

Parasitology MTLE Review

Jasmen S. Pasia, RMT, MSMT Arthropod/vector-transmitted
Faculty, Medical Laboratory Science Ex: malaria/filarial (mosquito)
Department Leishmania (sandfly)
San Pedro College Trypanosomes (American reduviid bugs;
Africa: tsetse fly)
PARASITOLOGY – science that deals with the Babesia (tick)
study of parasites
PARASITE – any organism that lives in or on DIFFERENT MODES OF TRANSMISSION
the body the host
HOST – the one that harbours the parasite
 Food-borne
Types of Hosts
Definitive
 Ex: Taenia solium (pork), Taenia
saginata (beef); Trichinella spirallis (pork);
2. Intermediate
Toxoplasma gondii (any meat) ; (fish)
3. Reservoir
Capillaria, Heterophyids, Clonorchis,
4. Paratenic
Opistorchis, Diphyllobothium; Paragonimus
5. Incidental
(crab); Fasciola (vegetables); Echinostoma
(snails)
Parasite Classification (Habitat)

Ectoparasite  Water-borne
Endoparasite
 Ex: amoeba, Giardia, Blastocystis,
Cryptosporidium
Parasite Classification (Based on
Relationship with the host)

Obligatory
 Directly-transmitted – Ex; enterobius,
T. vaginalis, (contact borne)
Facultative
Intermittent
Spurious Portals of Entry
Accidental /Incidental Mouth (Oral Cavity)
Permanent A) ingestion of:
Pseudoparasite embryonated eggs (A. lumbricoides)
protozoan cysts (amoeba, giardia)
metacercaria (liver, intestinal, lung, and
Parasite Classification (Based on the effect pancreatic flukes)
of parasite to the host)
B) intimate oral contact
Trichomonas tenax
Pathogenic Entamoeba gingivalis
Non-pathogenic

DIFFERENT MODES OF TRANSMISSION

Portals of Entry

 Soil-transmitted – development in soil

before they
Skin
A) Active penetration
become infective. filariform larvae
Ex: Ascaris, Trichuris, Hookworms, (hookworm and
Strongyloides strongyloides)
cercariae
(schistosomes)
 5. Tissue Aspirates
Portals of Entry
• Liver – E. hystolytica (liver amoebic
• Introduction of a vector abcess)
E. granulosus ( hydatid

– Biological = mosquito (with development

and multiply) •
sand)

Pulmonary – E. histolytica (
Pulmonary AA) – trophozoites

– Mechanical – flies (with no development

• Duodenal – S. stercoralis (A), G.
lamblia (T)
and multiplication)
• Lymph Node – Trypanosoma
(Chagas Disease)
Portals of Entry

• Others
• CSF – Trypanosoma (Not in Phil
setting)
A) Sexual Contact
Trichomonas vaginalis • Naegleria & Acanthamoeba (Phils)
B) Transplacental
Toxoplasma gondii • Hydrocoele fluid – W. bancrofti
C) Transmammary (microfilaria)
Strongyloides (scrotal sac fluid)
stercoralis
D) Intranasal
Naegleria fowleri (PAM)
Acanthamoeba Portals of Exit
culbertsoni (GAE) 5. Tissue Biopsy
E) Anal (homosexual) anilingus (anal- Muscle – T. spiralis (no in Phil setting)
oral sex) – Giardia, E. Cysticercus cellulose (T. solium)
histolytica, E. vermicularis, Sparganum (Diphyllobothium)
Rectal – Schistosomes
Lymph Node – Adult Filarial worms
Skin – Onchocerca volvulus (not Phil setting)
Portals of Exit Cutaneous Leishmaniasis (not Phil setting but
by OFW)
Stool Orifice Swabs
= recovery of ova T. vaginalis (vagina)
E. vermicularis (perianal)
Urine
= T. vaginalis, S. haematobium Parasites
Can be cultured: protozoa; hemoflagellates;
Sputum malaria
= Paragonimus westermani
= ASH Clinically significant Parasites
Single-celled parasites – Protozoa
Multicellular worms – Metazoa (helminths)
Nematodes – roundworms
Portals of Exit Cestodes – tapeworms
Trematodes – flukes
Blood
= microfilaria (Wuchereria, Brugia, Loa loa) Arthopods – insect and their allies (Animalia)
= trophozoites, gametocytes, schizonts
(Plasmodium spp, Babesia)
 Quick Quiz Specimen collection and processing
Which of the following are key discoveries that
contributed to current knowledge about Specimen Collection and Processing
parasites? Practice Question:
A. Consistent status quo preservation of
samples How many stool samples should be collected
B. Techniques that indicate only the when following the typical O & P collection
presence or absence of parasites protocol?
C. Modifications of traditional parasite A. 1
identification techniques B. 2
D. Decrease in parasite incidence because C. 3
of global travel D. 4

Quick Quiz Stool for Ova and Parasite (O & P)

The primary function of a host in a parasite-host Examination
relationship is to: Collection and Transport
A. Carry on the parasite’s life cycle. A. Morphologic forms of both protozoa and
B. Provide immunologic protection for the heminth are demonstrated from a
host. properly collected and prepared stool
C. Carry on the host’s life cycle. specimen

–
D. Provide a food source for the host.
Typical stool collection protocol:
Quick Quiz
Which of the following key pieces of information
may be extracted from the portion of a parasite’s • 3 specimens collected
every other day or 3
life cycle that occurs outside the body?
A. parasitic disease symptoms and disease stools in 10 days
processes
B. epidemiology and prevention and • Amoebiasis 6 specimens
in 14 days
control measures
C. appropriate parasite diagnosis
methodologies Considerations for Stool Collection
D. selection of antiparasitic medication Medications

Quick Quiz
Which of the following groups of symptoms
– Barium, bismuth, or mineral oil (stool
should be collected prior to therapy or
represents those most commonly observed in not until 5 to 7 days after the completion
parasitic infections? of therapy)
A. diarrhea, abdominal cramping, and
anemia Container
B. enlargement of the spleen, fever, and Clean, watertight container with a tight-fitting lid
chills Amount: 2 – 5 g
C. skin lesions, abdominal pain, and Free of contamination: urine, water, soil, toilet
diarrhea paper
D. abdominal cramping, abdominal pain, Properly labelled: Px’s name, ID, physician’s
and diarrhea name, date and time of sample collection
(Helpful information but may not be provided:
Quick Quiz suspected dx, travel history, clinical findings
Which of the following specimen type is most
often submitted for parasite study?
A. Blood
B. Sputum Considerations for Stool Collection
C. Urine 3. Time frame from sample collection to
D. stool receipt and examination in the
laboratory
Motility of protozoan trophozoites: fresh
specimen is required • it preserves specimens for
up to several years

Liquid specimens: examined within 30 • it has long shelf life

minutes
Formalin

Semi-formed: mixture of protozoan cyst

and trophozoite, examined within 1 hour – Disadvantages:

Formed: can be held for 24 hours

following collection
• it does not preserve
parasite morphology
Fixatives for Preservation adequately for permanent

–
smears

•
substances that preserve the
morphology of protozoa and trophozoites cannot be
prevent further development of usually recovered
certain helminth eggs and larvae

•
–
morphologic details of
cysts and eggs may fade
Universal ratio: 3parts fixative to 1
with time
part stool
Polyvinyl Alcohol (PVA)

– Specimen should be fixed: at least

30 minutes – Composed of:
Formalin
–
–
plastic powder (acts
as an adhesive for
All-purpose fixative for the recovery the stool specimen
of protozoa and helminth when preparing

–
slides for staining)

2 concentrations are available:

– Combined with

– 5% concentration –
ideally preserves
Schaudinn solution
which contains zinc
sulfate, copper
protozoan cyst sulfate, or mercuric
chloride as base

– Polyvinyl Alcohol (PVA)

–
10% concentration
– preserves
helminth eggs and
larvae Advantages:
Formalin
•
– Advantages:
it can be used for preparation
of a permanent stained smear

• it is easy to prepare • long shelf life when stored at

room temperature
 stain to detect coccidian

• Trophozoites and cysts of the

protozoa, as well as most
oocyst

helminth eggs may be Sodium Acetate Formalin (SAF)

recovered
Polyvinyl Alcohol (PVA) – Disadvantages:

– Disadvantages:
• because the adhesive
properties of SAF are not
good, the addition of
albumin to the microscope
• Though it can be used for
concentration technique, the
slide is necessary to
ensure adhesion of the
specimen to the slide
recovery of ova is not as
effective as when formalin is
used (two-vial system is an
option) • protozoa morphology is not
as clear in permanent

• Schaudinn contains mercuric

chloride which is a health
stains as when using
mercury-containing
preservatives
hazard.
Sodium Acetate Formalin (SAF)
•
–
Choice of permanent stain:
only good for IH and not for
Wheatley trichrome stain
Alternative to the use of PVA and
Schaudinn

–
Modified PVA

Concentration and permanent

stained smears • Using copper sulfate or zinc sulfate
as base
Sodium Acetate Formalin (SAF)

– Advantages:
• Can be use for both concentration
and permanent stained smears

• requires single vial and

mercury-free • Quality is not as good as mercury-
based fixatives

• long shelf life

• easy to prepare Alternative Single-Vial System

• can be used for preparing

• Free of formalin and mercury
smears with modified AF
 • Can be used for both concentration
and permanent stained smear
Processing of Stool Sample
Microscopic Examination

•  ova


Quality is not as good as when
using mercury-based fixative cyst (formed), trophozoite (watery)

 adult

Stool preservatives and applicable laboratory

procedures
 larval stages
Quick Quiz
What is the purpose of fixatives for the  crystals


collection of stool samples?

• pus


Enhance the motility of protozoa.

• Stain the cytoplasmic inclusions of

protozoa.
yeast

• Preserve the morphology of

protozoa and prevent further
development of helminths.
Stool Examination

• All of the above.

