

Clinical Parasitology
Epidemiology Toxoplasma gondii
Infective Stage Diagnostic Stage
Tachyzoites, Bradyzoites
• It is more common in tropical and
Bradyzoites, and
subtropical countries with poor sanitary Oocyst
conditions. Hosts Infected Vector
Prevention and Control Humans, Pigs, NA
Mouse, Cats, Birds,
Mouse
• Good Sanitary practice Pathogenesis Treatment
• Thorough washing and cooking of food Toxoplasmosis Pyrimethamine
• Drinking safe water MOT Diagnosis
Blood Transfusion Giemsa Stain
Life Cycle Mother to fetus
Organ Transplant
Ingestion of
contaminated food
and water
• Completes its life cycle when the cat
family of Felidae serves as definitive hosts
• Intermediate Hosts: Rats & Birds
• Definitive Hosts: Cat
Characteristics of Parasite

-Oocyst-
• Passed out in the cat in unsporulated
stage and will become sporulated in the
environment for 3-4 days
• Sporocysts contains 4 sporozoites that
penetrates to the intestinal epithelium
• The parasites gain entry to the lymphatics
then spread to the different organs,
tissues, and fluids of the body
-Tachyzoites-
Pictures of Parasite
• Multiplies through variation of binary
fission called endodyogeny
• Cells in which endodyogeny occur
eventually burst, thus liberating
trophozoites that invade other cells
-Trophozoite-
• Crescent-shaped with pointed anterior
and rounded posterior
• Can prevent the digestion by lysozyme
• Mishandling of live trophozoites may also
infect the laboratory personnel

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 23

Clinical Parasitology
Pathogenesis and Clinical Manifestation Pictures of Parasite

• Commonly asymptomatic as long as the

immune system is functioning well
• most common manifestation is
encephalitis, myocarditis and focal
pneumonia
• Babies may exhibit clinical manifestations
like chorioretinitis, epileptic seizures,
jaundice, hydrocephaly, and microcephaly
• Death of the infected newborn babies is
usually due to anemia with pneumonia.
Epidemiology

• Toxoplasmosis is endemic worldwide in

humans and in domestic and wild animals
as well
Prevention and Control

• Food should be protected from cats

• Meat and eggs should be well cooked
• Unpasteurized milk should be avoided
• Pregnant women should be avoid contact
with cats
• Lab workers should be careful in handling
the parasite
Life Cycle

T. gondii Tachyzoites:

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 24

Clinical Parasitology
Sarcocystis spp. • Intestinal form that presents with nausea,
Infective Stage Diagnostic Stage abdominal pain, and diarrhea
Cyst with Bradyzoites Sporocysts and Thin- • Symptoms may last long up to 5 years
walled Oocysts
Hosts Infected Vector Epidemiology
Humans, Pigs, Cattles NA
Pathogenesis Treatment • In the Philippines, studies involving the
Sarcosporidiosis or Rarely required examination of muscle tissues obtained
Sarcocystosis Corticosteroids- for from water buffaloes, cattle, pigs, and
symptomatic
goats revealed the presence of S. cruzi
MOT Diagnosis
Ingestion of raw or Fecal Flotation Wet Prevention and Control
undercooked meat Mount
Muscle Biopsy
• Humans are definitive hosts but • Cooking or Freezing of Meat
occasionally an intermediate hosts • Boiling of Water
• Has many several forms and the simplest • Animals must be prevented from ingesting
form is called zoite Oocysts

Characteristics of Parasite Life Cycle

-Zoite-
• A banana-shaped cell with pointed
anterior end (apical complex)
-Sporulated Oocyst-
• Undergoes sporogony creating 2
sporocysts (with 2 sporozoites each) and
release it in environment.
• Once ingested, they undergo two asexual
reproduction called as schizogony or
merogony that develops into meronts.
• In the third asexual generation, schizonts
or meronts forms into metrocytes and
encyst in the muscles, initiating the
sarcocyst formation.
-Sarcocyst-
• When the small, rounded, non-infectious
metrocytes mature, they give rise to
infectious, crescent-shaped bodies called
bradyzoites.
Pathogenesis and Clinical Manifestations

• Has two types; A Rare Invasive form and

Intestinal form.
• Rare invasive form presents with
vasculitis and myositis

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 25

Clinical Parasitology
Pictures of Parasite Blood and Tissue Flagellates

Sarcocystis spp. Zoite: Trypanosoma cruzi

Infective Stage Diagnostic Stage
Metacyclic Trypomastigote
Trypomastigote
Hosts Infected Vector
Humans and Reduviid Bug
Mammals (Triatoma,
Panstrongylus,
Rhodnius)
Pathogenesis Treatment
American Benznidazole
Trypanosomiasis or
Chagas Diseases
MOT Diagnosis
Sarcocystis spp. Oocyst:
Kissing bugs of the Exposure to Vector
Vector Thick and Thin
Giemsa Stain
• The only parasite that was discovered and
studied before it was known to cause a
disease.
Characteristics of Parasite
Sarcocystis spp. Sarcocyst:
-Amastigote-
• Round or ovoid in shape
• Usually in small groups of cyst-like in
collection tissue
• Found in the midgut of the vector
-Trypomastigote-
• Long and slender
• Pointed posteriorly with an undulating
membrane that extends a full body’s
length.
• Has a single flagellum that locates near
the kinetoplast.
-Epimastigote-
• Has an undulating membrane that is half
of its body’s length and 1 flagellum
Pathogenesis and Clinical Manifestation

-Chagomas-
• Furuncle-like painful lesions seen with
induration with regional lymphadenopathy
(entry site)

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 26

Clinical Parasitology
-Romana’s Sign-
• Parasite penetrates in the conjunctive and
swollen eyelids but it is painless and can
cause edema.
-Chronic Phase-
• Enlargement of Heart
• Poor ECG findings
Epidemiology
Trypanosoma brucei gambiense
Infective Stage Diagnostic Stage
• Chagas disease is estimated to have Metacyclic Trypomastigote
infected more than 10 million people Trypomastigote
worldwide Hosts Infected Vector
• Most cases are reported in the Latin Humans and Cattles Tsetse Fly (Glossina
Americas, where more than 25 million (reservoirs) spp.)
people are at risk for the disease Pathogenesis Treatment
Human African IV Suramin- for both
Prevention and Control Trypanosomiasis IM Pentamidine- for T.
gambiensei
MOT Diagnosis
• Vector Control
Bite of the Vector Polymerase Chain
• Medications Reaction (PCR)
• Blood Screening Enzyme-link
Immunoassay (ELISA)
Life Cycle CSF Study
• A Gambian sleeping disease
• Infects in the places of western and
central sub – Sahara
• Accounts for 95% of HAT cases (mas
abundant)
• Reservoir hosts: dogs, pigs, sheep, cattle
Characteristics of Parasite

-Trypomastigote-
• It is polymorphic: slender, short, stumpy,
Pictures of Parasite
flattened, & fusiform
• Blunt posterior
• Central nucleus and karyosome
• Undulating membrane found anteriorly
Pathogenesis and Clinical Manifestation

-Early Stage or Hemolymphatic Stage-

• Parasites proliferate in the bloodstream
and lymphatics.
• Symptoms: Fever, headache, anemia

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 27

Clinical Parasitology
-Winterbottom’s Sign- Trypanosoma brucei rhodesiense
• Enlarge posterior cervical lymph nodes Infective Stage Diagnostic Stage
(Gambian trypanosomiasis) Metacyclic Trypomastigote
Trypomastigote
Epidemiology Hosts Infected Vector
Humans and Cattles Tsetse Fly (Glossina
(reservoirs) spp.)
• Sleeping sickness affects around 300,000 Pathogenesis Treatment
to 500,000 people in 36 countries within Human African IV Suramin- for both
sub-Saharan Africa Trypanosomiasis IM Pentamidine- for T.
• Tsetse flies live near the banks of rivers gambiensei
and streams, therefore transmission can MOT Diagnosis
readily occur when people frequent these Bite of the Vector Polymerase Chain
areas to swim and do their laundry Reaction (PCR)
Enzyme-link
Prevention and Control Immunoassay (ELISA)
CSF Study
• Rhodesian sleeping sickness
• Vector Control
• Hazard for workers in game reserves and
• Insecticides
guests
• Protective Clothing
• Acute but rapidly fatal
• Regulation and Treatment of Reservoir
• Accounts for 5% of HAT cases (mas
Hosts
gamay)
Life Cycle • Reservoir Hosts: cattle and game animals
*The rest is the same with gambiense*
Pictures of Parasite

