Microbiology Lecture Notes

Medical Assistant Course

General Bacteriology
Gram negative cocci

Gram negative bacilli (rods)

Gram positive bacteria
 Anthrax

• Infectious agent:Bacillus anthracis, gram positive

, encapsulated spore - forming aerobic bacilli
• reservior: Herbivorous animals
• Mode of tranamission: Contact with tissue of
animal (Cutaneous), inhalation of spores
(pulmonary) and ingestion of contaminated meat
(Gastrointestinal)
• Incubation period: A few hours to 7 days
 Anthrax

• Period of communicability: Man to man transmision ;rare

.Spore contaminated artical & soil ; infective for decade
• Diagnosis: Clinical and bacteriological confrimation
• Prevention: Cell free vaccine to high risk personel .Dispose
animal faeces by burning or by deep burial in lime pit .
Decontaminate animal products; gas sterilized commercial
wool ,hair & hides in endemic area, wear proective clothing
or gloves when handling potentially infected material . Active
immunization of domestic animals.
• Treatment:Antibiotic
 Tetanus
•
• Infection agent: Clostridium tetani , gram positive spore
-bearing anaerobic bacilli
• Reservior: Instestine of horse & other animals, including
humans (a harmless normal inhibitant)
• mode of transmission: Tetanus spores introduced into the
body usually through a puncture wound contaminated with
soil , street dust or animal or human feces ;through
lacerations , burns.
• Incubation period: Usually 3-21 days ( 1day to several month
)
 Tetanus
• Diagnosis: Clinical and bacteriological confirmation .
It is characterized by painful muscular contractions
(masseter “ risus sardonicus ’’and neck muscles
“lock jaw’’, trunk muscles opisthotonus ). Abdominal
rigidity is a common first sign suggestive of tetanus
in older children & adults.
• Prevention: UCI with tetanus toxoid (DPT , DT , TT )
• Treatment:Surgical wound debridement ,
Antibiotics,Tetanus immune globulin
Tetanus
 Leptospirosis

• Infection agent: Leptospira interrogans; tightly

coiled , thin flexible spirochetes , one end is
often bent forming a hook.
• Reservoir & Source: Animal (Rodents). Patients
after first week of illness
• Mode of transmission: Inoculative method
;penetration of mucous membrane or breaks in
skin.
• Incubation period: 1-2 weeks
 Leptospirosis

• Diagnosis: Clinical (fever,intense headache,

jaundice ,haemorrhage ,nephritis ) and
bacteriobiological comfrimation (Dark ground
microscopic examinition of blood and urine, serology
)
• Prevention: Avoid exposure to potentially
contaminated water, Control rodents. Give
chemoprophylaxis during heavy exposure . Vaccinate
farm & pet animals.
• Treatment:Antibiotics
 Cholera

• Infectious agent:Vibrio cholerae ; gram negative

coma shape bacilli with a single polar flagellum .
They are actively motile, falcultative anaerobes..
• Reservoir: Humans . Vibrios survive in water for
up to 3 weeks
• Mode of transmission: Person to person
contact, by water ,food ,and flies.
• Incubation period: 1-3 days
 Cholera

• Period of communicability: variable (usually 2

weeks or less)
• Diagnosis: Clinical (abrupt onset of watery
diarrhoea due to enterotoxin which causes
hypersecretion of fluid & eletrolyte in small
intestine ) and bacteriological confrimation
• Prevetion: Health education ; Active
immunization with cholera vaccine .
• Treatment:Prompt fluid & eletrolytes replacement
Cholera
 Enteric fever
• Infectious agent: Salmonella typhi,
Salmonella paratyphi A,B,C: gram negative
bacilli,motile by peritrichous flagella.
• Reservior: Humans ; patients & carriers
• Mode of tranamission:Vehicle -borne indirect
contact with articles soiled with dischages
from lesions of infected people
• Incubation period : 10-14 days
 Enteric fever