– Direct Fecal Smear

– Most common
routine procedure in
Processing of Stool Sample
the laboratory
Macroscopic Examination

 Color
– Saline and iodine
wet mount

 Consistency – Motility of

 Gross presence of parasites

trophozoite and
demonstration of
helminth eggs

 Mucus
– Cheap, readily

 Blood
available

 Somehow odor
– NSS and 1-3%
Lugol’s iodine
solution
 Stool Examination Sedimentation

– Kato-Katz Technique
–Formalin-Ethyl Acetate Concentration
Technique (FEACT)

– For enumeration of
eggs
– widely used
technique

– Most commonly
– follows the principle
of specific gravity
used for evaluating
epidemiology, effect
of control
– provides good
recovery of most
measures, drug parasites and easy
trials to perform

– Uses glycerine as
clearing agent
– Disadvantage:
presence of fecal
debris

– Standard template
–Acid-Ethyl Acetate Concentration
» 20 mg
Technique (AEACT)

» 50 mg –Merthiolate-Iodine Formlin Concentration

Technique (MIFC)

» 47.1 mg – Sensitive for

moderate and
heavy infections

– Not adequate for

light infections (less
Concentration Methods than 10 eggs/gram
of stool)

– Concentration technique provide

the ability to detect small numbers
of parasites that might not be
detected using direct wet
preparations.

–
Flotation Methods

2 types: –Zinc Sulfate Flotation Technique

• Sedimentation
• Based on differences of
specific gravity between
sample debris
• Flotation • Specific gravity: 1.18 to 1.20

• Advantage
 – More fecal debris is
• Designed to confirm the
removed and it
presence of protozoan cyst
yields cleaner
and or trophozoite
prepartion

• Disadvantage
• Review 300 fields before
– Denser eggs will declaring negative
sink and hence will
be missed out • 2 commonly used stains in

• Examine with saline and

iodine preps
O&P

– Wheatley Trichrome

– Concentrated wet – Iron Hematoxylin

prepartion

– Concentrated
iodeine preparation
Wheatley Trichrome

– Most widely used permanent stain

Flotation Methods
– Long shelf life

– Brine Flotation Technique

– There are distinct color differences

• using saturated saline

among the cytoplasmic and nuclear
structures

• Good for oocyst recovery

– Sheather’s Sugar Flotation Technique

• sugar solution Iron Hematoxylin

– time consuming

Permanent Stains – reveals excellent morphology of the

–Permanent stained smear

intestinal protozoa

• acontains
microscope slide that
a fixed sample that
– nuclear detail of these organisms is
considered to be stained clearer and
has been allowed to dry and sharper than when stained with trichrome
subsequently stained
 – Doudenal Material
NSS vs Iodine
NSS Preparation • nasogastric intubation
the cyst wall is refractile and relatively
thin • Enterotest

•
the cytoplasm is colorless with a ground
glass appearance Giardia, Cryptosporidum,
nuclei are rarely visible, sometimes one Isospora, Strongyloides
may appreciate the outline of the
nucleus
if present, the glycogen mass is a clear – Sigmoidoscopy Material

•
or empty space in the cytoplasm
if present, the chromatoidal bars are E. histolytica, Coccidia,
refractile Microsporidia

Iodine preparation – Cellophane Tape Preparation

The cytoplasm is greenish yellow
The nuclei are clearly seen with central • E. vermicularis, Taenia spp

•
karyosome
If present, the chromatoidal bars are The standard protocol to
refractile rule out a pinworm infection
If refractile, the glycogen mass is dark is 5
yellowish brown in color
Specialized Stains

– Modified Acid-fast stain

• Important permanent stain

procedure for the detection
Other Specimens and Laboratory Technique
of oocysts of
Cryptosporidium, Isospora,
and Cyclospora
– Blood

– Modified IH
• Plasmodium, Leishmania,
Trypanosoma, Babesia,

• microfilariae

•
incorporated with carbol
fuchsin to detect AF Motility (Trypanosoma and
protozoa microfilariae )

– Modified Trichrome Stain • Capillary puncture (fingertip

• demonstrate spores of
or earlobe)

microsporidia
• Venipuncture (EDTA tube)

• Timing of collection is
essential

Other Intestinal Specimens

Other Specimens and Laboratory Technique
• 1 ml veni blood + 10 mL 2%

– Thick and thin smear

•
formalin

•
Centifuge 1 minute (500 x
g)
Thick smear – for
quantitation (3 drops of
blood) • Prepare thick smear, dry,
stain with Giemsa

• Thin smear – for species

identification (1 drop of
blood)
Other Specimens and Laboratory Technique

– Buffy Coat Slides

•
Thick vs Thin Smear
Thick Smear
Thin Smear Buffy coat from oxalated or
Other Specimens and Laboratory Technique citrated blood in a Wintrobe
tube

– Permanent Stains • Spin for 30 mins at 100 x g

• Wright’s stain – contains

fixative and stain in 1
• Obtain the buffy coat using
a capillary pipette
solution (only yields
satisfactory results)
• Thick smear, dry, stain with

•
Giemsa
Giemsa Stain - preferred
stain as it allows for the
detection of parasite detail
• Good for Trypanosoma and
Leishmania
necessary for species
identification

Other Specimens and Laboratory Technique

Appearance of Select Parasitic Structures and

Background Material on Giemsa Stain – Blood Culture

•
Other Specimens and Laboratory Technique

–
including bone marrow and
tissue
Knott Technique

• Designed to concentrate
• Leishmania and
Trypanosoma
blood specimens suspected
of containing low numbers
of microfilariae
 • Novy-McNeal-Nicolle (NNN) • Peritoneal fluid
medium
• Bronchial washings
• NNN slant + 1 drop of blood
or ground tissue (penicillin
is added if contamination is Other Specimens and Laboratory Technique
suspected)

• Examine every other day at – Tissue and Biopsy Specimens

HPO and negative cultures
should be held for 1 month • Surgical removal of the specimen
histologic tissue sections and
impression smears (preferred method)

Other Specimens and Laboratory Technique • Leishmania, Toxoplasma, free-living

ameba, Trypanosoma, Trichinella,

– Cerebrospinal Fluid
microsporidia

• Primarily for amebic

• Hepatic abscess - specimen of
choice for liver abscess caused by E.
conditions of select amoeba
histolytica
species

• African sleeping sickness

• wet preparations for motility

Other Specimens and Laboratory Technique

•
(N,A,T)
– Sputum

•
Can be cultured in non-
nutrient agar seeded with E. Paragonimus westermani
coli (incubate at 35C)

• Examine for evidence of • ASH

amoeba feeding on the
bacteria • Entamoeba gingivalis

• Other species: Toxoplasma,

microsporidia, T. solium
• Sputum is treated with N-
acetylcysteine
cysticercus larvae,
Echinococcus
• 3% NaOH for 30 minutes,
centrifuge, examine the sediment

Other Specimens and Laboratory Technique

– Other Sterile Fluids

Other Specimens and Laboratory Technique

• Fluid present in cysts – Urine and Genital Secretions

• Aspirates • Schistosoma haematobium

 • Trichomonas vaginalis

• Culture pouch is available

Other Specimens and Laboratory Technique

Other Specimens and Laboratory Technique

– Skin Snips

•Onchocerca volvulus
– Eye Specimens •2 methods ( skin fluid without
•corneal
Acanthemoeba is best dx using
scrapings
bleeding)
• Making a firm scleral

•mayContact
punch into the skin
lens or contact lens solution with a specially
be a sample designed tool

•calcofluor
Scrapings should be stained with
white stain followed by
• Razor blade making
a small cut on the
skin
microscopic examination using
fluorescent microscopy
•Material is placed in approx. 0.2 mL
•Acanthamoeba
Apple green is the color of
cyst
of saline, incubate for 30 minutes,
examine microscopically

•Other parasites: •Jerky movement of the parasite

» Toxoplasm should be visible, if present, because
they tend to migrate into the liquid
a
from the skin snip
» Microsporidi
a

» Loaloa

Other Specimens and Laboratory Technique

Other Specimens and Laboratory Technique

– Mouth Scrapings and Nasal

– Animal Inoculation

Discharges
•
•
Leishmania, Trypanosoma,
Toxoplasma
E. gingivalis, T. tenax (oral
scrapings)

• N. fowleri (nasal discharges)

• mice, guinea pigs, hamsters

• Material should be placed in clean

airtight collection container
– Xenodiagnosis
 • T. cruzi – an uninfected reduviid bug
is allowed to take a blood meal from
• 4 parts fixative to 1 part stool

the Px and the bug’s feces is then

examined

Quick Test

Quick Test – One of the biggest disadvantages of

formalin as a fixative for O & P is that:

– In the collection and transport of stool

specimens for parasites, which parasite
• It cannot be used for
concentration procedures.
stage is most affected by the length of time
from collection to examination?
• It cannot be used for
• cyst
permanent stained slides.

• Trophozoites
• It cannot be used for direct
microscopic examinations.

• Oocysts • It cannot be used for

• Helminth larvae
detecting protozoan.

Quick Test

–
Quick Test

– When using preservatives, what is the

appropriate ratio of fixative to stool?
Which of the preservatives contains
mercuric chloride?

• 1 part fixative to 1 part stool

• Formalin

• 2 parts fixative to 1 part stool

• SAF

• 3 parts fixative to 1 part stool

• PVA

• Modified PVA
 General Statements:

Subkingdom protozoa

 All amoebas are capable of producing cyst

and trophozoite except for Entamoeba
gingivalis.

Intestinal and Luminal Protozoa  All intestinal amoebas are commensals

except Entamoeba histolytica.

• Stages of Development

• Cyst – infective stage

E. histolytica trophozoite: Typical characteristics
at a glance

• Trophozoite – vegetative stage

 E. histolytica cyst: Typical characteristics at a
glance

• Clinical Symptoms:

• Entamoeba histolytica only tissue invader

• Asymptomatic Carrier State

• cysts can survive weeks in moist environment

• Symptomatic Intestinal Amebiasis
• Size of cyst: <10 micra – E.hartmanii
>10 micra – E. histolytica, E. dispar.
E.moshkovskii
• Symptomatic Extraintestinal
Amebiasis
• needs micrometry

• when reporting :

– E.dispar/
histolytica/ E.

