Symptomology

Symptomology is branch of medical science concerned with the

aggregate symptoms of the disease in the body. So, symptomology is the set of
symptoms characteristic of a medical condition or exhibited by a patient.
Symptom is Greek word meaning accident, misfortune, or is a departure from
normal function or feeling which is apparent to a patient, reflecting the presence
of an unusual state, or of a disease. 

Types
Symptoms may be briefly acute or a more prolonged but acute
or chronic, relapsing or remitting. 
1. Asymptomatic conditions also exist (e.g. subclinical infections and silent
diseases like sometimes, high blood pressure).
2. Constitutional or General symptoms are those related to the systemic
effects of a disease (e.g., fever, malaise, anorexia, and weight loss). They
affect the entire body rather than a specific organ or location.
3. Presenting symptom are used to describe the initial concern which brings a
patient to a doctor for proper diagnosis and treatment.
4. Cardinal symptom are those symptoms that ultimately leads to a proper
diagnosis or treatment.
5. Non-specific symptoms are self-reported symptoms that do not indicate a
specific disease process or involve an isolated body system. For
example, fatigue is a feature of many acute and chronic medical conditions,
which may or may not be mental, and may be either a primary or secondary
symptom. Fatigue is also a normal, healthy condition when experienced after
exertion or at the end of a day.
6. Positive symptoms are symptoms present in the disorder but not normally
experienced by most individuals. Examples are hallucinations, delusions,
and bizarre behavior.
7. Negative symptoms are functions that are normally found in healthy
persons, but that are diminished or not present in affected persons. Examples
are social withdrawal, apathy, feelings, pleasure and defects in attention
control.

General Symptoms
Abdominal Pain, Diarrhea, Nausea, Vomiting, Dysentery with blood/
mucus, Gas/ bloating, Rashes/ Itching around the rectum and vulva, feeling
tiredness, Weight loss, Passing a worm in stools
The parasitologist Cox noted that:
"Humans are hosts to nearly 300 species of parasitic worms and over 70
species of protozoa, some derived from our primate ancestors and some
acquired from the animals we have domesticated or come in contact with during
our relatively short history on Earth".
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Hymenolepis Nana
Hymenolepis nana are also known as
Rodentolepis nana, Vampirolepis nana or dwarf Scientific classification
tapeworm. It is a cosmopolitan species though most
common in temperate zones, and is one of the most Kingdom: Animalia
common cestodes (a type of intestinal worm
Phylum: Platyhelminthes
or helminth) infecting humans, especially children.
Hymenolepiasis is the most common intestinal Class: Cestoda
tapeworm infection of humans caused by it. This
Order: Cyclophyllidea
infection does not require an intermediate host and
infection can occur directly from one infected person Family: Hymenolepididae
to another by fecal-oral transmission.
Genus: Hymenolepis
Hymenolepis nana is derived from Latin
word nanos – dwarf, it is a small species, seldom Species: H. nana
exceeding 40 mm long and 1 mm wide.
Life Cycle
Infection is acquired mostly from eggs in the feces of another infected
individual, which are transferred in food, by contamination. Eggs hatch in the
duodenum, releasing oncospheres, which penetrate the mucosa and come to lie
in lymph channels of the villi. An oncosphere develops into a cysticercoid
which has a tail and a well-formed scolex. It is made of longitudinal fibers and
is spade-shaped with the rest of the worm still inside the cyst. In 5-6 days,
cysticercoids emerge into the lumen of the small intestine, where they attach
and mature.
Reproduction
H. nana, like all tapeworms, contains both male and female reproductive
structures in each proglottid. This means that the dwarf tapeworm, like other
tapeworms is hermaphroditic. Each segment contains three testes and a single
ovary. When a proglottid becomes old and unable to absorb any more nutrition,
it is released and is passed through the host's digestive tract. This gravid
proglottid contains the fertilized eggs, which are sometimes expelled with the
feces. However, most of the time, the egg may also settle in the microvilli of the
small intestine, hatch, and the larvae can develop to sexual maturity without
ever leaving the host.
Nutrition
The dwarf tapeworm, like all other tapeworms, lacks a digestive system
and feeds by absorption on nutrients in the intestinal lumen.
Epidemiology
The dwarf tapeworm or Hymenolepis nana is found worldwide. More
common in warm parts of South Europe, Russia, US and Latin America and
Asia. Infection is most common in children, in persons living in institutional
settings, crowded environments and in people who live in areas where sanitation
and personal hygiene is inadequate.
Infection is most common in children aged 4–10 years, in dry, warm
regions of the developing world. About 75 million carriers of H. nana with up to
25% prevalence in children worldwide as recorded per the report of UN. One
becomes infected by accidentally ingesting dwarf tapeworm eggs, ingesting
fecal contaminated foods or water, by touching mouth with contaminated
fingers, or by ingesting contaminated soil, and/or accidentally ingesting an
infected arthropod.
Symptoms
It ranges from mild (Asymptomatic) to severe.
Toxemia Intestinal inflammation Diarrhea Abdominal pain Anorexia
Nausea Loss of appetite Weakness Difficulty sleeping
Headache Itchy buttocks
Treatment
Single dose of Praziquantel is given. This will affect the parasite after 10
min and after 30 min parasite will be completely paralyzed and dislodged from
human small intestine. Isoquinoline razin is a new broad-spectrum drug with
less side effects.
Prevention
 Good hygiene
 Public health and sanitization should be optimized.
 Elimination of rodents from house.
 This will minimize the spreading of H. nana worms and preventing fecal
contamination of food and water.
 Rodents or insects control spray is also effective.
 Control of flies, green insects and other arthropods is also essential for the
prevention of H. nana infection.
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Giardia Lamblia