• Diagnosis: Clinical (An acute severs illness, containous

fever,step-ladder pattern ,bradycardia , headache,
apathy , prostration , splenomegaly ,maculopapular
rash (rose-sport) ,leucopenia ,constipation followed
by “ peasoup’’ diarrhoea ,abdominal
distention),bacteriological (1week blood culture,2,3
week stool & urine culture) and serological(Widal
test)confirmation.
• Prevention: Health education , TAB vaccination
• Treatment:Appropriate antibiotics
 Whopping cough

• Infectious agent: Bordetella pertussis , small gram

negative bacilli with capsule.
• Mode of transmission: Via reapiratory droplets.
• Incubation period: 1-2 weeks
• Diagnosis: Clinical (disintegration of organisms libreate
toxin that irritate respiratory epithelial cells , catarrhal ,
paroxysmal , convalescent stages)and bacteriological
confrimation
• Prevention: DPT , DT vaccination
• Treatment:Antibiotics and Hyperimmune globulin
 Plague

• Infectious agent: Yersinia pestis: a gram negative bacilli, bipolar

staining (safety pin appear ance) .
• Reservoir: Wild rodents
• Mode of transmission: Zoonosis . By rat flea Xenopsylla cheopis )
bite or contact
• Incubation period: 2-7 days
• Diagnosis: Clinical (high fever , painful lymphadenopathy; bubonic
plague , cough ,blood-stained sputum ; pneumonic plague ,
haemorrhage;septicamic plague)and bacteriological confirmation.
• Prevention: Anti-rodent , anti- flea measures, vaccination
• Treatment:Antibiotics
 Tuberculosis

• Infectious agent: Mycobacterium tuberculosis ,

Mycobacterium bovis & other atypical mycobacteria ;
acid fast bacilli.
• Mode of transmission: Via droplets produced by
coughing . Raw milk has served as a vehicle .
• Diagnosis: Clinical (pulumonary tuberculosis ; cough
more than 3week , fever , weight loss, night sweat,
Haemoptysis, Regional lymphadenopathy,
extrapulumonary tuberculosis (brain, bone, kidneys,
intestinal TB), miliary tuberculosis.
 Tuberculosis

• Bacteriological confirmation - sputum smear microscopy

with Ziehl Neelsen stain- Sputum collected 3 consecutive
days (morning / spot sputum), CXR and Tuberculin test are
available. Lowenstein Jensen (LJ) media for TB culture.
• Prevention: BCG vaccination , socio -economic
development , health education about to control Air-
borne transmission of TB (avoid overcrowded area, use
towels outside when sneezing & coughing, protect family
members, timely recognition and effective treatment)
• Treatment:DOTS (anti-TB drugs).
Tuberculosis
 Leprosy

• Infectious agent:Mycobacterium leprae; acid fast bacilli arranged

in cigar bundles shapes.
• Reservior: Humans
• Mode of transmission: Contact with patients. Bacilli remain
viable for at least 7 days in dried nasal secretion .
• Incubation period: 9 month to 20 years
• Diagnosis:Clinical (affect cooler parts of the body ; skin, peripheral
nerve ,Types; lepromatous (nodular skin lesions) , Tuberculoid
( macular skin lesions with severe asymmetric nerve involvement),
Borderline (Indeterminate )and bacteriological confirmation
• Treatment:Rifampicin , depsone , clofazimine .
General Virology
 What are Viruses?

• Virus particle called virion

• Comprised of two parts:
1. Nucleic Acid
2. Protein coat (capsid)
• Nucleocapsid- capsid with nucleic acid inside
• Each capsid made of identical protein
subunits called capsomeres
 What are Viruses?