E.moshkovskii –
indistinguishable

– E.(pathogenic)
histolytica
Entamoeba histolytica
– dispar/E.moshkovsk
E.

ii

(nonpathogenic
)

• Asymptomatic Carrier State

Entamoeba histolytica
• the parasite is a low-virulence
strain
 • the inoculation into the host is low

• patient’s immune system is intact Entamoeba histolytica

Entamoeba histolytica
• Symptomatic Extraintestinal Amebiasis

• Liver abscess

• Amebic pneumonitis

• Weakness, weight loss, sweating,

pronounced nausea, vomiting

• Symptomatic Intestinal Amebiasis

• Migrate and infect the lung,
pericardium, spleen, skin, and brain

• Amebic colitis – intestinal infection

caused by the presence of amebas
• Men: venereal amebiasis (penile
amebiasis from a woman with
exhibiting symptoms vaginal amebiasis)

• Amebic dysentery – presence of

blood and mucus in the stool
Virulence Factors
1) a surface galactose binding lectin that
mediates E. histolytica binding to host
cells and may contribute to amebic

• Secondary bacterial infection –

after formation of flask-shaped
resistance to complement,

Virulence Factors
ulcers in the colon, cecum, 2) amebapores, small peptides capable of lysing
appendix, rectosigmoid area of the cells, which may play a role in killing
intestine intestinal epithelial cells, hepatocytes, and
host defense cells, and

Virulence Factors
3) a family of secreted cysteine proteinases that
play a key role in E. histolytica tissue
 invasion, evasion of host defenses, and
parasite induction
of gut inflammation

•Wet mount and permanent staining techniques

– Ova and Parasite exam (at least 3
samples required)

– Fresh stool Exam with Microscopy

and gross exam

– Motile or encysted organisms

– Watery stool with mucus or blood

•amoeba
Culture: TYI-33 supports the growth of

Entamoeba histolytica
•(preferred)
Entamoeba histolytica stool antigen testing

Mode of Transmission
– Test Sensitivity: 87%

• Transmission via fecal-oral route

– Test Specificity: >90%

• Food preparation contaminated by poor

hygiene

• Human waste used for crop fertilization

• Oral-anal sex

Laboratory Diagnosis

Laboratory Diagnosis

• Other tests
– Fecal leukocytes positive

– Occult blood positive

– Fecal eosinophilia (Charcot-Leyden

crystals present) E. hartmani trophozoite: Typical characteristics
at a glance

– Antigen Tests:

• ELISA

• IHA

• GDP

• IIF

E. hartmani cyst: Typical characteristics at a

glance
Entamoeba histolytica

Treatment:
Paramomycin
Diloxanide furoate (Furamide)
Metronidazole (flagyl)
tetracycline with diiodohydroxyquin

E. hartmani
TROPHOZOITE
CYST

E. coli cyst: Typical characteristics at a glance

Entamoeba hartmanni

• designated as “small race” E. histolytica

• Px are generally asymptomatic

E. polecki trophozoite: Typical characteristics at
a glance

E. coli trophozoite: Typical characteristics at a

glance
 E. polecki cyst: Typical characteristics at a
glance

Endolimax nana cyst: Typical characteristics at

a glance

E. polecki

TROPHOZOITE E. nana
CYST

TROPHOZOITE
CYST

Endolimax nana trophozoite: Typical

characteristics at a glance

Iodamoeba butschlii trophozoite: Typical

characteristics at a glance
 Entamoeba gingivalis trophozoite: Typical
characteristics at a glance

Iodamoeba butschlii cyst: Typical characteristics

at a glance

E. gingivalis

TROPHOZOITE
TROPHOZOITE

Iodamoeba butschlii

Naegleria fowleri
TROPHOZOITE
CYST
 Naegleria fowleri Flagellate form: Typical
characteristics at a glance

 major cause of a disease called

PAM

 has 2 long flagella at one end

 most cases are contracted in lakes

and swimming pools

 probably the flagellated

trophozoites are forced deep into the
nasal passages when the victim dives
in water

 found in USA, Czechoslovakia,

Mexico, Africa, New Zealand,
Australia, Phil

Naegleria fowleri cyst: Typical characteristics at

a glance

Naegleria fowleri Ameboid trophozoite: Typical

characteristics at a glance

Acanthamoeba culbertsoni
• cause chronic infection of the skin or CNS
in immunocompromised persons

• has small spiky acanthopodia Quick Quiz

• causes keratitis
• A main difference between the
trophozoite of E. histolytica and E.

•
hartmanni is which of the following?
Granulomatous Amoebic Encephalitis
• Trophozoites of E. histolytica are
smaller in size

• Presence of pseudopods

• Trophozoites of E. hartmanni do not

contain ingested rbc

Acanthamoeba culbertsoni trophozoite: Typical

• Nuclear structure and peripheral
chromatin
characteristics at a glance Quick Quiz

• Which of the following factors is not

responsible for the asymptomatic carrier
state of a patient infected with E.
histolytica?

• low virulence strain

• Low inoculation into host

• Intact patient’s immune system

• Patient’s blood type

Quick Quiz

Acanthamoeba culbertsoni cyst: Typical • Which of the following statements is not

true about the cysts of E. polecki?
characteristics at a glance
• Cysts vary in shape from spherical to
oval
• trophozoites are delicate and motile

• Cysts contain at least 4 nuclei

• trophozoites are easily destroyed by
gastric juices

• The typical cyst nucleus resembles that

of E. histolytica
• trophozoites are resistant to the
environment outside the host

• A diffuse glycogen mass may be

present in the cytoplasm of the cyst
• replication occurs in the trophozoite
stage
Quick Quiz

• The known morphologic forms of N.

fowleri are:
Flagellates

Giardia intestinalis
• Ameboid trophozoites, flagellate forms,
and cysts • Cercomonas intestinalis

• Ameboid trophozoites, immature cysts,

and mature cysts • Discovered by French scientist: Dr. F. lambl
and the Czechoslovakian scientist Dr. Giard, it’s
• Eggs, larvae, and adults
called Giardia lamblia

• Flagellate forms, cysts, and larvae

Quick Quiz
• Its formal name is still currently until review by
ICZN but is proposed to be Giardia intestinalis

• The specimen of choice for the recovery

of N. fowleri:

• sputum

• Stool

• CSF
Giardia intestinalis trophozoite: Typical

• urine
characteristics at a glance

Quick Quiz

• Which of the following is not true about

amebic trophozoites?
 and low grade fever

Giardia lamblia

• METHODS:

Giardia intestinalis cyst: Typical characteristics

 DFS
at a glance
 Zinc-sulphate floatation technique

 Duodeno-jejunal aspiration

 Entero test (gelation capsule attached

to a string 6-8 hrs)

 ELISA
Giardia intestinalis
Trophozoite
Cyst
Giardia lamblia

• Giardia lamblia

•
PATHOGENESIS

 Incubation period is 1-4 weeks (9 days) Treatment:

 Mild-moderate infections:
=cramping and dirrheic stools
 Quinacrine
=excessive flatus with an odor
of H2S
= abdominal bloating, nausea, and anorexia  Metronidazole

 Furazolidone

•
Giardia lamblia

PATHOGENESIS
 Acrasil

 Severeinfections:
= malabsorption in the gut
= inflammation of the mucosa
and hyperplasis of the Chilomastix mesnili
lymphoid follicles
= wt. loss, body malaise, chills,
• Lives in the cecal region on the colon

• Has a well-defined trophozoite and

cystic stage

Dientamoeba fragilis trophozoite: Typical

characteristics at a glance

Trichomonas hominis
Chilomastix mesnili trophozoite: Typical
characteristics at a glance
• Exist only in trophozoite stage

• Human commensal

• Measures 7-20 um long, 5-18 um wide

• Exhibit a nervous, jerky motility

• With 1 nucleus, with small central

karyosome, no peripheral chromatin

•
Chilomastix mesnili

•
3 -5 anterior flagella responsible for
nervous, jerky motility
TROPHOZOITE:

• Axostyle that extends beyond the

posterior end of the body

Chilomastix mesnili
• Full body length undulating membrane

• CYST:
Trichomonas vaginalis

• exist only in trophozoite stage

• cytoplasm contains a remarkably large
amount of siderophil granules
• MALE: vector from one female to
another; symptomless, or irritating
persistent urethritis

• HABITAT: vagina and prostate

gland

• prefers slightly alkaline environment or

somewhat more acid than that of Trichomonas vaginalis
healthy vagina

• Diagnosis:

 demonstration of trophozoite in
sedimented urine, vagina secretions,
and scrapings, prostatic secretions
TREATMENT:

 metronidazole

 Douche of vinegar and lactic acid

Trichomonas vaginalis trophozoite: Typical

characteristics at a glance

Trichomonas tenax

• Exist only in their trophozoite stage

Trichomonas vaginalis
• Found in the oral cavity

• In male, it can be demonstrated in the

• Measures 5-14 um long

urine, urethral discharge or following

massage of the prostate • One ovoid nucleus

• TRANSMISSION: S.I. • With five flagella, 4 extend anteriorly, one

•
extends posteriorly

FEMALE: Trichomonas vaginitis

• Undulating membrane extending 2/3 of body
length
• Nucleus
Quick Quiz

Quick Quiz • A flagellate trophozoite that could be

described as 9 to 12 um with one or two nuclei,

• This flagellate morphologic structure is

often not visible under microscopic
each with 4 symmetrically positioned chromatin
granules and vacuoles containing bacteria in the
cytoplasm, would most likely be which of the
examination: following?

• Undulating membrane
• G. intestinalis

• Pseudopods
• D. fragilis

• Flagella • C. mesnili

• Axostyle
Quick Quiz
• B. hominis
Quick Quiz

• Which specimen type and collection

regimen would be most appropriate for
• Infant infections with T. vaginalis tend to
affect which of the following of these
the diagnosis of G. intestinalis: body areas?

• 1 stool sample • respiratory and genital

• 2 stool samples • Genital and intestinal

• Multiple stool samples collected on

subsequent days
• Intestinal and eye

• One stool sample and one blood sample

• Respiratory and eye
Hemoflagellates
Quick Quiz

•
Morphological Stages

•
G. intestinalis trophozoites attach to the
mucosa of the duodenum and feed with
the assistance of this morphologic Amastigote
structure:

• sucking disk • Promastigote

•
•
Axostyle

Axoneme
• Epimastigote
• Trypomastigote
• the sexual cycle (sporogony) takes place
in mosquitoes
Blood and Tissue Flagellates

Blood and Tissue Flagellates

MALARIA (Italian mal’aria)
Treatment/Prevention/Control


The current standard treatment for first stage
disease is:

•
acute and sometimes chronic
infection of the bloodstream
Intravenous pentamidine (for T.b.