Giardia lamblia, also known as Giardia Scientific classification

intestinalis or Giardia duodenalis is a flagellated
parasitic microorganism, that colonizes and Phylum: Metamonada
reproduces in the small intestine either in
Order: Diplomonadida
duodenum or upper part or in jejunum, causing
giardiasis. The parasite attaches to Family: Hexamitidae
the epithelium by the help of a pair of disc or
sucker, and reproduces via longitudinal binary Genus: Giardia
fission. Giardiasis does not spread via the
bloodstream, nor does it spread to other parts of Species: G. lamblia, G. agilis,
the gastrointestinal tract, but remains confined to G. ardeae, G. muris,
the lumen of the small intestine. Giardia G. psittaci, G. microti
trophozoites absorb their nutrients from the
lumen of the small intestine, and are anaerobes. 
So, this infect human, sheep, birds and other primates. Giardia lambliasis
can occur through ingestion of microbial cyst in contaminated or other objects
found in by the fecal route which can be infected animals including humans.
There are two types:
Trophozoites
They are the pyriform (PEAR like shape cell) that will be 10 to 20 µm,7
to 10 µm across ,2 to 4 µm thick. They are motile by way of 4 pairs of flagella
and responsible for propelling the trophozoites towards intestine. It has two
nuclei both of which are actively transcribing mRNA.
Cyst
It has oval shape with long, 5-8µm across and 3-5µm thick. Young cyst
contains two nuclei while on maturation nuclei number will be 4.
Giardia prevalent in warm climate mostly and mostly effects children.
Giardia lack mitochondria, so researcher found other organelles that perform
work of mitochondria which is called MITOSOME.
Cyst are very hard and can persist in very hard environmental condition.
cyst can survive for few weeks to months in very unfavorable environmental
condition i.e. in cold water, in wells in city water reservoir even present after
treatment with chlorine while trophozoites can survive for 1 to 14 days with
average life sustaining expectancy is 7 days.
TRANSMISSION
THIS disease is transmitted from other animals to human, so they cause
zoonotic infection.
SYMOTOMS
Diarrhea, nausea, cramping, fatigue, headache, fever, excessive bloating,
abdominal pain.
TREATMENT
Metronidazole, Tinidazole = more effective but more side effects.
Ciprofloxacin, and Mebendazole = less effective but with no side effects.
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 Trichuris trichuria
Background
Trichuriasis, which is infection with the Scientific classification
parasite Trichuris trichiura, or whipworm, is a very
common intestinal helminthic infection worldwide. Kingdom: Animalia
About one quarter of the world's population is Phylum: Nematoda
thought to carry the parasite. Principally a problem
in tropical Asia and, to a lesser degree, in Africa and Class: Enoplea
South America, a lack of a tissue migration phase
and a relative lack of symptoms characterize Order: Trichocephalida
whipworm infection.
Family: Trichuridae
Trichuris is also nota\]
Genus: Trichuris
\ for its small size compared with Ascaris
lumbricoides. Only individuals with heavy parasite Species: T. trichiura
burden become symptomatic. Vitamin A deficiency
has been seen in patients with trichuriasis.
The human whipworm (Trichuris trichiura or Trichocephalus
trichiuris) is a round worm (a type of helminth) that causes trichuriasis (a type
of helminthiasis which is one of the neglected tropical diseases) when it infects
a human large intestine. It is commonly known as the whipworm which refers to
the shape of the worm; it looks like a whip with wider "handles" at the posterior
end.
Epidemiology
Within the United States, more than 2.2 million people are thought to be
infected each year reported in 2008. Poor hygiene is associated
with trichuriasis as well as the consumption of shaded moist soil, or food that
may have been fecal contaminated. Children are especially vulnerable to
infection due to their high exposure risk. This is especially true in developing
countries, where poor sanitary conditions correlate with heavy disease burden
and infections. 
Morphology
Trichuris trichiura has a narrow anterior esophageal end and shorter and
thicker posterior end. These pinkish-white worms are threaded through
the mucosa. They attach to the host through their slender anterior end and feed
on tissue secretions instead of blood. Females are larger than males;
approximately 35–50 mm long compared to 30–45 mm.
Infection
The relative tissue invasion causes occasional peripheral eosinophilia.
The cecum and colon are the most infected sites, although in heavily infected
individuals, infection can be present in more distal segments of the GI tract,
such as the descending colon and rectum.
Trichuris is spread via fecal-oral transmission. Eggs are deposited in soil
through human feces. After 10-14 days in soil, eggs become infective. In
contrast to other parasites, such as A. lumbricoides, no tissue migratory phase
occurs with Trichuris organisms, confining infection to the GI tract. Larvae
hatch in the small intestine, where they grow and molt, finally taking up
residence in the cecum and ascending colon.
The time from ingestion of eggs to development of mature worms is
approximately 3 months. During this time, there may be no shedding of eggs
and only limited evidence of infection in stool samples. The female Trichuris
begin to lay eggs after 3 months of maturity. Worms may live from 1-5 years,
and adult female worms lay eggs for up to 5 years, shedding up to 20,000 eggs
per day.
Eggs are infective about 2–3 weeks after they are deposited in the soil
under proper conditions of warmth and moisture. They become embryonated
and enter the "infective" stage. These embryonated infective eggs are ingested
and hatch in the human small intestine exploiting the intestinal microflora as
hatching stimulus.
Prevalence of helminth infection was higher in the schools where hygiene
conditions are up to the mark.
Symptoms
Pain full and frequent defecation, bloody diarrhea, abdominal pain
nausea, headache sudden or unexpected weight loss, fecal incontinence,
uncontrollable defecation.