Pictures of Parasite

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 28

Clinical Parasitology
Leishmania spp. -Diffuse Cutaneous Leishmaniasis-
Infective Stage Diagnostic Stage • Also known as anergic or lepromatous
Promastigote Promastigote or leishmaniasis
Amastigote
• Localized non - ulcerating papule may
Hosts Infected Vector
result in numerous diffuse satellite lesions
Humans Sandfly (OLD-
Phlebotomus, NEW- affecting face and extremities
Lutzomiya) -Mucocutaneous Leishmaniasis-
Pathogenesis Treatment
Leishmaniasis Pentavalent Sb • Affected by L. braziliensis
compound • Involves nasal and oral cavities that cause
Sodium nasal stuffiness, epistaxis, and destruction
Stibogluconate of nasal septum (espundia)
Meglumine
MOT Diagnosis -Visceral Leishmaniasis-
Bite of the Vector Giemsa and H&E • Affected by L. donovani, L. chagasi, L.
Stains infantum
Lesions and Tissue • Presents with twice -daily fever spikes
Scrappings
(double quotidian)
• It is differentiated by the location of
• Kala azar - disseminated parasitosis
development inside the vector and
• Post-Kala Azar Dermal Leishmaniasis
endemicity
(PKDL) - a cutaneous eruptions that may
• OLD WORLD – L. tropica, L. aethiopia, L.
cause hypopigmented macules, malar
major
erythema, nodules and ulcerations.
• NEW WORLD – L. mexicana , L.
amazonensis, L. guyanensis, L. chagasi Epidemiology
• Reservoir Hosts: Dogs in urban and
Rodents in both rural and urban areas
• Leishmaniasis is a global disease
Characteristics of Parasite distributed across 88 countries in four
continents
-Amastigote- • It affects more than 12 million people
worldwide, and more than 350 million are
• Ovoid or Round in shape
at risk for the disease.
• Has large nucleus with axonemes that
arises from the kinetoplast extending to Prevention and Control
the anterior tip
-Promastigote- • Use of repellants with DEETT and
permethrin
• Has a single free flagellum
• Insecticide-treated clothing
• Multiplies through binary fission
• Fine-mesh bed nets
Pathogenesis and Clinical Manifestation • Regulation of reservoir hosts

-Cutaneous Leishmaniasis-
• Raised edges and central crater
• Can heal spontaneously but may leave a
disfiguring scar
• Oriental button - nodule at the inoculation
site

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 29

Clinical Parasitology
Life Cycle  A soil-transmitted helminth (STH), along
with Trichuris Trichiura and Hookworm,
which means that the soil plays an
important in development and
transmission of the parasite
 It doesn’t reside in the small intestine but
it has a heart-lung migration
Characteristics of Parasite

-General-
 So-called “polymyarian type” because of
the somatic muscle arrangement in which
Pictures of Parasite
cells are numerous and project well into
the body.
 Adult Ascaris do not attach in small
intestines.
 It produces pepsin inhibitor 3 (PI-3) that
protects worms from digestion and
phosphorylcholine that suppresses
lymphocyte proliferation.
 A female Ascaris produces 200,000 eggs
per day but it decreases if there is an
increasing worm load.
 The larvae undergo two molts to reach
their 3rd stage within the egg and become
Nematodes embryonated.
 When ingested, the embryonated eggs
Ascaris lumbricoides (Giant will hatch the larvae in small intestine and
Roundworm) will migrate to the cecum (large intestine)
Infective Stage Diagnostic Stage and will penetrate the mucosa
Embryonated Egg Fertilized or  It can go and infect other parts of the body
Unfertilized Egg such as the liver and lungs.
Hosts Infected Vector  In the lungs, larvae will undergo molting
Humans NA
(shredding of protective layer) and after, it
Pathogenesis Treatment
will migrate to the larynx and oropharynx
Ascariasis Albendazole
for to be swallowed in the digestive tract
Mebendazole
Pyrantel Pamoate -Infertile Eggs-
MOT Diagnosis
Fecal-Oral Direct Fecal Smear  Longer and Narrower than fertile eggs.
Ingestion of (DFS)  Has a thin shell and irregular coating filled
Embryonated eggs Kato-thick Smear with refractile granules.
Kato-Katz Technique  Difficult to Identify
Formalin Ethyl/Ether
Concentration -Fertile Eggs-
Technique (FECT)  Has a thick, transparent, hyaline shell with
 The most common intestinal nematode of a thick outer layer as a supporting
man or giant roundworm structure.

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 30

Clinical Parasitology
 Has delicate vitelline, lipoidal, inner Pictures of Parasite
membrane, which is highly impermeable.
A. lumbricoides Infertile Eggs:
-Embryonated Eggs-
 Larvae can now be seen inside the egg.
 Has a thin, transparent, hyaline shell
Pathogenesis and Clinical Manifestations

 Majority of the Ascaris infection are

asymptomatic.
 Most frequent complain is vague
abdominal pain.
 Moderate infection: lactose intolerance
and vitamin A malabsorption; Heavy A. lumbricoides Fertile Eggs:
infection: bowel obstruction
Prevention and Control

 Provision of safe water, environmental

sanitation, hygiene education, and regular
deworming, which are the components of
the WASHED (water, sanitation, hygiene,
education, deworming) framework.
Life Cycle A. lumbricoides Embryonated Egg:

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 31

Clinical Parasitology
Trichuris trichiura (Whipworm) entire whip-like portion into the intestinal
Infective Stage Diagnostic Stage wall.
Embryonated Egg Unembryonated Egg
Pathogensis and Clinical Manifestation
Hosts Infected Vector
Humans NA
-Amebic Dysentery-
Pathogenesis Treatment
Trichiuriasis Albendazole  The anterior portions of the worms are
Mebendazole embedded in the mucosa that can cause
petechial hemorrhage which can led to
MOT Diagnosis this dysentery because the ulcers provide
Fecal-Oral Direct Fecal Smear a suitable site for tissue invasion
Ingestion of (DFS) w drop of saline
Embryonated eggs Kato-thick Smear- -Appendicitis-
highly recommended
 The lumen of the appendix may be filled
Kato-Katz Technique
Formalin Ethyl/Ether with worms which can cause consequent
Concentration irritation and inflammation
Technique (FECT) -Light Infections-
 Another parasite that is soil transmitted
helminth  Moderately associated with anemia
 Embryonation occurs in clayish soil and  Usually asymptomatic and the presence
more susceptible to desiccation (extreme of the parasite may be discovered only in
dryness) routine stool examinations
 No heart-lung migration -Heavy Infections-
Characteristics of Parasite  Strongly correlated with anemia
 May result in Trichuris dysentery
-General- syndrome manifested by chronic
 Females (are larger than males) have dysentery and rectal prolapse because
blunt posterior end (anus only) while worms may found throughout the colon
males have coiled posterior (anus and and rectum
single spicule) Prevention and Control
 Females can lay up to 3,000-10,000 eggs
per day
 Similar to Ascaris infection (WASHED
-Eggs- framework)
 Lemon or football shape  Provision of safe water, environmental
 Has yellowish outer and transparent inner sanitation, and hygiene education
shell
 Under favorable conditions, the eggs
develop and become embryonated within
2 to 3 weeks
-Larvae-
 Inhabits the cecum and penetrates the
intestinal villi for 3-10 days
 It secretes a pore-forming protein, called
the TT47 that allows them to imbed their

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 32

Clinical Parasitology
Life Cycle Hookworms (Necator americanus,
Ancylostoma duodenale)
Infective Stage Diagnostic Stage
Filariform Larva Eggs
Hosts Infected Vector
Humans NA
Pathogenesis Treatment
Hookworm Infection Albendazole
Mebendazole

MOT Diagnosis
Skin penetration Direct Fecal Smear
(DFS)
Kato-thick Smear or
Kato-Katz Technique
Formalin Ethyl/Ether
Concentration
Technique (FECT)
Pictures of Parasite Culture Methods like
Harada Mori
T. trichiura Egg:  Most commonly found in tropical and
subtropical countries
 Found in the Philippines especially in
agricultural areas
 Blood-sucking nematodes
 Attaches to intestinal mucosa and can
migrate to heart-lung (roundworm and
whipworm in one)
 Characterized as meromyarian type in
which the muscle cells are arranged in per
dorsal or ventral half
Characteristics of Parasite

T. trichiura Larvae: -Eggs-

 Have bluntly rounded ends
 Has single thin transparent hyaline shell
 Can sustain in the environment which is
damp, sandy, friable soil with decaying
vegetation at 24℃-32℃
-Rhabditiform Larvae-
 It resembles like S. stercoralis but is much
larger, more attenuated posteriorly, and
have a longer buccal cavity
-Filariform Larvae-
 N. americanus: buccal spears are
conspicuous and parallel throughout;

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 33

Clinical Parasitology
transverse striations are seen on the Prevention and Control
sheath in the tail region
 A. duodenale: inconspicuous buccal
 Regular mass drug administration
spears and transverse striations on the
sheath in the tail region  Implementing of WASHED approach
 Vaccines
-Necator americanus-
Life Cycle
 Females are larger than males
 Adults are small, cylindrical, fusiform,
grayish-white nematodes
 Posterior end has broad, membranous
caudal bursa with rib-like rays (used for
copulation)
 Buccal capsule has a ventral pair of
semilunar cutting plates
 Head is curved opposite to the curvature
of the body
-Ancylostoma duodenale-
 Slightly larger than N. americanus Pictures of Parasite
 Single-paired male or female reproductive
organs Hookworm Egg:
 Head continues in the same direction as
the curvature of the body
 The buccal capsule has two pairs of
curved ventral teeth
Pathogenesis and Clinical Manifestations

 Sites of infection: Site of entry, Lungs

during larval migration, and the Small
intestine which is the habitat of the adult
worms
 Penetration of filariform larvae in the skin
causes maculopapular (rashes), and
itching (also known as a ground inch or Hookworm N. americanus:
dew inch)
 Hookworm infection is usually chronic
 Chronic moderate or heavy hookworm
infection results in heavy anemia due to
primarily continuous loss of blood
 Necatoriasis: purely percutaneous
 Ancylostomiasis: percutaneous and oral
route