•
gambiense); or

Intravenous suramin (for T.b. rhodesiense)

 it is characterized by fever, intermittent
chills, sweating, anemia, and
splenomegaly

• Eflornithine Five Species of Plasmodia

1. Plasmodium vivax (Benign Tertian Malaria)
Phylum Apicomplexa (Sporozoans) Schizogonic Cycle: 48 hrs
Characteristics of Apicomplexa
2. Plasmodium malariae (Quartan Malaria or
• Shape of cell maintained by pellicle.
Malariae malaria) Schizogonic
Cycle: 72 hrs
• Locomotion characterized as gliding.
Cilia absent, but some species produce
3. Plasmodium falciparum (Malignant tertian
malaria) Schizogonic Cyle: 36-42
flagellated or ameboid gamest. hrs

• Asexual and sexual reproduction. 4. Plasmodium ovale (Ovale Malaria)

• Unique system of organelles, the apical

complex in anterior region of cell.
Schizogonic Cycle: 48 hrs

5. Plasmodium knowlesi (Schizogonic

•
Cycle: 24 hrous)
All intracellular parasites at some stage
in the life cycle.
Mosquito vectors
SPOROZOANS
• Anopheles flavirostris
The Genus Plasmodium - Principal vector which breed in
slow, flowing, partly shaded clean
mountain streams in the

• member of Class Sporozoa

Philippines

2. A. mangyanus

• causes malaria in mammals and birds

- clean stream breeder

•
3. A. balabacensis
– forest rain pool breeder
the asexual cycle (schizogony) takes
place in the rbc of vertebrates 4. A. litoralis
– brackish water
 RECRUDESCENCE
5. A. maculatus - arise from increase in numbers of
– stream breeder persisting blood stage forms to
clinically detectable levels and not
LIFE CYCLE: from liver stage forms

•
ERYTHROCYTIC SCHIZOGONY
Asexual Cycle - Schizogony P. vivax & P. ovale
- - young rbc
schizonts and P. malariae
- older rbc
merozoites P. falciparum
- - rbc of all stages
human host
MORPHOLOGY OF MALARIA PARASITES
THE MALARIA PARASITE
• Sexual Cycle - Sporogony
- gametes
Three developmental stages seen in blood
films:
- oocysts
- sporozoites • Trophozoite
- female
anophiline
mosquito
• Schizont

Plasmodium vivax
• Gametocyte

Plasmodium malariae Features of Plasmodium

STAGES FOUND IN THE CIRCULATING
Plasmodium falciparum BLOOD

•
Red Cell Morphology
Plasmodium vivax and Plasmodium
ovale • Size of RBCs

•
- relapsing fever is due to the renewed
exoerthrocytic and eventually from Enlarged?
erythrocytic schizogony from latent P. vivax
hepatic sporozoites called P. ovale
HYPNOZOITES
Relapsing Fever
EXOERYTHROCYTIC SCHIZOGONY

• Not enlarged?

 proliferative phase – P. falciparum

 Awakened hypnozoites –smaller
P. malariae – occassionally
than normal

 Red Cell Morphology

•
occurs in the liver parenchymal cell

 Infection of RBC’s

•
ruptured liver schizont releases
merozoite
single?

• P. malariae and P. falciparum

– suggestive usually of P. vivax
- recurrences of fever is called
 Loosely scattered chromatin
Golden brown pigments scattered at
• multiple?
the central half

– common to P. falciparum
P. vivax trophozoite
Red blood cells infected by P. vivax are often
larger than uninfected red blood cells.
Red Cell Morphology They are approximately 1.5 times the size of a
normal cell.
Presence of stipplings or clefts?
Stipplings clearly visible (Schuffner’s ) P. vivax P. vivax trophozoite
or Irregular or fragmented cytoplasm (amoeboid)
P. ovale
Mature ring forms tend to be large and coarse

Stipplings not clearly visible P. falciparum or Schuffenr’s dots are frequently visible
P. malariae
P. vivax schizont

Plasmodium falciparum (trophozoite stage)

Diagnostic points
• A schizont showing the large number of
merozoites typical of this species (16-24).
Small, regular, fine to fleshy cytoplasm
Infected RBCs not enlarged
Numerous, multiple infection is common
Ring, comma, marginal or accole forms are
• Also note the larger size compared to a
normal red blood cell.
seen; often have double chromatin dots
Maurer’s dots not clearly visible
P. falciparum trophozoite P. malariae trophozoite

• Early trophozoites have the characteristic

signet ring shape.
• the tendency of infected cells to be of
normal or smaller size (arrows).

• Also, unique to P. falciparum is the

presence of multiple trophozoites in one
• Band form

cell. P. malariae schizont

A schizont containing merozoites (6 to 12) giving
P. falciparum schizont a coarse granular appearance.
Diagnostic points
small., rarely fill the RBC COMPARISON OF PLASMODIUM SPECIES
RARE in peripheral blood AFFECTING HUMANS
16-32 or more merozoites in compact cluster Shuffner’s dots

•
Single or dark pigment
Usually associated with many young ring forms A red blood cell showing the Schuffner's
P. falciparum gametocyte dots characteristic of cells infected by
Diagnostic points Plasmodium vivax and Plasmodium ovale.
Banana-shaped or rounded
Macrogametocyte Plasmodium knowlesi
Small, compact, central chromatin dot

•
Pigments closely adhere to the
chromatin
Microgametocyte Ring forms resemble Plasmodium
Broader, shorter and more sausage- falciparum
shaped
 •
• Band form resemble Plasmodium
malariae
similar P vivax with 3 exceptions: the
incubation period is longer, 72 hrs
schizogonic cycle and nephritic syndrome
is a complication that seems to be peculiar

•
with P.malariae
PATHOGENESIS
High incidence of misdiagnosis Plasmodium ovale

• Requires PCR
• Benign Tertian Malaria or Ovale Malaria

•
PATHOGENESIS
Plasmodium vivax
found in West Africa, South America, and
 the incubation period from mosquito bite Asia
ranges from 1-3 weeks (developing in PATHOGENESIS

•
the liver)
Plasmodium falciparum

•
a typical pattern of this infection is: chills,
fever, sweating Malignant Tertian Malaria, Sub-tertian,
Estivoautomal, or Falciparum Malaria
 recurrences of this cycle may take place
periodically for 2 – 5 years until the exo-
erythrocytic cycle is spent
• common during summer or Autumn
Weather

PATHOGENESIS
Plasmodium malariae • significantly differ from other forms of
malaria in that the other forms are not

• Benign Quartan Malaria or Malariae

malaria
usually fatal
PATHOGENESIS


•
Complications:
dominant in areas with subtropical or
temperate climate
 Hyperplexi – greater then 40C


• similar P vivax with 3 exceptions: the
Algid malaria – cold inside, hot
outside
incubation period is longer, 72 hrs
schizogonic cycle and nephritic syndrome  Cholera-like Complications-
is a complication that seems to be peculiar diarrheic stool samples
with P.malariae
PATHOGENESIS  Acute hemolytic crisis – black water
Plasmodium malariae fever due to severe hemoglobinuria

• Benign Quartan Malaria or Malariae

 Impaired blood flow – hemostasis
and thrombi formation


malaria
Cerebral malaria

• dominant in areas with subtropical or

 Glumerulonephritis
temperate climate  Tropical Splenomegaly

 Hemolytic anemia
 PATHOGENESIS blood in a thick film in

–
relation to WBC
Acute hemolytic crisis – black
water fever due to severe
hemoglobinuria which results to
 an average of 8000
leukocytes per l is
anemia and renal failure taken as the standard

– Impaired blood flow – hemostasis

and thrombi formation, the
Methods of Counting Malaria Parasites in Thick
Blood Films
parasitizeed rbc have the tendency
to stick to the walls of capillaries
and small blood vessels

Diagnosis
» A suitable
counting
method for

• Thick and thin smear

-Giemsa stain (BEST STAIN)
positive
blood film
is:

•
-Acridine orange staining
two tally counters are

•
required to count parasites
Serologic Tests and leukocytes separately
-Indirect Fluorescent Antibody
-ELISA
• (a) if, after 200 wbc,10 or

•
more parasites have been
identified , record the results
Antigen or DNA Probe Detection Method in the record form, showing
-Immunocapture Assay parasites per 200
detection of Plasmodium specific lactate leukocytes
dehydrogenase

•
Methods of Counting Malaria Parasites in Thick
Blood Films
Dipstick Tests
-based on the detection of histidine-rich

•
P.falciparum antigen in whole blood
a)Parasite-F test (Becton Dickinson)
-may give false (+) result in rheumatoid (b) if, after 200 leukocytes
factor have been counted, 9 or
b) ICT Malaria Pf test (ICT Diagnostics) less parasites have been
counted, continue counting
Methods of Counting Malaria Parasites in Thick until 500 leukocytes have
Blood Films been counted and record
the parasites per 500
leukocytes
A) Parasites per l

 With adequate
accuracy
Methods of Counting Malaria Parasites in Thick
Blood Films

 based on the number

of parasite per l of
number of parasites x 8000 = parasites per l
number of leukocytes
• if 200 WBC are counted, the parasites are
multiplied by 40,
Treatment
• if 500 leukocytes are counted the
parasites are multiplied by 16.

• chloroquine
Methods of Counting Malaria Parasites in
Thick Blood Films • atovaquone-proguanil (Malarone®)
B. Plus System
+ = 1-10 parasites/100 thick • artemether-lumefantrine (Coartem®)

•
film
fields
++ = 11-100 parasites/100 thick mefloquine (Lariam®)

•
films
+++ = 1-10 parasites/one thick film
fields quinine

•
++++ = more than 10 parasites/one
thick film field
quinidine

• doxycycline (used in combination with

quinine)
Treatment

• clindamycin (used in combination with

–
quinine)
Suppressive, by acting upon
asexual blood cell stages and
preventing the development of
clinical symptoms.

– Therapeutic, by also acting upon

asexual forms to treat the acute Treatment
attack.