• A virus is a non-cellular particle made up of

genetic material and protein that can invade
living cells.
Virus Shapes
 Viewing Viruses
•Viruses are smaller than the smallest cell
•Measured in nanometers
•Viruses could only be seen when the electron
microscope was invented in the 20th century
 Virus size
• Approximately 100 to 1000 fold smaller than
the cells they infect
• Size generally from 10 nm to 500 nm
• The smallest viruses contain very little nucleic
acid, perhaps as little as 10 genes
Size of Viruses
 Characteristics
• Some viruses are enclosed in an protective
envelope
• Some viruses may have spikes to help attach to
the host cell
• Most viruses infect only SPECIFIC host cells
 Characteristics
•Outside of host cells, viruses are inactive
•Lack ribosomes and enzymes needed for
metabolism
•Use the raw materials and enzymes of the host
cell to be able to reproduce

Ebola Virus HIV Virus

 Viral Genome
• Structure of viral genome is unusual
• Contain only single type of nucleic acid- DNA
or RNA
• DNA may be linear or circular, either double-
stranded or single-stranded
• RNA is usually single-stranded
 Used for Virus Identification
• RNA or DNA Virus
• Do or do NOT have an envelope
• Capsid shape
• HOST they infect
 5 Steps of Lytic Cycle
• Attachment to the cell
• 2. Penetration (injection) of viral DNA or RNA
• 3. Replication (Biosynthesis) of new viral
proteins and nucleic acids
• 4. Assembly (Maturation) of the new viruses
• 5. Release of the new viruses into the
environment (cell lyses)
 Viral Latency
•Some viruses have the ability to become
dormant inside the cell
•Called latent viruses
•They may remain inactive for long periods of
time (years)
•Later, they activate to produce new viruses in
response to some external signal
•HIV and Herpes viruses are examples
 Latency in Eukaryotes
•Some eukaryotic viruses remain dormant for
many years in the nervous system tissues
• Chickenpox (caused by the virus Varicella
zoster) is a childhood infection
•It can reappear later in life as shingles, a painful
itching rash limited to small areas of the body
 Retroviruses
•Contain RNA, not DNA
•Family Retroviridae
•Contain enzyme called Reverse Transcriptase
•When a retrovirus infects a cell, it injects its
RNA and reverse transcriptase enzyme into the
cytoplasm of that cell
 Persistent Viral Infections
• Occurs gradually over a long period
• Example: Measles
• Several years after contracting measles can
get Subacute sclerosing panenchaphalitis
 Viral-Induced Tumors
• Tumor- results from abnormal growth of cells
• Tumor-causing viruses- Oncogenic Viruses
• Benign tumor
• Malignant tumor
 Viral-Induced Tumors
• Proto-oncogenes- normally occurring genes
• They can be converted to oncogenes by:
• radiation
• chemical carcinogens
• DNA damage
• Viruses
 Viral-Induced Tumors
• Benign
• Malignant  cancer, metastasizes
• Proto-oncogenes and oncogenes are regulatory genes
• Properties of normal and transformed cells
• Only about 15% of human tumors are due to viruses
• Examples of human tumors:
– Kaposi’s sarcoma (herpes virus)
– Squamous cell carcinomas (HPV)
– Hepatocellular carcinoma (HCVHBV and )
Kaposi’s Sarcoma

Purplish lesions of a skin cancer not usually

seen in young men
 Respiratory viruses
• Influenza A, B
• Respiratory syncytial virus
• Parainfluenza viruses
• Adenovirus
• Rhinovirus: Common cold, many serotypes, no
systemic problems, a nuisance only.
 Influenza Pathology
The hemagglutinin of
the virus attaches to The neuraminidase
the sialic acid The virus emerges removes the sialic

A. covering the surface

of the human cell B. The virus penetrates
the cellular wall C. Replication D. from the cell covered
in sialic acid E. acid and the virus is
freed from the cell

Hemagglutinin Viral RNA Nucleus

Neuraminidase

Sialic acid

10. Laver WG. Bischofberger N, Webster RG. Disarming flu viruses, Sci Am 1999; January.
Available at http://www.sciam.com/1999/0199issue/0199/laver.html. Accessed May 6, 1999.
12. Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases. 4th edition.
New York, NY:Churchill Livingstone;1995:1552-1554,1556
20. Piedra PA. Influenza virus pneumonia: Pathogenesis, treatment, and prevention. Semin Respir Infect 1995;10:216-223
 Epidemiology of influenza