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 34

Clinical Parasitology
Hookworm A. duodenale:
Characterisitics of Parasite

-Parasitic Filariform-
 Is non-feeding and slender
 Female: colorless, semi-transparent, with
a striated cuticle
 It is similar to the hookworm filariform
larva but is usually smaller, with a distinct
cleft at the tip of the tail.
Hookworm Rhabditiform Larvae: -Free-living Larvae-
 Free-living female is smaller than parasitic
female
 Female: It has a muscular double-bulbed
esophagus, and the intestine is a straight
cylindrical tube
 Male: has a ventrally curved tail, two
Hookworm Filariform Larvae: copulatory spicules, a gubernaculum, but
no caudal alae
-Rhabditiform Larvae-
 It has an elongated esophagus with a
pyriform posterior bulb
 This species differs from the hookworm in
being slightly smaller and less attenuated
(lessen or weakened) posteriorly
Strongyloides stercoralis -Eggs-
(Threadworm)  Clear thin shell and similar to hookworm
Infective Stage Diagnostic Stage eggs but smaller
Filariform Larva Rhabditiform Larva
Hosts Infected Vector Pathogenesis and Clinical Manifestations
Humans NA
Pathogenesis Treatment
 Acute Infections: (a) invasion of skin by
Strongyloidiasis Albendazole
Thiabendazole filariform larvae (b) migration of larvae in
the body, and (c) penetration of the
MOT Diagnosis Intestinal mucosa by adult female worms
Skin penetration Baermann Funnel  Is a syndrome of accelerated autoinfection
Gauze Method which usually, but not invariably, occurs in
Culture Methods like the immunocompromised
Harada Mori  Light Infections does not caused intestinal
 Soil-transmitted helminth symptoms
 Is characterized by free-living rhabditiform  Moderate Infections causes diarrhea with
and parasitic filariform stages alternate constipation
 Definitve host to humans  Heavy Infections produces intractable,
painless, intermittent diarrhea (Cochin

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 35

Clinical Parasitology
China diarrhea) characterized by S. stercoralis Rhabditiform Larvae:
numerous episodes of watery and bloody
stools.
 Chronic Strongyloidiasis is often
asymptomatic but may also cause
Intermittent vomiting, diarrhea,
constipation, asthma, and borborygmi
(rumbling noise).
Prevention and Control S. stercoralis Egg:

 Prevention is similar to previous parasites

(WASHED Framework)
 Use footwear to avoid contact of the skin
in the soil
Life Cycle

Enterobius vermicularis (Human

Pinworm)
Infective Stage Diagnostic Stage
Embryonated Eggs Eggs in perianal folds
Hosts Infected Vector
Humans NA
Pathogenesis Treatment
Enterobiasis Albendazole
MOT Diagnosis
Fecal-Oral Graham’s scotch
adhesive tape swab
Pictures of Parasite  A familial disease
S. stercoralis Parasitic Filariform:  Infection is typically characterized by
perianal itching or pruritus ani
 This intestinal nematode is classified as
meromyarian, wherein the muscle cells
are arranged in two to five per dorsal or
ventral half
Characteristics of Parasite

-Adult Worm-
S. stercoralis Free-living Larvae:  Have circular alar expansion at the
anterior end and a prominent posterior
esophageal bulb
 Females has long pointed tail
 Males are rarely seen because they
usually die after copulation
 Found in cecum and adjacent portions of
small and large intestines

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 36

Clinical Parasitology
-Rhabditiform Larvae- Life Cycle
 Has the characteristic esophageal bulb,
but has no cuticular expansion on the
anterior end.
-Eggs-
 Asymmetrical in shape with flat on one
side and convex on the other side
 The translucent shell consists of an outer
triple albuminous covering for mechanical
protection and an inner embryonic lipoidal
membrane for chemical protection
 Eggs are resistant to disinfectants but
succumb (no longer resist) to dehydration
in dry air
 Inside the egg is a tadpole like embryo
Pictures of Parasite
that becomes fully mature outside the host
within 4 to 6 hours E. vermicularis Adult Worm:
 Hatches in the duodenum
Pathogenesis and Clinical Manifestations

 Migration of egg-laying females to the

anus causes irritation of the perineal
region
 Intense itching leads to scratching, and
may give rise to secondary bacterial
infection
 Children infected with this parasite may
suffer from insomnia due to the pruritus E. vermicularis Eggs:

Epidemiology

 Most common parasite in temperate

regions and less in tropical areas
Prevention and Control

 Personal cleanliness and personal

hygiene are essential
 Fingernails should be cut short and hand
washing should be done after using the
toilet
 Underwear, night clothes, blankets, and
bed sheets should be handled with care
and washed in hot soapy water
 Chemotherapy of the entire family is
recommended

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 37

Clinical Parasitology
Capillaria philippinensis (Pudoc Prevention and Control
Worm)
Infective Stage Diagnostic Stage
 Improve sanitation and health educational
Infective Larvae Unembryonated Eggs
programs
Hosts Infected Vector
 Capacity building for health personnel in
Humans, Fish-eating NA
Birds & Freshwater the field, including laboratory staff, for
Fish early and accurate diagnosis and
Pathogenesis Treatment treatment
Capillariasis Mebendazole Life Cycle
MOT Diagnosis
Ingestion of raw or Direct Fecal Smear
undercooked fish (DFS)
 One of the capillaria species known to
infect humans
 Fish-eating birds are natural hosts while
Humans are accidental hosts
 Belong to superfamily Trichinelloidea
(same as Trichuris and Trichenella)
Characteristics of Parasite

-Larvae-
 The esophagus has rows of secretory
cells called stichocytes, and the entire
esophageal structure is called a
stichosome
 Male have a thin filamentous anterior end
and a slightly thicker and shorter posterior
end
Pictures of Parasite
 Female are slightly larger than males
 First generation females produces larvae
to build up population
-Eggs-
 Peanut-shaped with striated shells and
flattened bipolar plugs
Pathogenesis and Clinical Manifestations

 Usually have abdominal pain and

borborygmi (rumbling noise)
 An intestinal capillariasis characterized by
abdominal pain, chronic diarrhea, and
gurgling stomach
 The disease may also be associated with
proteinlosing enteropathy, electrolyte
imbalance, and intestinal malabsorption.
Severe disease can result in death

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 38

Clinical Parasitology
 Microfilaria is enclosed in hyaline sheath
with angular curvatures and nuclei at the
tail tip
 Vector: Mansonia

Lymphatic Filiariasis (Wuchereria

bancrofti, Brugia malayi)
Infective Stage Diagnostic Stage
L3 larvae Adult Larvae Pathogenesis and Clinical Manifestations
Hosts Infected Vector
Humans Mosquitos and Black
Flies  Usually acquired in childhood but manifest
Pathogenesis Treatment in adulthood
Lymphatic Filariasis Diethylcarbamazine  Symptoms: Lymphaedema and
MOT Diagnosis Elephantiasis
Bite of a Vector Thick Blood Smears  Lymphedema is most common chronic
between 8 pm-4 am manifestation leading to elephantiasis
 When become lodged in the lymphatic affecting mostly lower limbs
system, these worms cause lymphedema,  Lymphangiectasia: enlargement of
lymphangitis, and in chronic cases, lymphatic system
elephantiasis
 Lymphangiogenesis: increase of
 Lymphatic filariasis: one of the most
lymphatic endothelial cell
debilitating diseases in tropics and 2nd
leading cause of permanent disability -Reasons why these parasites inhabits in Lymph
 Definitive Hosts: Humans Nodes:-

Characteristics of Parasite  No platelets

 No complement system
-Wuchereria bancrofti-  Incomplete coagulation system
 No polymorphonuclear cells
 Bancroft’s filarial worm
 Flow is not fast and violent
 Adult worms appear creamy white, long,
and filiform Prevention and Control
 Microfilaria is enclosed in hyaline sheath
that is longer with central dark-staining
 Prevent contact with mosquito vectors
nuclei
 Two major goals of The Global
 Vectors: Aedes, Culex, Anopheles
Programme to Eliminate Lymphatic
-Brugia Malayi- Filariasis (GPELF): to interrupt
transmission of the parasite via preventive
 Malayan filarial worm
chemotherapy, and to provide care for
 Indistinguishable with W. bancrofti
those who suffer from the clinical
manifestations of LF through hygiene
education programs.

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 39

Clinical Parasitology
Life Cycle Parastrongylus cantonensis (Rat
Lungworm)
Infective Stage Diagnostic Stage
L3 larvae L3 larvae
Hosts Infected Vector
Humans, Rats, & NA
Snails
Pathogenesis Treatment
Parastrongyliasis Albendazole
MOT Diagnosis
Ingestion of Magnetic Resonance
contaminated food Imaging (MRI)
and water WBC Count must be
very high
 Also known as Angiostrongylus
cantonensis
 Definitive Hosts: Rats
 Incidental hosts: humans, mollusks, slugs,
and snails
 Snails: Achatina fulica (African giant
snail), Hemiplecta sagittifera, Helicostyla
marcostoma, Vaginilus plebeius, and
Veronicella altae

Pictures of Parasite Characteristics of Parasite

-Adult Worms-
 Rats become infected when ingesting the
third-stage larvae
 Male have a well-developed caudal bursa,
which is kidney-shaped and single-lobed
 Female have uterine tubules arranged like
a barber’s pole pattern
 Posterior end is blunt shaped and can lay
up to 15,000 eggs per day
-Eggs-
 Have delicate hyaline shells
 Unembryonated when oviposited
Pathogenesis and Clinical Manifestations

 The disease is mild and no hospitalization

is necessary
 The infection is self-limited and symptoms
gradually disappear with recovery.