– Radical, for destruction of EE

forms. • Artesunate

– Gametocyticidal, for destroying

gametes.
• Primaquine is active against the dormant
parasite liver forms (hypnozoites) and

–
prevents relapses. Primaquine should not
Sporonticidal, for drugs that render be taken by pregnant women or by people
gametocytes noninfective in the who are deficient in G6PD (glucose-6-
mosquito. phosphate dehydrogenase). Patients
should not take primaquine until a
screening test has excluded G6PD
deficiency.
 Babesiosis • Caused by the apicomplexan parasite
Toxoplasmosis gondii
• Infection of rbc often producing febrile
illness • immunocompromised individuals may

•
experience serious complications

•
Transmitted by ticks (Ixodes scapularis,
Ixodes pacificus)
In utero, it may result in serious congenital

• Caused by Babesia microti

infection with sequelae or still-birth
Life cycle

• mulitiply in rbc by schizogony but do not

produce gametocytes
• Definitive host- cat and other feline

• Appear as delicate ring forms that may

easily confused with malaria • Intermediate host- humans, pigs, cow,
carabao
Babesia microti CAT (Sporogony)

• The organisms resemble P.falciparum • Enteroepithelial cycle

asexual schizogony

•
Sexual gametogony
they vary more in shape and in size; and *immature oocyst passed in the cat’s
they do not produce pigment feces

• evidence of Maltese cross formation

• Immature oocyst mature to the infective
stage
Babesia microti 2 sporocysts with 4 sporozoites each (2-21
TICK vector of Babesia days)
The organism belongs to the genus Ixodes Man and Other Animals
Diagnostic Procedures

• Blood smear
• When mature oocyst is ingested,
sporozoites are released forming

• Indirect Fluorescent Antibody

trophozoites
*tachyzoites- actively growing trop
*bradyzoites- latent or slow growing

• PCR
trophozoites
Transmission

Treatment
• Ingestion of inadequately cooked meat,
esp lamb or pork

• antimicrobial drugs such as clindamycin*

plus quinine or atovaquone* plus
• Ingestion of infective oocysts from material
contaminated by cat feces

•
azithromycin are often used.
Miscellaneous protozoa
Drinking contaminated water or
Toxoplasmosis unpasturized goat’s milk
• Organ transplantation - PCR

• Blood transfusion
- Sabin-Feldman dye test

• Transplacental
- IFA

Clinical Manifestation
- EIA

• Active infection (all nucleated cells)

Blastocystis hominis (5-20 micra)

fever
lymphadenopathy • often mistaken as an amoeba; probably in

•
taxonomy
Congenital
depends on the age of gestation when the • very refractile

•
infection is acquired
spherical/ovoidal

• 1st half pregnancy

- intrauterine death
• one large central body (appearing a
vacuole)
- microcephaly
- hydrocephaly with intracranial calcification – but it is not actually vacuole

• 2nd half of pregnancy

– pushes the nuclei to the cystic call

-usually assymptomatic at birth though fever,

– associated with diarrhea in
immunocompromised patients (e.g.
hepatosplenomegaly and jaundice may Colon CA; HIV/AIDS)
appear
-choriorenitis, psychomotor retardation and
convulsive disorders may appear months • found also in pigs and chickens
(Philippines); dogs (Australia), monkeys
or years later
Coccidia

• Immunocompromised individuals Cryptosporidium hominis (4-6 micra)

•
-present CNS involvement
-pneumonitis, myocarditis, retinitis, pancreatitis Causes diarrhea

•
or orchitis
Diagnosis Immunocompetent: resolved

• Examination of tissues, blood, and body • Immunocompromised

fluids
– Prolonged

- Demonstration of tachyzoites or tissue – fluid loss (3-6 L/day )

–
cysts
cholecystitis
- Animal inoculation to uninfected mice – respiratory infection

– AIDS
• Transmission:
• Autofluorescence blue (color reaction in
– Ingestion of contaminated water seconds)

–
•
Contaminated apple cider

– Contaminated swimming pools Isospora belli

• Immunocompromised: diarrhea
• Diagnosis:
•
– Stool concentration – Sheather’s
Stool examination

flotation
– Oocyst with 2 sporoblasts
– Acid-fast staining – Modified
Kinyoun’s (cold/chemical method) – 4 sporozoites in each sporoblast

• Comparison • Maybe mistaken for Eimerina

–
Cryptosporidium
Yeast
Oocyst with 4 sporoblast

• Kinyoun
Green
Red
– 2 sporozoites in each sporoblast

•
•
Auramine/
Rhodamine orange
not stained Oocyst comparison

• Iodine
brown
colorless
Isospora Eimeria

• Sporoblast 2 4

Cyclospora cayetenensis
• Spozoites 4 2

• larger than cryptosporidium (8-10 micra)

•
•
Acid-fast organism

cyanobacteria-like Subkingdon Metazoa

– diarrhea Phylum Nematoda

General Characteristics
– symptoms similar to
cryptosporidium • Elongated, cylindrical, not segmented

• Oocyst: wrinkled appearance in

microscopy
• With separate sexes
• With complete digestive tract • Small Intestine

•
Ascaris lumbricoides
Strongyloides stercoralis
Sensory organ: chemoreceptor : Hookworms
head(cephalic) – amphids Capillaria philippinensis

•
Trichinella spiralis
Phylum Nematoda
Tail (caudal) – phasmids Habitat

Phylum Nematoda
General Characteristics
• Large Intestine
Trichuris trichiura

•
Enterobius vermicularis
Females larger than males and have a Phylum Nematoda
straight tail Habitat

• Males have curved tail with spicules for

copulation
• Tissue Nematodes
Trichinella spiralis

•
Wuchereria bancrofti
Unsegmented Brugia malayi
Onchocerca volvulus

• Complete digestive tract (mouth to anus)

Loa loa
Dirofilaria immitis

•
Gnathostoma spinigerum
No circulatory system Dracunculus medinensis

• Found in the intestine, blood, and tissue Habitat

Phylum Nematoda

• Worldwide distribution
• Larva Migrans in Man
Angiostrongylus cantonensis
Ancylostoma caninum
Phylum Nematoda
Dracunculus medinensis
General Characteristics
Ascaris lumbricoides

• Aphasmids
Trichinella spiralis
• Ascaris lumbricoides
Trichuris trichiura
Capillaria philippinensis
Phylum Nematoda
• “Giant intestinal worm”
General Characteristics
•
•
Anterior end: 3 lips (trilobed anterior end)
Phasmids
Ascaris lumbricoides
Strongyloides stercoralis
• Posterior end: curved (male); straight
(female)
Hookworms
Enterobius vermicularis
Filarial worms • If egg is unfertilized it will be the end stage

•
Phylum Nematoda
Habitat
If fertilized larva embryonated egg
(infective stage)
 •
• Infective stage – develop in soil ( 2 weeks)
Albendazole, mebendazole, Levimasole

Ascaris lumbricoides
Egg (3 Types)

• Fertilized Egg

• 45 to 70 micra by 35 to 50 micra
Ascaris lumbricoides

•
•
shorter than the infertile eggs
• Prevention and Control:

•
there is an outer coarsely
mammilated albuminous covering

• Compact yolk granules

Proper disposal of feces.

Ascaris lumbricoides
• Cooking well of vegetables.

•
•
Unfertilized Egg
• Avoid using human feces as fertilizer.

•
88 to 94 micra by 39 to 44 micra

•
Proper hygiene.
it is thin-shelled Trichuris trichiura

• they are difficult to identify and are

found only in the absence of males • “whipworm”

•
Ascaris lumbricoides

• Fleshy portion: posterior end

•
Decorticated Egg

• Absence of albuminous coating

Thinner: anterior end (esophagus) 
stichosomes  stichocytes

•
Ascaris lumbricoides

•
facilitate invasion of target tissues
“Diagnostic stage: - fertilized/unfertilized,
corticated/uncorticated
• Posterior end: curved (male) with spiny
lanceolate spicule; straight (female)
•
•
Larval migration : respiratory symptoms;
Loeffler’s syndrome
Adult worms: found in cecum
Trichuris trichiura
• Adults: - obstruction of (1) intestines

•
( heavy worm burden); (2) pharynx (even
single worm); common bile duct
Trichuris eggs – barrel-shaped, Japanese
( cholelithiasis) ; 3 lips, 2 spicules
lantern, football
( Lipsum sensory papillae)

• Treatment: (broad spectrum)

• protruding bipolar plugs
• embryonation (i) : 3weeks • Direct Fecal Smear

• No respiratory symptoms
• Kato-Katz Technique

• Heavy infection
•
•
Concentration Technique
(Recovery of eggs in the stool specimen)
Abdominal pain

• Trichuris trichiura

•
Diarrhea

• Dysentery
Prevention and Control:

• Anemia • Proper disposal of feces.

• Rectal prolapse • Hand washing.

•
Trichuris trichiura

• Life Cycle
Infective Stage
AVOID using human fecal matter as
fertilizer.
- embryonated egg
Definitive Host
- humans
• Community eudcation.

Diagnostic Stage Trichuris trichiura

- egg (unsegmented)

• No heart and lung phase

• Treatment:

• Resides in the large intestine • Piperazine citrate

• No intermediate host needed

Trichuris trichiura
• Mebendazole

• Pathology:
• Pyrantel Pamoate

•
Capillaria philipinensis
mild ulceration
•
• Abdominal pain
•
Peanut shaped (pitted shell)

1963 – first reported PGH

• Diarrhea • 1967, epidemic in Capillariasis in

•
Pudoc, West Tagudin, Ilocos Sur
(approximately 1,300 persons became
“rectal prolapse” ill and 90 persons died of the infection)
Trichuris trichiura
•
• Diagnosis:
“Mystery disease” or “pudok disease”
• Females: typical  uterus (1 row of
eggs); reproduction oviparous • Prevention and Control:

• atypical  2-3 rows of eggs; larviparous

•
•
Proper disposal of feces.

•
Males: with a sheathed spicule, without
spines

•
Proper cooking of fishes.