• Two important proteins present on the surface of the virus:

– hemagglutinin: Sticks the virus to cell receptors
– neuraminidase: Frees the virus to infect other cells
• These proteins serve as the basis for the naming of
influenza viruses
– eg. Influenza A Beijing H1N1 or Panama H3N2
– And of course the dreaded avian flu

–H5N1!!!!!
 Influenza A: Pandemics
There were three important pandemics in the last century!

Year Influenza A subtype Comment

1918 H1N1 Spanish flu

1957 H2N2 Asian flu

1968 H3N2 Hong Kong flu

These we believe This one we think

occurred when Flu A spread directly from
mixed in pigs birds and then evolved
like H5N1 threatens
 Influenza-host interaction

inhalation

attachment to upper respiratory mucosa

primary replication

secondary spread and cytokines

muscles lungs heart other organs

 Influenza: Complications
• Lower respiratory tract (direct viral effect)
– Croup, bronchiolitis (kids)
– Primary influenza pneumonia
• Secondary bacterial infection
– Pneumonia
– Otitis media
• Other complications
– Heart failure
 Who gets the complications?
(and who benefits most from vaccine?

• Elderly, especially in residential care units

• Patients with:
– chronic respiratory disease eg asthma, cystic
fibrosis
– chronic heart disease
– immunosuppression due to treatment or disease
– haematological disorders
– chronic renal failure
– chronic metabolic disease e.g. diabetes mellitus
Diagnosis of respiratory viral infections

• Clinical syndrome
• Time of year
• What’s in the community?
• Virus isolation
• Virus antigen detection (not rhinovirus)
• Molecular methods eg. PCR
• Serology (not rhinovirus)
Immunology Lecture Course
 Immunology

– Study of physiological defenses by which the host

destroys or neutralizes foreign matter
• Both dead and living foreign matter

• 2)Modern concept---- Immunity is a function

of which an individual recognizes and excludes
antigenic foreign substances.
 Functions of Immune System

 Immune defense

 Immune homeostasis

 Immune surveillance
 Functions and Manifestation of Immunity

Functions Normal Manifestation Abnormal Manifestation

Immune Anti-infection Hypersensitivity

Defense Immunodeficiency

Immune Eliminate injured and senile cells immune dismodulation

Homeostasis Tolerate to self components Autoimmune disease

Immune destroy transformed cells Tumor or

Surveillance (anti-tumor ) Persistent virus infection
Prevent from persistent infection
 Major Histocompatibility Complex – MHC

• The human MHC is the Human Leukocyte Antigen

system – HLA

The histocompatability antigens are coded for a group

of genes called MHC located on chromosome 6.

• MHC of genes produces 2 classes of MHC molecules:

– Class-1
– Class-2
 The inflammatory response mobilizes
nonspecific defense forces
• Tissue damage triggers the inflammatory response
• The inflammatory response can
– disinfect tissues
– limit further infection
The initial immune response
results in a type of “memory”
Activation of Helper T cells
Activation of Cytotoxic T cell
(Cellular immune response)
Activation of B cell
 Induction of Immune Responses

Activation and proliferation of TH cells. (a) is required for generation of

humoral response (b) and cell-mediated response to altered self-cells (c).
 Importance of Humoral Response

• Soluble antibodies
– The simplest ammunition of the immune
response
– Interact in extracellular environments such as
body secretions, tissue fluid, blood, and lymph
 Importance of Cellular Response

• T cells are best suited for cell-to-cell

interactions, and target:
– Cells infected with viruses, bacteria, or
intracellular parasites
– Abnormal or cancerous cells
– Cells of infused or transplanted foreign tissue
 Antibodies

Antibody composed of two heavy chains and two light chains. These
chains bind together to make a Y shaped molecule.
 IgM
• IgM expressed as membrane bound
anitbodies on B-cells
• Pentamer
– 5 units held together by disulfide
bonds
– J (Joining) chain functions in the
polymerization of monomers
• First immunoglobulin class produced in a
primary response to an antigen
• Has 10 anitgen binding sites
• More effective at stimulating complement
• Large-size - does not diffuse well
• The FC receptors on phagocytes bind IgM
(opsinization)
 IgD
• Found on surface of
mature B-cells.