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 40

Clinical Parasitology
Prevention and Control Trichinella spiralis (Porkworm)
Infective Stage Diagnostic Stage
Encysted larvae Encysted larvae
 Handwashing
Hosts Infected Vector
 Public should be discouraged from eating Humans, Wild and NA
raw or poorly cooked mollusks or Domestic Animals
unwashed vegetables Pathogenesis Treatment
 Awareness and education on proper Trichinellosis Albendazole
eating habits and safe food preparation MOT Diagnosis
Ingestion of raw meat Enzyme-linked
Life Cycle Immunoabsorbent
Assay (ELISA)
Muscle Biopsy
 The most important cause of trichinellosis
in humans and the species that adapted
to domestic and wild pigs
Characteristics of Parasite

-Adult Worm-
 Male has a single testis located near the
posterior end of the body
 Female has a single ovary which is
Pictures of Parasite situated in the posterior part of the body
 Can live up to 30 days and capable of
P. cantonensis Worm: laying 1,500 larvae in its lifetime
-Encysted Larvae-
 It has a spear-like, burrowing anterior tip
 The reproductive organs, at this stage, are
not yet fully developed but even then, it is
already possible to identify the sex of the
parasite.
Pathogenesis and Clinical Manifestations

P. cantonensis Egg:
 The severity of symptoms depends on the
intensity of infection
 The clinical conditions are divided into
three phases, namely: enteric phase,
invasion phase, and convalescent phase
which corresponds to incubation and
intestinal invasion
Prevention and Control

 Must be cooked (minimum of 77 degrees

Celsius) or freezing (-30 degrees Celsius)
 Health Education

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 41

Clinical Parasitology
Life Cycle Anisakis spp.
Infective Stage Diagnostic Stage
L3 larvae Adult Worm
Hosts Infected Vector
Humans, and Marine NA
Animals
Pathogenesis Treatment
Anisakiasis or Albendazole
Anisakidosis Endoscopic Removal
MOT Diagnosis
Ingestion of raw or Enzyme-linked
undercooked Immunoabsorbent
seafoods (esp. fish Assay (ELISA)
and squids) Endoscopic
Examination
 Nematode parasites of whales, dolphins,
porpoises, walruses, seals, sea lions, and
other deep marine mammals.
Pictures of Parasite
 Definitive hosts: cetaceans, pinnipeds,
T. spiralis Adult Worm: bearded seal, and gray seal
 Accidental host: humans
 Common infective species: Anisakis
simplex, Psuedoterranova decipiens,
Contracaecum spp. and Hysterothylacium
spp.
Characteristics of Parasite

-3rd Stage Larvae-

 They have a complete digestive tract, and
the sexes are separate
 Anisakis that is : Milky white in color, long
stomach, blunt tail with mucron are
T. spiralis Encysted Larvae: referred to as type 1 larvae
 Type II larvae have shorter stomachs and
blunt tails
Pathogenesis and Clinical Mnaifestations

 3rd-stage larvae will not develop into

adults in human gut but it can result to
gastric and intestinal pathology
 Second manifestation is the allergic
reaction of the chemicals secreted by the
worms

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 42

Clinical Parasitology
Prevention and Control Toxocara canis, Toxocara cati
(Dog/Cat Roundworm)
Infective Stage Diagnostic Stage
 Marine fish, squid, and shellfish must be
Eggs L3 larvae
thoroughly cooked prior to consumption
Hosts Infected Vector
 Raw and undercooked seafoods must
Humans, Dogs and NA
undergo blast freezing (-35 degrees Cats
Celsius) before preparing to it to be Pathogenesis Treatment
cooked Toxocariasis Albendazole
Life Cycle Mebendazole
MOT Diagnosis
Ingestion of eggs Polymerase Chain
Foodborne Reaction (PCR)
Transmission Magnetic Resonance
Imaging (MRI)
 A zoonotic disease which may present as
a public health problem with stray dogs
and cats common in urban areas
 Accidental Host: humans
 While the larvae do not develop into adult
worms in the human host, they can cause
severe local reactions that may result in
significant damage.
 When infective eggs of these roundworms
are ingested by humans, larvae are
released and penetrate the intestinal wall
then migrate via the veins into the liver
and the rest of the body, where they
remain as larvae.
Pictures of Parasite Characteristics of Parasite

-Toxocara canis-
 MOT is more on transplacental
transmission
 Adult dogs: penetrates the gut wall and
migrate to tissues where they encyst
 Female Adult dogs: the encysted stages
are reactivated during pregnancy, and
infect their puppies through the
transplacental and transmammary routes
 Young dogs: after hatching, migrate
through the circulatory system to the lungs
and trachea.
 Females produces 200,000 eggs per day
-Toxocara cati-
 Follows a life cycle similar to that of T.
canis except that vertical transmission is

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 43

Clinical Parasitology
attributed more to lactation than Life Cycle
transplacental transmission
 Causes fewer cases of human infection
than T. canis
Pathogenesis and Clinical Manifestations

 Generalized lymphadenopathy is an
infrequent manifestation of toxocariasis
 3 clinical forms of toxocariasis: visceral
larva migrants (VLM), ocular larva
migrants (OLM), and covert toxocariasis
(CoTOX)
-Visceral Larva Migrants- Pictures of Parasite
 The result of migration and subsequent
death of the larvae in the different tissues Toxocara canis:
and organs, producing an intense
inflammatory response manifested as
eosinophilic granulomas.
-Ocular Larva Migrants-
 This resulted of only few larva invaded in
the ocular and occasionally only 1 larva
can invade and affect almost all the ocular Toxocara cati:
structures
 Expressed with signs and symptoms
manifested in the eyes
-Covert Toxocariasis-
 Usually asymptomatic and eosinophilia is
less frequent
Prevention and Control
Eggs:

 Control and capture of stray dogs and

cats
 Cleaning up feces from soil and
pavements
 Gardens should be fenced to prevent
fecal contamination by dogs and cats.
 Hand washing should be encouraged
 Require owners to remove their pets’
feces from public areas

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 44

Clinical Parasitology
Cestodes  Has a thick outer membrane
 Inside the eggshell is the embryo or
Taenia saginata (Beef Tapeworm) oncosphere with 3 pairs of hooklets
Infective Stage Diagnostic Stage
Pathogenesis and Clinical Manifestations
Cysticercus Bovis Eggs or Gravid
Proglottids
Hosts Infected Vector  Most common complaint is passing of
Humans and Cattle NA proglottids or segments in the stools
Pathogenesis Treatment  Causes mild irritation to the site of
Taeniasis Praziquantel (until attachment of T. saginata
scolex is recovered)
MOT Diagnosis Life Cycle
Ingestion of Raw or Identifying the
Undercooked Meat characteristics of
proglottids, scolex, or
eggs
Formalin Ethyl/Ether
Concentration
Technique (FECT)
Perianal Swabs
 7 cm long
 Humans are definitive hosts and never be
intermediate hosts
 Will not go to the brain, only the T. solium
 It is devoid of hooks or a rostellum.
Pictures of Parasite
Attached to the scolex is a short neck
from which a chain of immature, mature,
T. saginata Mature Proglottids:
and gravid proglottids develop.
Characteristics of Parasite

-Mature Proglottids-
 Gravid proglottids are longer and wide
 Square in shape and contain mature male
and female reproductive organs
 Testes are follicular in manner that is
scattered throughout the proglottid T. saginata Gravid Proglottids:
numbering from 300-400
-Gravid Proglottids-
 Undergoes apolysis (The shedding of
gravid proglottids by the tapeworm) and
passed out in the feces
 Contains 97,000-124,000 ova and
annually, the worm may passed out
594,000,000 ova
-Ova-
 Spherical or subspherical in shape

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 45

Clinical Parasitology
T. saginata Eggs:  Infected meat is usually called as
“measely pork”
Characteristics of Parasite

-Adult Worm-
 In general morphology, the difference
between T. solium and T. saginata are the
presence of an accessory ovarian lobe,
the absence of a vaginal sphincter, and
the smaller number of follicular testes
T. saginata Scolex: (100- 200) in the mature proglottid of T.
solium
 It is shorter than T. saginata and may
have 8,000-10,000 proglottids
 The scolex of T. solium has 4 acetabula
and is smaller than T. saginata
 Scolex also of T. solium has cushion-like
rostellum with double crown which is
absent in T. saginata
-Gravid Proglottids-
 Contains approximately 30,000-50,000
ova
Taenia solium (Pork Tapeworm)  T. solium proglottids are relatively less
Infective Stage Diagnostic Stage active than the proglottids of T. saginata
Cysticercus Eggs or Gravid  Contains 7 to 13 lateral branches as
Cellulosae Proglottids opposed to 15 to 20 branches of T.
Hosts Infected Vector saginata
Humans and Pigs NA
Pathogenesis Treatment -Ova-
Taeniasis & Praziquantel
 T. solium eggs are indistinguishable from
Cysticercosis Albendazole
T. saginata
MOT Diagnosis
Ingestion of Raw or Identifying the  Have a thick brown striated embryophore
Undercooked Meat characteristics of surrounding a hexacanth (penetrates the
Fecal-Oral proglottids, scolex, or gut wall and travels throughout the body)
eggs embryo.
Magnetic Resonance
-Mature Cysticercus-
Imaging (MRI)
 Humans are both definitive and  This happens only if humans act as
intermediate hosts intermediate hosts
 Individuals harboring the adult Taenia  The mature cysticercus is oval,
solium can infect themselves translucent, and has an opaque
(autoinfection) due to poor hygienic invaginated scolex with four suckers and a
practice. circlet of hooks.
 The difference to T. saginata is aside from  Usually encapsulated in the tissues but
scolex, it has a brain involvement not encapsulated in the brain