•
+ stichocytes – for attachment and
prenetration (both male and female)
Freezing of fishes.
Capillaria philipinensis Hookworms

• Diagnostic Stage – adults, larvae,

unembryonated egg (stool) by typical
• Human: Necator americanus (New World);
Ancylostoma duodenale ( old world)
female

• Water: embryonated egg

• Animals: Ancylostoma braziliense (rat
hookworm); Ancylostoma caninum (dog
• Fish : 3rd stage larvae (infective stage);
hookworm)
“jumping (fish) salad”
• Copulatory bursa – (fan-shaped) for
• Birds : natural definitive host; reservoir identification (males)

•
host

• Disease – autoinfection due to atypical

Buccal capsule – (dental pattern) is used
for identification

•
females
N. americanus – pair of semilunar
• - chronic intractable diarrhea plates

• - abdominal pain
• A. duodenale – 2 pairs of teeth

•
• - gurgling of stomach (Borborygmi)
•
A. braziliense – 1 pair of teeth

A. caninum – 3 pairs of teeth

• - flattened villi (malabsorption)
Hookworms
• - protein-losing enteropathy

Capillaria philippinensis • LS: Eggs in Feces Rhabditiform 

•
Filariform (i)

Diagnosis: • Humans: Filariform (penetrates skin) 

•
heart-lung phase  adult

Demonstration of characteristic
eggs in the feces.
• Rhabditiform: feeding stage (open-mouth)

•
•
Filariform: infective stage (closed-mouth)

Larva and adult stages may also

be seen. • Hookworm disease: Anemia
Capillaria philippinensis
• Hookworm infection • Bulbuous esophagus

• Skin penetration- “ground itch” (human) • Long buccal cavity (approximately as

•
long as the width of the body)
- “creeping eruption” (animals) 
cutaneous larva migrans serpigenous
tunnel
• Inconspicuous genital primordium
Hookworms

Hookworms
• Morphology:
Filariform Larva:

• Larval migration – ( - lungs)

respiratory symptoms  “wakana • Infective, non-feeding stage

•
disease”

• 700 um long

•
Adults – suck out blood (anemia)

• - microcytic hypochromic anemia (IDA)

Straight espohagus (1/4 of the length
of the body)

• - A. duodenale ( increase blood loss –

0.15 – 0.25 mL/day)
• Pointed tail
Hookworms

• - Necator (0.03 mL/day) • Life Cycle:

Infective Stage
Hookworms - filariform larva
Definitive Host

• Morphology:
Female Worm:
- humans
Diagnostic Stage
- Eggs

•
Hookworms

•
10-13 mm long
• Diagnosis:

•
Pointed tail

• Adults may live 2-14 years

Demonstration of characteristic egg in
the feces (2-8 cell stages)

• Rarely seen in the stool since firmly

attached to the mucosa
• Larva is not seen in feces (unless the
specimen is left for 24 hours)
Hookworms

•
Hookworms

•
Morphology:
Rhabditiform Larva:
Diagnosis:

• Non-infective, feeding stage

R-E-M-E-M-B-E-R

If a stool specimen is left at room temperature,

the larva may continue to develop
 and must be differentiated with
Strongyloides. Strongyloides stercoralis – “Thread worm”

Strongyloides stercoralis – “Thread worm” Differential: (Hookworm and Ss)

• • Rhabditiform Larva
Facultative parasite : (free-living adults:
male/female) •1. Buccal canal – open: wider (Ss),
longer (Hw)
• Parasitic female: (inside intestines; female
only)
•2. esophagus
•3. genital primordium – conspicuous
• Filariform with 4 distinct lips
(Ss), not evident (HW)

• Undergo parthenogenesis (fertilize self)

• Filariform Larva

• Habitates the duodenum (like Giardia)

1. tail – shallow biforkation (Hw);
BIFID/notched (Ss)

•
2. buccal canal- closed
Produce fertilized eggs rhabditiform (d)
Strongyloides stercoralis

• Autoinfection – immunocompromised • Life Cycle:

•
Infective Stage
Rhabditiform – feeding statge - Filariform Larva
Definitive Host
• Filariform larva - infective stage
- Humans, Monkeys
Diagnostic Stage
- Rhabditiform Larva
Strongyloides stercoralis – “Thread worm” in stool sample
Disease : skin penetration: larva currens NB: Eggs hatch in mucosa of intestines and
•lung migration: Loeffler’s syndrome; increased are rarely seen in feces.
It has both a free-living and
eosinophilia, increased IgE
parasitic cycle.
•intestinal: mistaken as peptic ulcer disease, Enterobius vermicularis
“Seat worm/ Pin worm” “Oxyuris”
“Cochin-China diarrhea”

•immunocompromised: hyperinfection,
extraintestinal disease • Adults: + cephalic alae (winged-like
•Dx Spx: (R) stool; (F) sputum; (A) duodenal expansion); cecum
aspirate

• Baermann Technique – Female: straight Measures 8 to 13 mm by

0.4 mm; male: curved, die after copulation
• If R. larvae constantly eats, it remains as R. Measures 2 to 5 mm by 0.1 to 0.2 mm.
larvae

•If not, it becomes F. larva

• Egg shell – flattened one side (lopsided/
D-shaped)

• Free-living Male (ss) • with larva inside, infective stage

•ventrally curved tail, 2 copulatory-spicules,
gubernaculum but no caudal aloe
• eggs are deposited in perianal skin
(requires oxygen)
• become adults in small intestine  female
adults (larviparous)

• maturation time to larva ( 4 - 6 hours) • larva deposited in mucosa

Enterobius vermicularis
“Seat worm/ Pin worm” “Oxyuris”
• encysted larva in striated muscles; or in
feces (seldom)  “blind/dead end alley”
infection (only in man)

• Disease : “Oxyuriasis or Enterobiasis”

• Other hosts: rodents, pigs

• pruritus ani – lack of sleep, 2o bacterial

infection Trichinella spiralis – “ pork worm”

• extraintestinal – vagina, uterus, fallopian

tube, peritoneal cavity • -anterior end: + stichocytes

• familial and easy transmission : (1)

airborne, (2) hand to mouth, (3) infected
• - Dx: SPx

linens
• muscle biopsy,
• Diagnosis: scotch tape swab (with
Toluene cleaning agent
• Bachman Intradermal Test,

•
•
Bentonite Flocculation Test
(BFT/LFT),
simultaneously treated especially if familial

Enterobius vermicularis
• ELISA

•
•
Enzyme Detection (Creatinine
phosphokinase, LDH, myokinase),
Life Cycle:
Infective Stage
- embryonated egg
• Beck’s Xenodiagnosis (animal
experimentation) *infected
Definitive Host muscles  albino rats/mice
- Humans
No IH needed
Autoinfection is very
possible • autopsy, + (female trichinella), + larvae

Extra-intestinal Nematode Trichinella spiralis

Trichinella spiralis – “ pork worm”

• Clinical Disease

• adult male: conical papillae (copulation); • Destruction of the muscle fiber.

•
spicule is absent

• Eosinophilia

•
LS = encysted larva : (infective and
diagnostic stage)
May have myocardial involvement
 Trichinella spiralis Blood and Tissue Nematodes

• Prevention and Control • The “microfilariae group”

•
•
Sterilizing garbage containing raw
meat scraps.
Wuchereria bancrofti

• Cook meat properly (77oC or 170oF).

•
•
Brugia malayi
Storage at
for 6 days.
-150C for 20 days or -300C
• Loa loa

• Screening of pigs.
• Onchocerca volvulus

• Public Education.
Wuchereria bancrofti

Trichinella spiralis
•
•
Diseases:
- Bancroftian filariasis
Treatment: - Wucheriasis
- Elephantiasis

• Thiabendazole
Wuchereria bancrofti

• Mebendazole • Microfilaria:
- sheathed
- no nuclei at the tip of the
Blood and Tissue Nematodes tail

• The “microfilariae group”

- norturnal periodicity (9pm-2am
is its greatest concentration in the
blood)

• General characteristics:
Wuchereria bancrofti

• Require an arthropod as an
intermediate host.
• Elephantiasis:
- permanent blockage of
lymphatic system can occur in
• Diagnosis is made by examining
Giemsa stained thick and thin blood
LOWER extremities

smears (except O. volvulus – skin Wuchereria bancrofti

scraping from nodules)

• They exhibit periodicity. • Diagnosis:

- demonstrate in blood smears
(thick and thin) sheathed microfilariae
with no nuclei at the tip of the tail
 Brugia malayi - allergic reaction due to worm

•
migration in tissue and death in
capillaries
Disease: Loa loa
- Malayan filariasis

Brugia malayi
• Diagnosis:
- demonstrate in blood smears

•
(thick and thin) sheathed microfilariae
with continuous nuclei to the tip of the
Microfilariae: tail
- sheathed - found in Africa
- nuclei stops then there is Onchocerca volvulus
a clear space with 2 distinct
nuclei at the tip of the tail
- exhibits SUB-periodicity • Also known as the “Blinding Worm”

Brugia malayi • Disease:

- Onchocerciasis

• Elephantiasis:
- restricted to the UPPER
- Onchocercosis
- River blindness
Onchocerca volvulus

•
extremities

Microfilariae
Brugia malayi - only pathogenic tissue
nematode which is not sheathed

• Diagnosis:
- demonstrate in blood smears
- no nuclei at the tip of the tail
- found in nodules under skin,
not in peripheral blood
(thick and thin) sheathed microfilariae Onchocerca volvulus

•
with 2 terminal nuclei in tail

• Generally found in the Far East

Clinical Significance/Disease:
- sever dermatitis
- microfilaria in ocular
structures may result in
Loa loa blindness

•
- leading cause of blindness
in Africa
Also known as the “Eye Worm”
Onchocerca volvulus

• Microfilariae
- sheathed • Diagnosis:
- nuclei up to the tip of the - demonstrate from skin
tail snips/tissue scrapings unsheathed
- exhibits diurnal periodicity microfilariae with no nuclei in tail
(microfilaria is shed in peripheral Tissue Nematodes

•
blood constantly day or night)
NB:
Loa loa TPE or tropical pulmonary
eosinophilia is associated with the

• Causes calabar swellings

microfilariae of these nematodes
Tissue Nematodes
 Treatment/Prevention/ Life Cycle

•
Control

• Control on mosquitoes and human

Infective Stage – 3rd stage larva

•
sources of infection.
• Definitive host – humans, dogs, horses

•
Spraying of houses with residual
insecticides.
Intermediate host - cyclops

• Diethylcarbamazime (DEC) Life Cycle

Dracunculus medenensis

• Ivermectin • Infective Stage – 3rd stage larva

•
Dracunculus medinensis
Common Name:
Definitive host – humans, dogs, horses

• Guinea worm
• Intermediate host - cyclops

• Fiery serpent Treatment:

Dracunculus medenensis

• Medina Worm
• Removal of Worm

•
Disease:

• Dracunculiasis Filtering water sources

•
Dracunculus medenensis

• found in the subcutaneous tissues and

muscles of humans, dogs, and sometimes cattle
Avoid contact with contaminated
water
Angiostrongylus cantonensis
and horses Common Name:

•
• cutaneous nodules and subsequent ulcers
Dracunculus medenensis •
Rat-Lung Worm

Was described by Chen in 1935 from

Morphology domestic rats in Canton, China

• Males are small (1.2-2.9 cm long) • The worm normally lives in the lungs

• Females measures 60cm in length

of rats but can cause eosinophilic
meningoencephalitis in man
Angiostrongylus cantonensis

• Disease:

•
The larvae, which measure between 500
and 700 micrometers, can live for 6 days
in clean water and 2 to 3 weeks in muddy
water. Angiostrongyliasis
Dracunculus medenensis
• Eosinophilic meningoencephalitis
• Presumptive diagnosis is made by
travel history and exposure

•
Angiostrongylus cantonensis
Morphology
CSF (10% eosinophilia in proportion

• Male:
- pale and filiform, 16 to 19 mm x 0.26
•
to the WBC)

CT Scan
mm in diameter
- well-developed caudal bursa
(kidney-shaped and single-lobed) • ELISA
Angiostrongylus cantonensis
Angiostrongylus cantonensis Prevention/Control
Morphology

• Female: • Proper eating habits

•
- pale and filiform, 21 to 25 mm x
0.30-0.36 mm in diameter
- uterus round spirally around the Safe food preparation

•
intestine (barber’s pole pattern)
- lays 15,000 eggs/day
Elimination of IH

•
Angiostrongylus cantonensis
Eggs

•
Washing of leafy vegetables

Have delicate hyaline shells

• Eating sufficiently cooked prawns and

•
crabs

Measure 46-48 micra x 68 micra

•
Angiostrongylus cantonensis
Treatment

•
Unembryonated when oviposited
Angiostrongylus cantonensis
Life Cycle No antihelminthic treatment is
recommended

• Infective stage – 3rd stage larva

•
•
Thiabendazole, Medendazole,
Albendazole, Ivermectin (effective in
Definitive host – rats, humans experimental animals)

• Intermediate host – snails

(Achantina fulica)
Phylum Platyhelminthes

Angiostrongylus cantonensis Phylum Platyhelmintes

Diagnosis
•
•
FLATWORMS
Relatively difficult
• dorsoventrally flattened, bilaterally
symmetrical
 • covered by a membrane called
tegument
 Cyclophyllidea

•  Taenia solium and Taenia saginata


hermaphrodite, except for
Schistosoma species Hymenolepis nana and Hymenolepis
diminuta
Phylum Platyhelmintes
 Dipylidium caninum

• Class Cestoda  Raellitiena garrisoni



Echinococcus granulosus
Class Trematoda 3 types of proglottid:
C. Free-living flatworms
(Turbellarians)
Characteristics of Class Cestoda
• immature – undeveloped sexual organ,
nearest to the neck

• Taenia species (example) • mature – fully mature sexual organ

• Adult worms are seen in the intestine

• gravid – contains fertilized egg,
• Proglottids contain male and female parts
undergoes apolysis

• Eggs have 6 hooked embryos

Apolysis- normal process of detachment of the
gravid proglottid from the adult worm
General Structure of Tapeworms
• World-wide distribution
General Anatomy of Tapeworms
Species of Class Cestoda

• nOrespiratory, vascular, or digestive

system
• Species which require a vertebrate
intermediate host

• Ribbon-like body, flat – Taenia solium (pork tapeworm)

• Middle (intermediate host is required) – Taenia saginata (beef tapeworm)

Class Cestoda
– Echinococcus granulosus
(hydatid worm)

• Pseudophyllidea
Species of Class Trematoda

 Diphyllobothrium latum
Species which require an invertebrate
intermediate host

 Spirometra
• Dipylidium caninum (dog tapeworm,
double-pored tapeworm)
• Hymenolepis diminuta (rat tapeworm) • Dse: Megaloplastic anemia  parasites

•
compete with 3 VB12 absorption

Raillietina garrisoni

Species of Class Trematoda

• Stool examination: only eggs

Species which may or may not require Pseudophyllidean vs. Cyclophyllidean

intermediate host SCOLEX

•
Spatulated with bothria

Hymenolepis nana (dwarf tapeworm)

Species of Class Cestoda

Species which infect man in their larval
stages SEGMENTS

•
Genital pores + uterine pores
SCOLEX
Echinococcus granulosus (hydatid Globular with four muscular suckers
worm)

• Echinococcus multilocularis

• Taenia solium
SEGMENTS
No uterine pore but undergoes apolysis
D. latum vs. Cyclophyllidean

• Diphyllobothrium latum
Diphyllobpthrium latum: “broad fish
EGGS
Operculated, Immature, requires aquatic
vegetation to develop
tapeworm”

• scolex: spatulate/ spoon-like with 2

sucking grooves HOST

•
1st IH procercoid larva
EGGS
segments: anapolytic with uterine pore Passed out readily with hexacanth embryo
(with eggs of parasite), gravid (rosette
uterus)

• eggs: operculated

• Embryo: coracidium
HOST
One IH depending on species
Pseudophyllidean vs. Cyclophyllidean

• 2 intermediate hosts contain:

2nd IH plerocercoid
Taenia – cysticercus
Hymenolepis, Dipylidium, Raillietina –

• 1st IH : Cyclops/diatomus = procercoid

cysticercoid type
Echinococcus - hydatid

• 2nd IH: Fish (trout) = plerocercoid

Taenia solium vs Taenia saginata
Taenia solium vs Taenia saginata
 Taenia solium vs Taenia saginata bears a prominent rostellum with double row of
Taenia solium vs Taenia saginata 20 to 40 large and small hooklets
Taenia solium vs Taenia saginata Echinococcus granulosus
Taenia solium vs Taenia saginata 3 segments
Taenia solium vs Taenia saginata 1 immature
Taenia solium vs Taenia saginata 1 elongated mature
Taenia solium vs Taenia saginata 1 long gravid
Taenia solium vs Taenia saginata
Taenia solium vs Taenia saginata Echinococcus granulosus
Taenia solium vs Taenia saginata
Taenia solium vs Taenia saginata subspherical with a brown radially striated
Taenia solium vs Taenia saginata embryophore which cannot be differentiated
Taenia solium vs Taenia saginata from Taenia eggs
Taenia saginata asiatica or Taenia asiatica

•
Hydatid cyst
Echinococcus granulosus
Emerging infection in Asia Echinococcus granulosus
Echinococcus granulosus

• Acquired from eating raw pig liver, cattle,

goat
•
Quick Quiz

The cestode morphologic form

•
characterized by a segmented
appearance that houses male and
Contains a sunken rostellum and 2 rows of female reproductive structures is
hooklets unlike T. saginata
referred to as:

• Multiple adults may be present • Scolex

• Proglottid
Hymenolepis
nana vs
Hymenolepis
diminuta
Hymenolepis nana vs Hymenolepis
• Egg

diminuta
Hymenolepis nana vs Hymenolepis diminuta
• cyst
Quick Quiz
Hymenolepis nana vs Hymenolepis diminuta
Hymenolepis nana vs Hymenolepis diminuta
Hymenolepis nana vs Hymenolepis diminuta
Hymenolepis nana vs Hymenolepis diminuta
• Characteristics of the cestodes include
all of the following except:
Hymenolepis nana vs Hymenolepis diminuta
Hymenolepis nana vs Hymenolepis diminuta
Hymenolepis nana vs Hymenolepis diminuta • They are hermaphrroditic

Dipylidium
caninum vs
Raellitina
garrisoni
• They generally require IH

Dipylidium caninum
Dipylidium caninum
vs
vs
Raellitina garrisoni
Raellitina garrisoni • Their laboratory diagnosis consist of
finding larvae in the feces
Dipylidium caninum vs Raellitina garrisoni

Dipylidium caninum vs
Dipylidium caninum vs
Raellitina garrisoni
Raellitina garrisoni
• Their anatomic regions include the
scolex, neck, and strobila
Quick Quiz
Echinococcus granulosus
Echinococcus granulosus
• A persistent cough, localized pain, and
liver and lung involvement are
• A primary differential feature between
an H. nana egg and H. diminuta egg is
associated with an infection with which which of the following?
of the following cestodes?

• D. latum
• A flattened side for H. dimunta egg

• E. granulosus
• a thick shell for H. nana egg

• Both A and B
• Polar filaments in H.nana egg

• Neither A nor B
• Radial striations in H. diminuta egg
Quick Quiz

•
Quick Quiz

• Which of the following are key

distinguishing factors in differentiating
A unique characteristic of Dipylidium
caninum is which of the following?

an infection between T. saginata and T.

solium? • Lack of suckers on the scolex

• Egg morphology and number of uterine

branches in proglottid
• Formation of egg pockets

• Presence of hooklets on scolex and egg

• Proglottid resemblance to Taenia solium

morphology
• Alternation of female and male

• Presence of hooklets and number of

uterine branches in proglottid
proglottids
Quick Quiz

• Egg morphology and presence of

suckers on scolex
• A 2-year old girl and her pet dog were
diagnosed with D. caninum infection.
Quick Quiz This infection was acquired by which of
the following?

• Which of the following is characteristic

of an H. diminuta egg?
• Ingestion of the parasite’s egg

• Spherical, with radial striations

• Penetration of soil larva

• Ellipsoid, with terminal polar plugs

• Ingestion of a flea

• Oval, with thin shell and polar filaments

• Consumption of poorly cooked beef
Quick Quiz

• Oval, with polar thickenings and no

filaments
Quick Quiz
• Prevention and control measures to
prevent D. caninum infection include all
except which of the following?

• Treat dog and cat pets to prevent fleas

• Warn children against dog and cat ticks • Which of the following procedures would
not be appropriate for diagnosing an
• Deworm dog and cat pets, as needed infection with Echinococcus granulosus?

• Neuter dog and cat pets

Quick Quiz
• Serologic procedure, such as ELISA

•
•
O&P examination of stool specimen
The egg of D. latum is unique among
the cestodes in that it contains which of
the following?
• CT scan of suspect organ

• An operculum and terminal knob

• Biopsy of cyst
Quick Quiz

• Radial striations and oncospore • In humans, Echinococcus granulosus

infection results in which of the
• An operculum and lateral spine following?