• Biological function
unknown (thought
to function in
activation of B-cells)
 IgG
• Most abundant isotype in
serum (80%)
• Cross placenta and play
important role in
protecting fetus
– Provides passive immunity
to unborn fetus.
– Placental cells bind the Fc
portion of IgG and transfer
Ab across the placental
membrane.
• Activate complement
system
• Opsonin—phagocytosis
 IgE
• Mediate the immediate
hypersensitivity reactions
(hayfever, asthma, hives,
anaphylactic shock)
– Mast cells and basophils bind fc
portion of IgE
– Cross-linkage of receptor
bound IgE molecules by
antigen, induces degranulaltion
of the Mast and basophil cells
• Parasitic response
– Eosinophils express receptors
for IgE
 IgA
• Most abundant Ab in the body
• Found Predominantly in external secretions
i.e. Breast Milk, Saliva, tears, mucus.
• Serum form is a monomer
• Secretory form is a dimer or tetramer linked
together via a “secretory component” and a
J chain.
– J (Joining) chain functions in the
polymerization of monomers.
• Plasma cells that release IgA Abs are
concentrated along the Mucus Membrane
surface.
• Provides passive immunity to infants
through mothers breast milk
Antigen-Antibody Reaction
• If molecule of antigen and its specific antibody are
brought together in solution  linkage is formed
between Fab portion of Ab molecule and antigenic
determinants of Ag molecule.

• This interaction base on humoral response of

immune system to antigenic stimulation.
Application of Ag-Ab reactions
1. Diagnosis of infectious diseases
2. Diagnosis of autoimmune diseases
3. Typing of blood and tissue prior to
transplantation
Different kinds of Ag-Ab reactions
1. Agglutination
2. Precipitation
3. Complement fixation
4. Hemagglutination
5. Toxin-antitoxin neutralization (Neutralization of
virus)
6. Immunofluorescent
7. Immunoimbolization
8. Immunoblotting
9. RIA
10. ELISA
11. Capsule swelling
Agglutination Reactions
Agglutination Reactions
• Involve particulate
antigens and
antibodies

• Particulate Antigens
 part of surface of
some materials (RBC/
bacteria)

• If Ab is added to
suspension  bind of
Ab with surface of
Ag  visiable
agglutinate
Figure 18.4
Application of Agglutination Reaction
1. Widal test  diagnosis of enteric fever
2. Weil-Felix test  diagnosis of rickettsial
infection
3. Paul-Bunnel test  diagnosis of infectious
mononucleosis
4. Milk ring test  detection of brucella aggutinin
5. Whey test  detection of brucella aggutinin
6. ABO blood grouping
Precipitation Reactions
Precipitation
Reactions

• Involve soluble
antigens with
antibodies

• Antibodies cross
link with antigens in
the presence of
electrolytes 
formation of
precipitates
Figure 18.3
Application of Precipitation Reaction
1. Detection and identification of unknown Ag in
microbial infection (eg; Lancefield’s grouping of
Streptoccus, Elek’s test  toxigenicity test of
Corynebacterium diphtheriae)
2. Detection and identification of unknown Ab in
microbial infection (eg; VDRL test  syphilis)
Hemagglutination
Hemagglutination
• Hemagglutination involves agglutination of RBCs.
• Viral hemagglutination inhibition tests  ability of
antibodies' to prevent viruses from agglutinating
RBCs.