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 46

Clinical Parasitology
Pathogenesis and Clinical Manifestations Life Cycle

-Taeniasis-
 May result in mild and non-specific
abdominal complaints
-Cysticercosis-
 Often multiple and can develop in any
organs or tissue especially in the striated
muscles and brain but can also involve in
the tissues of eyes, heart, lungs, and
peritoneum.
 Cyst can survive in 5 years and upon
death, it will become calcified due to the
tissues response to the parasite
Epidemiology
Pictures of Parasite
 Distribution of T. saginata and T. solium
infections is highly related to the habit of T. solium Adult Worm:
eating undercooked or raw meat
 T. solium is especially common in Slavic
countries, Latin America, Southeast Asia,
China, and India
 T. saginata is common in Ethiopia and
East Africa
T. solium Gravid Proglottids:
 In Philippines, T. saginata > T. solium
Prevention and Control

 Cooking of meat is the primary measures

 Freezing the meat at -20C for 10 days kills
the cysticerci
 Sanitary inspection of all slaughtered pigs,
cows, and cattle should be done

T. solium Eggs:

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 47

Clinical Parasitology
T. solium Scolex:  Autoinfection can occur through the fecal-
oral route or within the small bowel
Characteristics of Parasite

-Adult Worm-
 Has a delicate strobila (segmented part of
tapeworm) that will reside in ileum
 Has a retractable rostellum armed with a
single row of 20-30 Y-shaped hooklets
T. solium Mature Cysticercus:  The scolex is subglobular with four cup-
shaped suckers
 The genital pores are found along the
same side of the segments
-Mature Proglottids-
 Contain three ovoid testes and one ovary
in a more or less straight pattern across
the segment
Cysticercus Cellulosae:  When segments become gravid, the
testes and the ovary disappear while the
uterus hollows out and becomes filled with
eggs.
-Eggs-
 Spherical or subspherical in shape and
colorless or clay-colored
 The oncosphere has a thin outer
Hymenolepis nana (Dwarf membrane and a thick inner membrane
Tapeworm) with conspicuous bipolar thickenings, from
Infective Stage Diagnostic Stage each of which arise four to eight hair-like
Embryonated Eggs Embryonated Eggs polar filaments embedded in the inner
Hosts Infected Vector membrane.
Humans, Cats, Dogs, NA
& Crustaceans Pathogenesis and Clinical Manifestations
Pathogenesis Treatment
Hymenolepiasis Praziquantel
 Symptoms are generally produced
Nitazoxanide
because of the patient’s immunological
MOT Diagnosis
Ingestion of Direct Fecal Smear response to the parasite.
Crustaceans with (DFS)  Light worm burden is generally
Embryonated Eggs asymptomatic
 Is a Cyclophyllidean tapeworm and the  Heavy infections may result in enteritis
smallest tapeworm infecting to humans due to necrosis and desquamation of the
 Children are usually affected intestinal epithelial cells (hubag ang tinae)
 This parasite is the only human tapeworm
that can complete its life in a single host
and doesn’t require an obligatory
intermediate hosts

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 48

Clinical Parasitology
Epidemiology H. nana Mature Proglottids:

 Usually found in the areas with warm

climate such as Southern USA, Latin
America, the Mediterranean, East Asia,
and the Philippines
 Transmission generally occurs where
there is poor sanitation, overcrowding,
and poor personal hygiene practices.
Prevention and Control
H. nana Eggs:
 Personal hygiene and environmental
sanitation
 Rodent Control
Life Cycle

H. nana Scolex:

Pictures of Parasite

H. nana Adult Worm:

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 49

Clinical Parasitology
Hymenolepis diminuta (Rat  Life span is short therefore, human
Tapeworm) infections are usually light
Infective Stage Diagnostic Stage
Epidemiology
Cysticercoid Larvae Eggs
Hosts Infected Vector
Humans and Rats NA  Human infection occurs worldwide and is
Pathogenesis Treatment more common to children than adults in
Hymenolepiasis Praziquantel poor communities with rat manifestation
MOT Diagnosis
Ingestion of Rodents Identification of eggs Prevention and Control
(Rats) in Stools
 Accidental human infections do occur  Rodent Control
resulting in hymenolepiasis  Elimination of insect intermediate hosts
 This parasite requires intermediate hosts  Sanitary disposal of human wastes
Characteristics of Parasite  Protection of foods
Life Cycle
-Adult Worm-
 Is larger than H. nana
 The scolex of H. diminuta has rudimentary
unarmed rostellum while H. nana has
retractable armed rostellum
 Has the same number of sexual organs to
H. nana; three ovoid testes and one ovary
 Genital pores of H. diminuta is unilateral,
the same with H. nana
-Eggs-
 Circular in shaped Pictures of Parasite
 The oncosphere is enclosed in an inner
membrane, which has bipolar thickenings H. diminuta Scolex:
but without the bipolar filaments
 The hooklets usually have a fan-like
arrangement
 H. diminuta eggs are distinguished from
H. nana eggs by their more circular
shape, larger size, and lack of bipolar
filaments
-Gravid Proglottids-
 Separates from the main body of the
worm, disintegrate, and release eggs into
the feces
Pathogenesis and Clinical Presentations

 The worm burdens in rodents and has low

chances to infect humans

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 50

Clinical Parasitology
H. diminuta Eggs: Characteristics of Parasite

-Adult Worm-
 The scolex is small and globular with four
deeply cupped suckers and a protrusible
rostellum, which is armed with one to
seven rows of rose thorn-shaped hooklets
 Measures 10-70 cm in length
-Gravid Proglottids-
 Proglottids are narrow which is like a
pumpkin seed shape
H. diminuta Gravid Proglottids:  Has two sets of male and female
reproductive organs and bilateral genital
spores
 The gravid proglottids have the size and
shape of a pumpkin seed and are filled
with capsules or packets of about 8 to 15
eggs
-Eggs-
 Spherical in shape, thin-shelled with
hexacanth embryo
Pathogenesis and Clinical Manifestations
Dipylidium caninum (Flea or
Double-pored Tapeworm)  Most infections are asymptomatic
Infective Stage Diagnostic Stage  Infection is rarely heavy and moderate
Cysticercoid Larvae Gravid Proglottids or and the symptoms are minimal
Ova Epidemiology
Hosts Infected Vector
Humans, Dogs and NA
Cats  Children are usually infected because of
Pathogenesis Treatment in close contact with their pet cats and
Dipylidiasis Praziquantel dogs
MOT Diagnosis  Human infection is rare but there are
Ingestion of Infected Proglottids should be recorded cases in European countries,
Flea pressed or flattened USA, Argentina, Rhodesia, China, and
for examination Philippines
 Very common intestinal parasite to dogs
and cats worldwide Prevention and Control
 Intermediate Hosts: Larval stages of
Ctenocephalides canis (dog flea),  Periodic deworming of cats and dogs
Trichodectes canis (dog louse)
 Health education in children particularly in
Ctenocephalides felis (cat flea), and Pulex
playing with pets
irritans (human flea)
 Accidental Hosts: Humans
 Children are usually infected

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 51

Clinical Parasitology
Life Cycle Raillietina garrisoni “Raillietina
Madagascariensis”
Infective Stage Diagnostic Stage
Cysticercoid Larvae Gravid Proglottids or
Eggs
Hosts Infected Vector
Humans, Rats, NA
Beetles, and Ants
Pathogenesis Treatment
Raillietina Infection Praziquantel
MOT Diagnosis
Ingestion of Beetles or Finding the
Ants characteristic
Pictures od Parasite proglottids or ova in
stools
D. caninum Adult Worm:  No Autoinfection occurs
 Accidental Hosts: Humans
 Intermediate Hosts: Ants and Beetles
(Flour Beetle)
 Definitive Hosts: Rats
Characteristics of Parasite

-Adult Worm-
D. caninum Gravid Proglottids:
 60 cm in length
 Scolex is subglobular with four acetabula
 The rostellum is armed with two
alternating circular rows of hammer-
shaped hooks. Several rows of spines
also surround the rostellum
-Mature Proglottids-
 Has bilobed ovary surrounded by 36-50
testes
 Genital pores opens on the side near the
D. caninum Eggs: anterior lateral border of the segment
-Eggs-
 The oncosphere is enclosed in two thin
membranes: an outer elongated
membrane and an inner spherical
membrane.
Pathogenesis and Clinical Manifestations

 Usually asymptomatic
 Children are brought for medical
consultation when proglottids are passed
out with their feces.