• A ciliated rhabiditiform larva • Eggs similar to those of H. nana

Quick Quiz
•
•
A nutritional deficiency
Which of the following associations is
correct for D. latum? • A hyatid cyst

• Snail-coracidium • Filariform larva

Quick Quiz
•
•
Copepod-procercoid

Fish-cysticercus
• Which of the following is the usual site
for Echinococcus ganulosus infection in
humans?
• Beetle-pleurocercoid
Quick Quiz • Brain

• The primary pathology associated with

• Liver
D. latum is which of the following?
• Lung
• Eosinophilic pneumonitis
• Genitalia
• Vitamin D deficiency
Classification of Ova

Schistosoma
• Vitamin B12 deficiency
Mature

Opithorchis
• Fat malabsorption
Quick Quiz
Clonorchis
Heterophyids
Immature
Paragonimus
 –
Fasciola
Fasciolopsis Emerges from daughter sporocysts
Echinostoma
Schistosoma spp – Escapes from the snail
BLOOD FLUKES: Schistosomes
– Has a body and a forked tail

• Schistosomes
– Infects man by skin penetration

– Schistosoma japonicum : Oriental

blood fluke
•
Schistosomulae

Schistosomule

– Schistosoma haematobium:
Vesical blood fuke
– Develops from cercaria after skin
penetration

–
– Schistosoma mansoni: Manson’s
Adapted to survive in serum or
physiologic saline at 37 0C
blood fluke
Schistosome Miracidium – Enter the pleural cavity---
diaphragm---peritoneal space---

• Miracidium
penetrate the liver to reach the
intrahepatic portions of the portal

– Hatches from the egg in slightly

alkaline clean water with a temp.
vein

between 25 0C to 310C

–
Schistosoma japonicum

•
Free swimming cilated embryo
liberated from the egg Schistosoma japonicum

– Photactic – Life cycle involves alternating

– Infect snails
parasitic stages in mammalian
hosts and free living stages

• Egg and miracidium

Schistosome Sporocysts and Cercaria
• First stage (mother)
• Mother sporocysts develop from
miracidium within the snail •
sporocyst

Second stage (daughter)

•
sporocyst
Daughter sporocyst develops from mother
sporocyst
• cercaria

•
• Cercariae develop from daughter
sporocyst •
Schistosomulum

Adult schistosome

Schistosome Cercaria Schistosoma japonicum

• Cercaria
• Schistosoma japonicum
 –
Schistosoma haematobium

•
Primarily parasites of the portal
vein and its branches Schistosoma haematobium adult

– Each female fluke deposits 500-

2000 immature eggs/day Schistosoma haematobium

–
–
Embryonation takes place within
10-12 days
• Schistosoma haematobium ova
Eggs escape through ulcerations in
the intestinal lumen and are
passed out with the feces
Schistosoma japonicum
– Note the presence of terminal
spine

•
Pathogenesis and Clinical Manifestations
Schistosoma japonicum in eternal copula
•
–
Schistosomiasis
Males have a gynecophoral canal
which receives the female during
copulation
• Host granulomatous reaction to eggs

Schistosoma japonicum • Pneumonitis due to schistosomula in the

•
lungs
Schistosoma japonicum Ova

– Ovoidal, rounded or pear-shaped

• Hepatosplenic disease

– Thin shell • Colonic schistosomiasis

– Pale yellow • Cerebral schistosomiasis

– Curved hook or spine or lateral
knob
Blood Flukes: Schistosomiasis

Blood Flukes: Diagnosis

– Laid in the multicellular stage and

embryonte within 10-12 days

Schistosoma mansoni
• Schistosomiasis

• Schistosoma mansoni male and female – Eggs may not be demonstrable in

the feces
– Female inside the gynecophoral
canal of male

Schistosoma mansoni
– Infections where there is scarring
prevent passage of eggs into the

• Schistosoma mansoni male and female

intestinal lumen

Blood Flukes: Diagnosis

– Female inside the gynecophoral

•
canal of male
Schistosomiasis
 –
Assay (ELISA)
using soluble
Stool Examination Techniques
antigens of adults
• Merthiolate-Iodine Formlin
Concentration Technique
and eggs

Blood Flukes: Treatment

(MIFC)

– Sensitive for
moderate and
• Treatment

heavy infections
– Praziquantel (heterocyclic
– Not adequate for prazinoisoquinolone compound)
light infections (less
than 10 eggs/gram – Single dose of 40-50 mg/kg

–
of stool)

• Kato KatzTechnique
25 mg/kg in two doses

– For enumeration of – 20 mg/kg in three doses

eggs

– Most commonly Blood Flukes: Epidemiology

used for evaluating

•
epidemiology, effect
of control
measures, drug In the Philippines

–
trials

24 endemic provinces

•
Blood Flukes: Diagnosis
Sorsogon

• Schistosomiasis • Oriental Mindoro

• Immunodiagnosis • Samar

– Intradermal tests for • Leyte

•
immediate
cutaneous Bohol
hypersensitivity
using adult worm
extracts • All provinces in Mindanao
except Misamis Oriental
– Indirect
hemagglutination
Liver Flukes
using adult worm Fasciola hepatica / Fasciola gigantica
and egg antigens
Sheep-Liver Fluke

– Circumoval
precipitin test
Giant Liver Fluke
Fasciola species

– Enzyme-Linked
Immunosorbent
• Found in the liver and biliary passages of
humans and ruminants
 •
• Fasciola hepatica
•
Ulceration

–
Diarrhea (sometimes bloody)
Sheep liver fluke
•
–
Abdominal pains
Temperate liver fluke
•
•
General intoxication
Epidemiology Echinostoma ilocanum
Fasciola gigantica

– Giant liver fluke • Echinostoma ilocanum is endemic in:

– Tropical liver fluke – Northern Luzon

Clonorchis sinensis
Chinese-Liver Fluke
Opisthorchis felineus/
– Leyte

Opisthorchis viverrini
Cat-Liver Fluke – Samar
INTESTINAL FLUKES
– Mindanao provinces

•
Fasciolopsis buski
Giant Intestinal Fluke
Heterophyid Group Artyfechinostomum malayanum

Echinostoma ilocanum
Garrison’s Fluke
– First reported in 1987
Intestinal Flukes:
Echinostoma ilocanum – Northern and Central Luzon
LUNG FLUKE

• Second Intermediate Host: Paragonimus westermani

Oriental Lung Fluke

– Pila luzonica (kuhol)

•
Lung Flukes: Paragonimus westermani

Paragonimus westermani adult

– Vivipara angularis (susong

pampang)
–
–
Hermaphroditic

Body covered with spines

Pathogenesis and Clinical Manifestations

– Reddish brown
Echinostoma ilocanum – Measures 4-6 mm in width and 3.5-

• Man gets infected when metacercariae in

the second intermediate hosts are –
5 mm in thickness

Resembles a coffee bean

ingested
– Adult worms are found in pairs or in
• Inflammation at the site of attachment of
adults
threes in fibrotic capsules or cysts
in the lungs

Paragonimus westermani
• Paragonimus westermani ova
•
Eurytrema pancreaticum

–
Pancreatic fluke
Yellowish brown
•
–
Stout worm with ruffled margins

Thick-shelled
• oral sucker is larger than the ventral

– Operculated with a thickened

abopercular egg
sucker

– May be seen in the sputum or in Eurytrema pancreaticum

•
feces if the sputum is swallowed
Pathogenesis and Clinical Manifestations
First Intermediate Host:

• Paragonimiasis – Macrochlamys indica (snail)

–
•
Cough

– Hemoptysis
Second intermediate Host:

– Symptoms consistent with

– Technomyrmex deterquens (ant)
pulmonary tuberculosis

– Misdiagnosed as PTB
Eurytrema pancreaticum

•
Epidemiology of Paragonimiasis
• Ova

•
Has a global distribution
– Operculated

–
In the Philippines

– Leyte Thick shelled

–
–
Sorsogon
– Dark brown in color

–
Mindoro

– Camarines Embryonated when laid

– Samar
Quick Quiz

– Davao • The first intermediate host for all

– Cotabato
trematodes is which of the following?

– Basilan
• Fish
Pancreatic Fluke
• Shrimp • Direct and concentration examinations
of stool
• Snail
• Following surgery and after autopsy
• Water plant
• Following surgery and duodenal
Quick Quiz aspiration

• Fasciolopsis buski infects which organ

in humans?
Quick Quiz

• Which of the following is a

• Bile ducts
recommended prevention and control
strategy designed to halt the spread of

• Liver
Clonorchis?

• Colon • Consuming raw, pickled. Freshwater

fish
• Small intestine
• Protecting food from flies
Quick Quiz
•
• The determination of Fasciolopsis
versus Fasciola can only be •
Avoidance of swimming in fresh water

Proper human and reservoir hot fecal

accomplished in the laboratory by the disposal
recovery of which of the following?

Quick Quiz
•
•
Eggs

• Larvae
The key feature that distinguishes
Heterophyes and Clonorchis ova is
which of the following?
• Adults

• Sporocyst
• Size

Quick Quiz
• Shape

•
• What procedures must be done to
recover the adult form of Clonorchis •
Appearance of shoulders

Location of operculum
sinensis?

Quick Quiz
• Direct examination of stool and after
autopsy
• The treatment of choice for Heterophyes
Quick Quiz

and Metagonimus which of the

following? • The typical transmission route of
Paragonimus to human consists of
which of the following?
• Niclosamide

• Praziquantel
• Consumption of contaminated crayfish
or crabs

• Pyrantel pamoate
• Swimming in contaminated water

• Metronidazole
• Hand-to-mouth contamination
Quick Quiz
•
•
Walking barefooted on cantaminated
sandy soil
The specimen of choice for the recovery
of Heterophyes and Metagonimus which
of the following?
Quick Quiz

• Stool
• The specimen of choice for the recovery

• Duodenal aspirate
of Schistosoma japonicum is which of
the following?

• Urine
• Tissue biopsy
• Sputum
• Urine

Quick Quiz
• Sputum

• In addition to its typical location,

Paragonimus eggs are also known to
• Stool

cause serious complications when

recovered in which of the following?

• Bile Quick Quiz

• CSF • The adults of this species of

Schistosoma dwell in the veins
• Brain tissue
surrounding the urinary bladder:

• Feces
• S. haematobium
• S. mansoni

• S. japonicum

• All of the above

Quick Quiz

• A systemic hypersensitivity reaction

caused by the presence of Schistosoma
is called which of the followin?

• Bilharziasis

• Katayama fever

• Swamp fever

• Shistosomiasis