Figure 18.7
 Immunofluorescnce
(Fluorescent Antibody Techniques)
• Fluorescent dyes can be covalently attached to Ab
molecules  identify Ag by using UV light in
Fluorescent microscope

Application
Direct
• Bacterial infection  diagnosis of plague,
gonorrhoea, cholera
• Viral infection  diagnosis of rabies, influenza

Indirect
•  diagnosis of syphilis
Fluorescent Antibody Techniques
( Direct )
Fluorescent Antibody Techniques (Direct)

Figure 18.10a
Fluorescent Antibody Techniques (Indirect)

Figure 18.10b
Immuno Immobization
• Certain motile micro-organisms lose their motility
when exposed to specific antiserum
• Immobilization by homologous antiserum is
observed under dark ground microscope

Application
1. Vibro immobilization test in cholera
2. Treponema pallidum immobilization test in syphilis
Enzyme-Linked Immunosorbent Assay
(ELISA)
• Use for quantitation of either Ag or Ab in patient
serum

Principle
• Linking of enzyme to known Ag or Ab  reacting
enzyme-linked material with patient’s serum 
assay the enzyme activity by adding the substrate
 estimating the color reaction
• Amount of Ab is proportionate to enzyme activity

Application
• Hormones, drug quantitation
• Detection of Ag/Ab (HBsAg, Rabies Ag, Ab to HIV,
HBV, HCV, Rubella)
Figure 18.12a
Immunoblotting
• Protein antigen is migrate in electrical gel at a rate
according to their molecular weights  these proteins are
transferred from gel onto filter paper (nitrocellulose
membrane) and then patient’s serum is added

• If Ab is present  they bind to specific Antigenic protein

 which can be detected by radioactive/ enzyme labeled Ab
 visible band on membrane
Types
• Southern blot  DNA
• Northern blot  RNA
• Western blot  Protein
IMMUNIZATION IN MYANMAR
Types of vaccines

1.Live vaccine – BCG, Polio,

Measle, Mumps, Rubella(MMR)
Yellow fever, Typhoid, chicken pox,
cholea

2. Killed vaccine - others

Polio, Typhoid – 2 types – both live & killed

• Vaccine

• Antigen

• Antibody Microbial
Contraindication to vaccination

All vaccines
(1) fever
(2) allergic to vaccine

Live vaccine
(1) immunosuppressed
(2) immunosuppressive treatment
BCG

 Live vaccine
 Intradermally deltoid muscle
 Any time from birth since mother’s immunity is
not transferred to fetus
 Side effect – inflammation, ulcer
Polio vaccine

(1)Live vaccine – oral

Side effect – transient diarrhoea, paralytic
poliomyelitis

(2)Inactivated(killed) vaccine – IM injection – can

use in immunodeficient person
Reduced side effect
DPT (Diphtheria, Pertussis, Tetanus)

IM injection-thigh

Pertussis
(1)Cellular
Side effect – reaction, convulsion due to fever or
encephalopahty

(2)Acellular – less side effect, can use in

immunodeficient person
Measle

o Live vaccine
o IM /SC injection
o Side effect – fever, red spots on trunk
Hepatitis B vaccine

IM injection - deltoid or antero-lateral thigh region

Regimes – 0,1,6 month
0,1,2,12 month( fast regime)

High risk pt – Human Hepatitis B immunoglobulin

1 time IM + HBV
 Previous immunization schedule
Antigen Dose Route Total Doses When Interval

BCG 0.05 ml Intradermal 1 6th week

DPT 0.5 ml IM 3 1 ½,2 ½, 3 ½ 1 mth

mth

OPV 2 Drops Oral 3 1 ½,2 ½, 3 ½ 1 mth

mth

Hepatitis B 0.5 ml IM 3 1 ½,2 ½, 3 ½ 1 mth

mth

Measle 0.5 ml IM 2 9th mth & 9mth

18mth
Recently given vaccines in Myanmar
(since Oct.2012)
BCG

Pentavalent – DPT(Diphtheria, Pertussis, Tetanus),

Hepatitis B,H.influrenza type B(Hib)
5 vaccines
OPV (Oral Polio Virus)