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 52

Clinical Parasitology
Epidemiology R. garrisoni Mature Proglottids:

 Almost all the children infected are below

3 years old
 Is a common intestinal cestode of rodents
in the Philippines where more than 20
human infections are recorded
Prevention and Control

 Elimination of rodents from households,

proper storage of grain products, and
sanitary waste disposal R. garrisoni Eggs:

Life Cycle

Diphyllobothrium latum (Fish or

Broad Tapeworm)
Infective Stage Diagnostic Stage
Pictures of Parasite Plerocercoid Larvae Unembryonated Eggs
Hosts Infected Vector
Humans and NA
R. garrisoni Scolex:
Crustaceans
Pathogenesis Treatment
Diphyllobothriasis Praziquantel
MOT Diagnosis
Ingestion of Raw or Direct Fecal Smear
Undercooked Fish (DFS)
Kato Technique
 Refers to the intestinal infection with the
adult worm
 Definitive Hosts: Humans
 Intermediate Hosts: Freshwater Copepods
(Cyclops)
 Reservoir Hosts: Dogs, Cats and other
Mammalian hosts

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 53

Clinical Parasitology
Characteristics of Parasite Life Cycle

-Adult Worm-
 Has 4000 proglottids
 The scolex is spatulate and has two
bothria or sucking grooves which are
located ventrally and dorsally
 The neck is long and attenuated, and is
followed by immature proglottids
-Mature Proglottids-
 Is longer width than its length
 Contains one set of reproductive organs
 The testes are located in the dorsolateral Pictures of Parasite
part of the proglottid
 The dark, rosette-like, coiled uterus D. latum Scolex:
located in the middle of the gravid
proglottid
 A symmetrical bilobed ovary is present at
the posterior third of the proglottid
 Approximately 1,000,000 ova may be
released daily
-Eggs- D. latum Mature Proglottids:

 The ova are usually yellowish brown, with

a moderately thick shell and an
inconspicuous operculum
Pathogenesis and Clinical Manifestations

 Infections are usually limited to one worm

but there are reports of mechanical
obstruction due to large number of worms
 The symptoms is due to absorbed toxins
or by-products of degenerating proglottids,
or due to mucosal irritation D. latum Eggs:

Epidemiology

 The preference for eating raw fish and the

lack of sanitary toilet facilities contribute to
the transmission of the parasite
 Is prevalent in the temperate zones where
the population has a habit of eating raw or
improperly cooked fish.

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 54

Clinical Parasitology
Extraintestinal Cestodes  The uterus is midline, with lateral
evaginations, and is filled with eggs which
Echinococcus spp. resemble those of other taeniid worms
Infective Stage Diagnostic Stage -Eggs-
Embryonated Eggs Hydatid Cyst
Hosts Infected Vector  Are swallowed by intermediate hosts and
Humans Dogs, and NA accidentally to humans
Sheep  In the intermediate hosts, the eggs
Pathogenesis Treatment hatches in duodenum and penetrate in the
Cystic Echinococcosis Albendazole intestinal wall where it scatters throughout
Mebendazole various tissues and organs where they
MOT Diagnosis develop into cysts
Fecal-Oral Enzyme-link
Immunosorbent Assay -Larval Stage-
(ELISA)  Also called as Hybatid Cyst
 Regarded as emerging/re-emerging  The brood capsule may rupture and
zoonotic disease release protoscolices
 6 recognized Echinococcus species but  Numerous protoscolices (parasite larvae)
these four are in public health importance; are found within the cyst that will be
these are E. granulosus (cause cystic completely developed and ingested to
echinococcosis), E. multilocularis (cause definitive hosts
alveolar echnococcsis), E. vogeli & E.
oligarthrus (cause polycystic Pathogenesis and Clinical Manifestations
echinococcosis)
 E. multilocularis, E. vogeli, and E.
 Caused by the developing larval cyst in
oligarthrus are less common because the tissues of the intermediate host
their life cycles are sylvatic.
 Echinococcal infection may be acquired
 E. granulosus- most common human
during childhood, infections involving the
cystic echinococcus liver and the lungs are often diagnosed in
 Accidental Hosts: Humans adults due to the cysts’ slow growing
 Definitive Hosts: Dogs and other nature.
Canidae’s  The most common and most important
 Intermediate Hosts: Sheep, Goats, Swine, site of involvement is the liver
etc.  Cysts are less commonly seen in the
Characteristics of Parasites spleen, kidneys, heart, bone, and central
nervous system
-Adult Worm- Epidemiology
 The scolex is typically taeniid in that it has
four acetabula. It is armed with 30 to 36  Cystic echinococcosis is the most
hooks common presentation of echinococcal
 Possesses a pyriform scolex, a short infection in humans
neck, and three proglottids: one immature,  Cystic echinococcosis is most prevalent in
one mature, and one gravid. countries in the temperate zones, such as
-Gravid Proglottids- southern South America, the
Mediterranean, southern and central parts
 Usually the widest and the longest of Russia, Central Asia, China, Australia,
proglottid. and parts of Africa

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 55

Clinical Parasitology
Prevention and Control Echinococcus Larval Stage:

 Dogs should not be allowed in

slaughterhouses, and refuse from these
facilities should be sterilized or properly
disposed
 Regular testing and quarantine, and
treatment of dogs with praziquantel
 Vaccination of livestocks
Life Cycle

Spirometra spp.
Infective Stage Diagnostic Stage
Plerocercoid Larvae Unembryonated Eggs
Hosts Infected Vector
Humans, Cats, Dogs, NA
& Crustaceans
Pathogenesis Treatment
Sparganosis Praziquantel
Surgical Removal
Pictures of Parasite MOT Diagnosis
Drinking contaminated Recovery of
Echinococcus Gravid Proglottids: water plerocercoid larvae
from infected tissues
 Also known as Spargana
 Zoonotic disease to cats, dogs, and other
carnivores
 There are many species of Spirometra but
these are known to infect humans:
Spirometra mansoni, Spirometra erinacei,
and Spirometra ranarum
 Paratenic Hosts: Pigs
 Accidental Hosts: Humans
Echinococcus Eggs:  Intermediate Hosts: Cyclops, Snakes
Characteristics of Parasite

-Adult Worms-
 Grows from plerocercoid larva in definitive
hosts
 Usually mistaken as adult
Diphyllobothrium latum although much
shorter

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 56

Clinical Parasitology
-Eggs- Pictures of Parasite
 Similar to Diphyllobothrium but smaller
Spirometra Adult Worm:
 Are operculated and immature
 Passed out with the feces of the definitive
hosts and become embryonated in water
Pathogenesis and Clinical Manifestations

 Larvae may found in any part of the body

but are common in eyes, muscular tissues
in thorax, abdomen, thights, inguinal
region, and viscera
 Patients may complain of painful edema Spirometra Eggs:
due to migrating larvae, hence, the
condition is also known as migrating
tumor
Epidemiology

 Cases of sparganosis have been reported

worldwide: in Africa, India, Holland,
Australia, and South America. In Asia, the
majority of cases came from Japan,
Korea, Thailand, Malaysia, and Indonesia Trematodes
Prevention and Control
Schistosoma spp. (Blood Flukes)
Infective Stage Diagnostic Stage
 Boiling of water is a must Cercariae Mature Eggs in feces
 Cooking the paratenic and intermediate (S. mansoni &
hosts thoroughly japonicum) and urine
(S. haematobium)
Life Cycle Hosts Infected Vector
Humans and Snails NA
Pathogenesis Treatment
Schistosomiasis or Praziquantel
Bilharziasis
MOT Diagnosis
Skin Penetration Microscopic
Fecal-Oral Examinations
Rectal or Liver Biopsy
 Parasitic blood flukes that infects birds
and mammals including humans
 Species of schistosoma: S. japonicum, S.
mansoni, S. haematobium, S. mekongi, &
S. intercalatum
 S. japonicum- predominant species in the
Philippines

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 57

Clinical Parasitology
 Intermediate Hosts: Oncolemania  After penetration, the cercariae loses its
hupensis quadrasi (for S. japonicum), tail and transforms into schistosomule
Biomphalaria (for S. mansoni), Bulinus
-Schistosomule-
(for S. haematobium & S. intercalatum), &
Neotricula aperta (for S. mekongi)  Adults has large suckers at the anterior
 Definitive Hosts: Humans, dogs, pigs, end, ventral sucker, and a gonophore
cats, carabaos, cows and other domestic  Are dioecious (species that have distinct
mammals unisexual individuals, each producing
either male or female gametes)
Characteristics of Parasite  Can break out in pulmonary
microvasculature , traverse the lungs,
-Egg-
escape in the pleural cavity, goes to
 Ovoid, round, or pear-shaped and is diaphragm, and penetrates the liver
yellow in color
Pathogenesis and Clinical Manifestations
 It has a thin shell and a residual tissue or
red blood cells
 Has curved hook or spine at the polar  When penetration happens, it always
ends if the egg is properly oriented associates with itch known as swimmers
 If immature eggs are passed in feces, it itch
will not become mature  This manifestation is self-limited and
repeated cercarial exposure causes these
-Miracidium-
acute reactions to wane over time
 Hatches from the eggs and most of them  Katayama fever (Snail Fever) or
can survive overnight Katayama syndrome is caused by the
 Are phototactic (locomotory movement migration of schistosomule, 2-12 weeks
that occurs when a whole organism after penetration
moves towards or away from a stimulus of  S. japonicum doesn’t multiply in its
light), swims actively in the water, and can definitive hosts, that’s why the basis of
be infective to snails for 8-12 hours intensity of the infection is based on the
 Penetrates to the tissues of the snail and number of eggs
once completed, the ciliated surface will  Egg disposition occurs at any organ but
be disappeared mostly, it occurs in liver
 The limiting factor of producing cercariae
from miracidium depends on the size of
Prevention and Control
the snail. The bigger the snail is, the more
it produces cercariae  Vaccines
-Sporocysts-  Proper sanitary disposal
 Environmental Control
 Are able to produce asexually and later
can give rise to cercariae for 60-70 days
-Cercariae-
 Has a body and forked tail
 Has also an oral sucker in the anterior end
of the body and small ventral sucker
 When cercariae swims in the water, it
facilitates the contact and attachment to
the skin of the host

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 58

Clinical Parasitology
Life Cycle Schistosoma Miracidium:

Schistosoma Sporocysts:

Pictures of Parasite

Schistosoma Egg:

Schistosoma Cercariae:

Schistoma Schistosomule:

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 59

Clinical Parasitology
Paragonimus westermani (Oriental -Mature Egg-
Lung Flukes)  Has thick shells
Infective Stage Diagnostic Stage  Oval in shape and yellowish-brown in
Metacercariae Unembryonated Eggs color
Hosts Infected Vector
 A flattened one but has prominent
Humans, Snails, & NA
operculum and opposite side has
Crab
Pathogenesis Treatment thickened abopercular portion
Paragonimiasis Praziquantel -Immature Egg-
MOT Diagnosis
Ingestion of Infected Stool Microscopy  Embryonates in water, soil, and leeched
Food Peripheral Blood feces
Count
Pathogenesis and Clinical Manifestations
 Definitive Hosts: Humans
 Intermediate Hosts: Snail (Antemelania
asperata, A. dactylus), & Crab  Early stages of infection is asymptomatic
(Sundathelphusa philippina) due to the slow migration of the parasite
 Antemelania dactylus is previously known  Provokes a granulomatous reaction that
as Brotia asperata gradually gives rise to the development of
 Sundathelphusa philippina is previously fibrotic cyst
known as Parathelphusa grapsoides  Heavy infections may cause both
pulmonary and ectopic (lung)
Characteristics of Parasite paragonimiasis

-Adult Lung Fluke- Epidemiology

 Reddish-brown in color
 Resembles like a coffee bean where it is  Largely determined by local patterns in
rounded anteriorly and slightly tapered consumption of inadequately cooked
posteriorly crustaceans and paratenic hosts
 The two testes are deeply lobed and  In Philippines, it is endemic in Mindoro,
situated opposite to each other Camarines, Sorsogon, Leyte, Samar,
 Ovary is located anterior to the testes Zamboanga del Norte, Davao Oriental,
Basilan, and Cotabato
-Cercariae-
Prevention and Control
 Is covered with spines, has an ellipsoidal
body, and small tail
 A stylet is present at the dorsal side of the  Safe food preparation
oral sucker  Avoid ingestion of raw or undercooked
crabs and other crustaceans, as well as
-Metacercariae-
the paratenic hosts also like pigs
 Round in shape
-Miracidium-
 It pushes itself in the operculum part of
the egg, swims freely in water and finds a
snail to infect
 Develops within 2-7 weeks

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 60

Clinical Parasitology
Life Cycle P. westermani Eggs:

Fasciolopsis buski (Intestinal Fluke)

Infective Stage Diagnostic Stage
Pictures of Parasite Metacercariae Unembryonated Eggs
Hosts Infected Vector
P. westermani Adult Lung Fluke: Humans, Snails, & NA
Pigs
Pathogenesis Treatment
Fasciolopsiasis Praziquantel
MOT Diagnosis
Ingestion of Encysted Stool Microscopy
Metacercariae
 Largest intestinal flukes on humans and
pigs
 Definitive Hosts: Humans and Pigs
 Intermediate Hosts: Snail (Segmentina,
P. westermani Cercariae:
Hippeutis) & Aquatic Plants (Trapa
bicornis, Lopmea obscura, Elocharis
tuberosa, Nymphaea lotus)
Characteristics of Parasite

-Adult Worm-
 Is elongated, oval in shape
 Doesn’t have a cephalic cone compared
P. westermani Metacercariae: to F. gigantica and F. hepatica
 Testes are dendritic, and are arranged in
tandem in the posterior half of the body
 Ovary lies at the right of the midline
-Metacercariae-
 Excysts in duodenum and attaches to the
intestinal wall
-Miracidium-
 Seeks out and infects the 1st intermediate
hosts which is the snail

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 61

Clinical Parasitology
 Inside the snail, it transforms into Pictures of Parasite
sporocysts, then further develops
producing the mother & daughter rediae, F. buski Adult Worm:
and cercariae
-Eggs-
 Is large and operculated
 Indistinguishable from F. hepatica & F.
gigantica
 Embryonates in water which gives rise to
miracidium in 3-7 weeks
Pathogenesis and Clinical Manifestations F. buski Eggs:

 Inflammation and ulcerations occur at the

attachment site of the worm, producing an
increase mucus secretion and minimal
bleeding
 In heavy infections, it may cause intestinal
obstruction
Epidemiology

 Fasciolopsiasis is endemic in Southeast

Asia, China, Korea, and India
 Not yet demonstrated endemicity in the
Philippines Echinostomatidae
Prevention and Control Infective Stage Diagnostic Stage
Metacercariae Unembryonated Eggs
Hosts Infected Vector
 Soaking of aquatic plants to water is Humans, Snails, & NA
avoided since metacercariae is sensitive Pigs
in dryness Pathogenesis Treatment
 Time between harvest and consumption Echinostomiasis Praziquantel
should be prolonged MOT Diagnosis
Ingestion of Detection of eggs in
Life Cycle Metacercariae from stools
snails
 Characterized by a collar of spines around
their oral suckers
 2 species have been documented in the
Philippines (Echinostoma ilocanum &
Artyfechinostomum malayanum)
 Definitive Hosts: humans, dogs, cats, rats,
and pigs
 Intermediate Hosts: Snails

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 62

Clinical Parasitology
Pathogenesis and Clinical Manifestations

 In heavy infection, inflammation develops

at the site of attachment of the adult worm
to the intestinal worm
Epidemiology
Characteristics of Parasite
 Have been recorded in Southeast Asian
-Adult Worm- and East Asian Countries
 Lives in the small intestine of definitive  Endemic in Philippines: Northern Luzon,
hosts Leyte, Samar, and some provinces in
 For ilocanum: reddish-gray in color, Mindanao
tapered at posterior end and has 49-51 Prevention and Control
collar spines, oral suckers lies in the
center of circumoral disks, ventral sucker
is situated at the anterior fifth of the body,  Avoid ingesting of raw or improperly
the testes are deeply bilobed, ovary is cooked second intermediate hosts
located anterior to testes, and uterine coils
Life Cycle
are found between the ovary and ventral
sucker
 For malayanum, rounded posterior end
with 43-45 collar spines, testes are large
with 6-9 lobes, ovary is small or rounded
or oval located anterior to the testes.
-Eggs-
 Matures in water and after 6-15 days,
miracidium hatches and infects the first
intermediate hosts
 For ilocanum, straw-colored, operculated,
and ovoid in shape Pictures of Parasite
 For malayanum, larger in size, golden-
brown in color, and operculated Echinostomatidae Adult Worm:
-Miracidium-
 For ilocanum, develops immediately into
mother rediae and thus producing the
daughter rediae and cercariae
 For malayanum, develops first into
sporocysts, then produces the mother
rediae, daughter rediae, and cercariae

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 63

Clinical Parasitology
E. ilocanum Egg:  Ovary is globular or slightly lobed located
in the submedian, pre or post-testicular
area
-Metacercariae-
 When reaches in duodenum, it excysts,
and young larvae attaches to intestinal
wall
 Develops into a sexually mature adult and
has a short life span which is 1 year
E. malayanum Egg:
-Miracidium-
 Hatches from the eggs and infects the first
intermediate hosts
 When inside, it develops into sporocysts
and develops 2 generations of rediae
-Eggs-
 Light brown in color, ovoid in shape, and
Heterophyid Flukes operculated
Infective Stage Diagnostic Stage  Doesn’t have abopercular protruberance
Metacercariae Embryonated Eggs which is contrast to Clonorchis and
Hosts Infected Vector Opisthorchis eggs
Humans, Snails, & NA
Fish Pathogenesis and Clinical Manifestations
Pathogenesis Treatment
Heterophyiasis or Praziquantel  There is usually inflammation when the
Heterophyidiasis
worm is attached or burrowed to the
MOT Diagnosis
intestinal wall
Ingestion of Kato-thick Method
Metacercariae from Formalin Ethyl/Ether  Most common clinical manifestation
snails Concentration observed were Peptic Ulcer Disease
Technique (FECT) (PUD) and Acid Peptic Disease (APD)
 Lives in the intestines of fish-eating hosts Epidemiology
 Major species: Heterophyes heterophyes,
Metagonimus yokogawai, Haplorchis
taichui, and Haplorchis yokogawai  Children and Elderly are not infected
 Intermediate Hosts: Snails (Melania  In the Philippines, before, it has low
juncea, Thiara riquetti), & Fish (freshwater prevalence of infection not until in 1980s,
or brackish water) it began to spread.
 Has been recorded in Egypt, Greece,
Characteristics of Parasite Israel, Western India, Central and South
China, Japan, Korea, Taiwan and
-Adult Worm- Philippines
 Is elongated, oval or pyriform
 Testes are variously arranged located at
the posterior end of the body

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 64

Clinical Parasitology
Prevention and Control Fasciola spp. (Liver Flukes)
Infective Stage Diagnostic Stage
Metacercariae Unembryonated Eggs
 Avoid ingesting raw or improperly cooked
Hosts Infected Vector
fish
Humans, Snails, & NA
 Surveillance of raw fish or kinilaw should Cattles or Sheeps
be considered Pathogenesis Treatment
Life Cycle Fascioliasis Triclabendazole
MOT Diagnosis
Ingestion of Stool Microscopy
Metacercariae
encysted in aquatic
plants or drinking
contaminated water
 These parasites are found in liver and
biliary passages