Measle
Recently given vaccines in Myanmar

vaccine frequency route time

BCG 1 intradermal < 2 mth

Pentavalent 3 IM 2,4,6 mth

thigh

OPV (Oral Polio 3 oral 2,4,6 mth

Virus)

Measle 2 IM 9,18 mth

deltoid
General parasitology
 The Protozoa

• Single-celled animals
• Size – 2 µm to 100 µm
• Free living species can infect humans opportunistically
• Severe diseases in immunocompromised individuals
• Intracellular parasites – red cells, macrophages, epithelial cells, brain
muscle
• Extracellular parasites – blood, intestine or urinogenital system
• Reproduction in humans – asexual by binary or multiple division of
growing stages (trophozoites)
• Sexual reproduction – normally absent or occurs in the insect vector
phase.
 Medically important protozoa
Location Species Mode of transmission Disease

Skin Leishmania tropica Sand fly cutaneous leishmaniasis

(Blood and tissue) L. braziliensis mucocutaneous
leishmaniasis

Intestine Cryptosporidium spp Ingestion of cysts in cryptosporidiosis

(Intestinal tract) Giardia lamblia food gardiasis
Cyclospora cayetanensis cyclosporiasis
Microsporidia microsporidiosis
Entamoeba histolytica amebiasis

Liver Entamoeba
Leishmania
Blood Plasmodium vivax, P. ovale Anopheles mosquito malaria
P. malariae
Trypanosoma gambiense Tsetse fly sleeping sickness

CentraL Nervous Toxoplasma gondii Ingestion of cyst in raw toxoplasmosis

System meat
Entamoeba amebae
Plasmodium malaria
Trypanosoma trypanosomes
 The Helminths

• Parasitic worms
• Have flattened bodies with muscular suckers and/or hooks for attachment
• Larval stages may measure only 100 – 200 µm
• Adult worm – may be centimeters or even meters long
• Transmission routes
• - swallowing infective eggs or larvae via the fecal-oral route
• - swallowing infective larvae in the tissues of another host
• - active penetration of the skin by larval stages
• - the bite of an infected blood-sucking insect vector
 The Helminths

• Helminths of human beings belong to two phyla

• (1) Platyhelminthes (flatworms) – lack a true body cavity (celom)
• All medically important species belong to the classes:
• Cestoda (tapeworms) – band-like and segmented
• Trematoda (flukes) – leaf-shaped

• (2) Nemathelminthes (worm-like, separate-sexed, unsegmented

roundworms
 Medically important Helminths
Disease and Parasite Location in Mode of Geographic Treatment of choice
host transmission distribution
Ascariasis Small intestine; Eating viable Worldwide Mebendazole, pyrantel
Ascaris lumbricioides larvae through eggs from feces- pamoate
Nematode (roundworm) lungs contaminated soil
or food

Dracunculiasis Subcutaneous; Dinking water Africa, Arabia, Mechanical or surgical

Dracunculus medinensis usually leg, foot with Cyclops Asia extraction,
(N), Guinea worm mebendazole

Schistosomiasis Venous vessels Larvae penetrate Africa, Praziquantel

Schistosoma haematobium of urinary skin in snail- Madagscar,
Trematode, bilharzia worms, bladder, large infested water Arabia to
blood flukes intestine, liver Lebanon

Strongyloidiasis Duodenum, Through skin and Worldwide Thiabendazole,

Strongyloides stercoralis jejunum, larvae by internal ivermectin
(N), threadworm through skin. autoreinfection
lungs
Taenia saginata Small intestine Uncooked beef Worldwide Praziquantel
Cestode, beef tapeworm
 Roundworm
• Ascaris lumbricoides = largest roundworm parasitizing the human
intestine. 
• Adult females: 20 to 35 cm
• Adult male: 15 to 30 cm
• Most common human helminthic infection = Worldwide distribution
• Highest prevalence = tropical and subtropical regions, and areas with
inadequate sanitation
• Microscopic identification of eggs in the stool most common method
 Diagnosis of Ascaris
• The recommended procedure is as follows:
– Collect a stool specimen.
– Fix the specimen in 10% formalin.
– Concentrate using the formalin–ethyl acetate sedimentation technique.
– Examine a wet mount of the sediment
• Where concentration procedures are not available = direct wet mount
examination of the specimen is adequate for detecting moderate to heavy
infections
• Adult worms occasionally in stool, mouth/nose and are recognizable by
their macroscopic characteristics.
 Larva hatching from an egg.

An adult Ascaris worm.  Diagnostic

characteristics: tapered ends;
length 15 to 35 cm (the females
Fertilized Ascaris egg, still at
the unicellular stage.  Eggs are tend to be the larger ones).  This
normally at this stage when worm is a female, as evidenced by
passed in the stool (complete the size and genital girdle (the
development of the larva dark circular groove at bottom
requires 18 days under area of image).
favorable conditions).
 
 Trematodes (fluke) 
• Schistosomiasis (Bilharzia)
• Most prevalent disease caused by flukes (~200 MIL)
• Snail vector
• Blood trematodes (fluke) 
• Three main species infecting humans:
– Schistosoma haematobium,
– S. japonicum,
– S. mansoni. 
 – Other species of schistosomes, which parasitize birds and mammals, can cause
cercarial dermatitis in humans = Swimmer's itch, also called cercarial
dermatitis, appears as a skin rash caused by an allergic reaction

• Schistosoma mansoni
– parts of South America and the Caribbean, Africa, and the Middle
East;
• S. haematobium
– Africa and the Middle East;
• S. japonicum in the
– Far East. 
• Schistosoma mekongi and S. intercalatum
– focally in Southeast Asia and central West Africa, respectively.
 Diagnosis

• Microscopic identification of eggs in stool or urine is the most practical

method for diagnosis 
• Stool examination should be performed when infection with S. mansoni or
S. japonicum is suspected
• Urine examination should be performed if S. haematobium is suspected
Cross-section of different human tissues
showing Schistosoma sp. eggs. Schistosoma
sp. in liver and bladder, respectively

Schistosoma mansoni eggs in a

patient from Egypt
Two images showing one of the types of cercaria which can cause
cercarial dermatitis. 
 Tapeworms
• Tapeworms
– Taenia saginata (beef tapeworm)
– T. solium (pork tapeworm) = measly pork or water
• Attach to the small bowel mucosa, but do not suck blood
• Both species are worldwide in distribution. 
• Taenia solium is more prevalent in poorer communities where humans live
in close contact with pigs and eat undercooked pork

• Very rare in Muslim countries.

• Length of adult worms is:
– usually 5 m or less for T. saginata (however it may reach up to 25 m)

– 2 to 7 m for T. solium

• Adults produce proglottids (segment, both male and female) which mature,
become gravid (carrying eggs) , detach from the tapeworm, and migrate to the
anus or are passed in the stool (approximately 6 per day)
• T. saginata adults usually have 1,000 to 2,000 proglottids,
• T. solium adults have an average of 1,000 proglottids
• Eggs contained in the gravid proglottids are released after the proglottids are
passed with the feces
• T. saginata may produce up to 100,000

• T. solium may produce 50,000 eggs per proglottid respectively.

 Taenia saginata Taenia solium

A, B, C: Scoleces of Taenia saginata (Figure A) and Taenia solium

(Figures B and C).  Scolex of T. saginata has 4 suckers and no
hooks.  T. solium has 4 suckers in addition to a double row of
hooks.
Taenia saginata adult worm.  The adult is 12 feet long.