Pictures of Parasite

H. flukes Adult Worm:

Characteristics of Parasite

-Adult Worm-
F. hepatica
 Has a large, broad, and flat body
 Distinguishing feature is the cephalic cone
which has a marked widening at the base
of the cone
 Suckers are small and are located close
H. flukes Eggs: to each other
 Testes are highly branched that occupies
the second and third quarters of the body
 Ovary is dendritic and situated in front of
the anterior exists
 Uterus is coiled and relatively short
F. gigantica
 Compared to hepatica, F. gigantica is
much longer
 Has the same distinguishing feature to
hepatica but its less develop shoulders
and shorter cephalic cone
 Distance between the posterior testes and
border of body is longer

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 65

Clinical Parasitology
-Eggs- Life Cycle
F. hepatica
 Is large, size, operculated and yellowish to
brownish in color
F. gigantica
 The same features with hepatica but
differs only in size which is slightly larger
Pathogenesis and Clinical Manifestations

-Acute or Invasive Stage-

 Happens when parasite migrates from
intestine to the liver and it burrows in liver Pictures of Parasite
parenchyma
 Which coincides with larval migration and Fasciola Adult Worm:
worm maturation in hepatic tissue
 Severity of injury depends on the number
metacercariae ingested by hosts
-Chronic Stage-
 Is asymptomatic
 The walls of bile may be eroded due to
the parasites re-enter in the liver
parenchyma
Epidemiology

 Has a worldwide distribution especially to Fasciola Eggs:

livestock-raising countries
 In the Philippines, dominant species
affected are cattle and water buffalos is F.
gigantica
Prevention and Control

 Through washing or cooking of vegetables

and boiling of water
 Elimination of snail intermediate hosts

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 66

Clinical Parasitology
Clonorchis sinensis & Opisthorchis Pathogenesis and Clinical Manifestations
spp. (Liver Flukes)
Infective Stage Diagnostic Stage -Clonorchiasis-
Metacercariae Embryonated Eggs
 Metacercariae reaching the biliary system
Hosts Infected Vector
mature and provoke pathological changes
Humans, Snails, & NA
as a result of trauma and irritation
Fish
Pathogenesis Treatment  Light infections are asymptomatic
Clonorchiasis & Praziquantel  Moderate infections may cause fever,
Opisthorchiasis Albendazole diarrhea, loss of appetite, rash, edema,
MOT Diagnosis and enlargement of liver
Ingestion of Cholangiography  High Infections may present acute pain in
metacercariae in ELISA the right upper quadrant
infected raw or PCR  Chronic infections may cause liver
undercooked fish Detection of eggs in malfunction
stools
 Small digenetic trematodes and are -Opisthorchiasis-
parasites of bile duct and gallbladder  Are often asymptomatic especially in light
 Intermediate Hosts: Snails & Fish intensity
 Opisthorchis spp. are O. felineus and O.  Severe infections are rare and it may
viverrini cause obstructive jaundice
 Cholangiocarcinoma is the most serious
complication of infection of
Oposthorchiasis
Epidemiology
Characteristics of Parasite
 Transmission of this pathogenesis is by
-Adult Worm-
consumption of raw, undercooked, salted,
C. sinensis Opisthorchis
dried, or prickled freshwater fish
C. sinensis is longer than Opisthorchis
Similarities of the two: location of vitellaria Prevention and Control
which are found in the middle third of the body
Testes: two large, Testes: are arranged
highly branched testes obliquely that is more  Proper human waste disposal
arranged in tandem in deeply lobulated and  Health education about cooked fish
the posterior half of positioned close to consumption
the body each other
Life Cycle
-Eggs-
 Yellowish-brown in color, and ovoid in
shape
 Has distinctively convex operculum and a
small protuberance at the abopercular
ends
 Difficult to differentiate with other liver
flukes species

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 67

Clinical Parasitology
Pictures of Parasite Neglected and Uncommon Tropical
Parasitic Diseases
C. sinensis Adult Worm:
Onchocerca volvulus
Infective Stage Diagnostic Stage
L3 larvae Microfilariae
Hosts Infected Vector
Humans and Fly Blackfly (Simulium)
Opisthorchis Adult Worm: Pathogenesis Treatment
Onchocerciasis or Ivermectin
River Blindness Doxycycline
MOT Diagnosis
Bite of the Vector Biopsy of skin nodules
Microfilariae in skin
snips

Characteristics of Parasite

 Sexes of the adult worms are separate

C. sinensis Egg:
 Microfilariae: unsheathed and the tail
tapers to a point and often sharply bent
 Nuclei do not extend to the tail tip
Pathogenesis and Clinical Manifestations

 Eyes and skin disease ris caused by

movement of the microfilariae around the
human body in the subcutaneous tissue
and can induce intense inflammatroy
reaction when they die
 Blindness is the most serious complication
Prevention and Control
Opisthorchis Egg:

 Vector control through spraying of

insecticides
Life Cycle

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 68

Clinical Parasitology
Pictures of Parasite  Calabar swelling or episodic angioedema
and subconjunctival migration of adult
worm can occur
Epidemiology

 Found mostly in Africa

Prevention and Control

 Avoid travels to areas with deerflies

 Using repellants with DEET
 Wear long sleeves and pants
Life Cycle

Loa Loa (African Eye Worm)

Infective Stage Diagnostic Stage
L3 larvae Microfilariae
Hosts Infected Vector
Humans and Fly Deerfly (mango fly
[Chrysops silacea],
mangrove fly
[Chrysops dimidata])
Pathogenesis Treatment
Loiasis Surgical Removal
Diethylcarbamazine
Albendazole
MOT Diagnosis
Bite of the Vector Microfilariae in Pictures of Parasite
peripheral blood
smears
ELISA
Luciferase
Immunoprecipitation
Systems (LIPS)

Characteristics of Parasite

 Sexes of adult worms are separate

 Microfilariae: sheathed with nuclei up to
the tail tip
 Exhibits diurnal periodicity
Pathogenesis and Clinical Manifestations

 Infection is usually asymptomatic

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 69

Clinical Parasitology
Dracunculus medinensis (Guinea Life Cycle
Worm)
Infective Stage Diagnostic Stage
L3 larvae L1 larvae
Hosts Infected Vector
Humans and Fish NA
Pathogenesis Treatment
Guinea Worm General wound care
Disease for bacterial infection
MOT Diagnosis
Ingestion of Clinical presentation
Contaminated water only
or Raw and No serologic tests
Undercooked aquatic available Pictures of Parasite
food sources
 Neglected tropical disease that affects
rural and isolated communities where
there is no access to clean and safe
drinking water
 MOT has seasonal pattern: In dry
seasons, people are generally get infected
in wet seasons. In wet seasons, people
are generally infected in dry seasons.
Pathogenesis and Clinical Manifestations
Mansonella spp.
 Has long incubation period (1 year) Infective Stage Diagnostic Stage
 Blisters develop anywhere on the skin but L3 larvae Microfilariae
mostly in lower extremnities (80-90% of Hosts Infected Vector
the cases) Humans, Fly, and To be mentioned
Insects
 Blisters will rupture, exposing the worm to
Pathogenesis Treatment
the water
Mansonellosis To be mentioned
 Common symptoms are mild fever, MOT Diagnosis
nausea, vomiting, dizziness, and itchy Bite of the Vector Microscopy
rash Serology
 Complications may include secondary Molecular detection-
bacterial infection to differentiate M.
streptocerca from O.
Prevention and Control volvulus

 Proper access to safe and clean drinking

water
 Infected patient is not allowed to enter
drinking water sources to avoid
contamination

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 70

Clinical Parasitology
Characteristics of Parasite Treatment

 M. perstans: blunt tail and nuclei extend to

tail tip. Microfilariae circulate in blood
 M. ozzardi: tail tapers to a point and nuclei
end before end of the tail. Tail is bent in
hook-like shape. Found in blood but rare Life Cycle
in skin
 M. streptocerca: tail is bent into hook-like
shape and nuclei extend to the end of the
tail. Microfilariae found in skin but do not
circulate in the blood

Pathogenesis and Clinical Manifestations

 Asymptomatic to mild presentation in

endemic regions
 Overlaps with other filarial diseases
 M. perstans: asymptomatic but may
present with symptoms due to worm
migration (subcutaneous swelling) and
even impaired visual acuity when
microfilaria enters the eye
 M. ozzardi: asymptomatic to non-specific
symptoms, eosinphilia is common
 M. streptocerca: less known clinical
presentation but may present with similar
symptoms to other members, except no
subcutaneous nodules
Diagnosis

-Microscopy-
 M. perstans and M. ozzardi- microfilaria in
blood sample
 M. streptocerca- skin nips
Epidemiology

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 71

Clinical Parasitology
Pictures of Parasite Different Diagnosis of Parasites

M. perstans: Formalin Ethyl/Ether Concentration

Technique

M. ozzardi:

Kato-katz Technique

M. streptocerca:

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 72

Clinical Parasitology
Different Staining Procedures in Fecal
Smears

Trichrome Stain

Iron Hematoxylin Stain

Acid-Fast Stain

Transcribed by: NIKOH ANTHONY C. EWAYAN, fRMT, fMD 73