Treatment
Anti-parasitic medication is required i.e. Albendazole, Mebendazole, or
ivermectin. These are the most effective given to the patient either will be given
single dose 2g or 500mg per day for 1 to 3 days if severe. There are no side
effects of Fenbendazole, Moxidectin and are very latest.

Prevention
 To reduce risk of getting Trichuris infection person should wash his hands
properly before handling foods.
 Hygenicity, educate the people not to play with soil, where we kept dogs and
cats and other organisms.
 Wash, peel and cook food thoroughly before eating and otherwise also
advise children not to eat soil and to wash their hands after playing outdoors.
 Boil or purified drinking water that may be contaminated with parasite.
 Avoid contact with soil contaminated fecal matter.
 Use caution around the fecal material and clear fecal material whenever
possible.
 Keep the grass cut short in the area where dogs and cats defecate regularly.
 Installation of effective sewage disposal system.
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Entamoeba Histolytica
Entamoeba histolytica is an anaerobic parasitic amoebozoan, part of
the genus Entamoeba. Predominantly infecting humans and other primates
causing amoebiasis. The word histolysis literally means disintegration and
dissolution of organic tissues.
The pathogenic nature of E. histolytica was first reported by Lösch in
1875, but it was not given its Latin name until Fritz Schaudinn described it in
1903.

Epidemiology
E. histolytica is estimated to infect about 50M people worldwide. E.
histolytica infection is estimated to kill more than 55,000 people each
year. Previously, it was thought that 10% of the world population was infected,
but these figures predate the recognition that at least 90% of these infections
were due to a second species, E. dispar, a more aggressive one. 
Risk factors
Although disease amoebiasis can be present in animals but is most
common in people living in developing and poor countries with unhygienic
sanitary system. It also is found in people who have traveled to developing
countries and in people who live in institutions that have poor sanitary
conditions and water contaminated with Entamoeba histolytica.

Transmission
The infection can be transmitted by loose feces, contaminated water, soil,
food, arthro-flies and other primates. It can also be transmitted by homosexual
mode of mating. It can occur when a person puts anything into their mouth that
has touched the feces of a person who is infected with E. histolytica, swallows
something, such as water or food, that is contaminated with E. histolytica, or
swallows E. histolytica cysts (eggs) picked up from contaminated surfaces or
fingers.
Mammals such as dogs and cats can become infected transiently but are
not thought to contribute significantly to transmission. 

Symptoms
Symptoms of amoebiasis may start about 2-7 days after exposure to E.
histolytica and may include:
A change in the sense of smell or taste Fever Sudden, severe
headache
Stiff neck Nausea and vomiting
In many cases, initial symptoms may include:
Fulminating dysentery, Bloody diarrhea, Weight loss, Fatigue, Abdominal pain,
and Amoeboma. 
The amoeba can actually 'bore' into the intestinal wall,
causing lesions and intestinal symptoms, and it may reach the blood stream.
From there, it can reach different vital organs of the human body, usually the
liver, but sometimes the lungs, brain, spleen, etc.
A common outcome of this invasion of tissues is a liver abscess, which
can be fatal if untreated. Ingested red blood cells are sometimes seen in the
amoeba cell cytoplasm.
Treatment
Several effective antibiotics are available to treat Entamoeba histolytica.
The infected individual will be treated with only one antibiotic if infection is
mild and most likely be prescribed with two antibiotics if severe.
Intestinal infection:
Nitroimidazole, Paromomycin and Diloxanide furoate, will be given
thrice a day for 10 days i.e. 750mg/ day.
Liver abscess:
Metronidazole and chloroquine, will be given twice for 3-5 days i.e.
1000mg/ day.
If severe, Iodoquinol and tinidazole will be given 2-3 times a day for 3-5
days i.e. 2000mg/ day.

Preventions

 Filtering or purifying drinking water with iodine or chlorine or by boiling

 Washing of fruits and vegetables that may have been contaminated by E.

amoeba. 

 Improved sanitation will help to reduce the likelihood of transmission of

parasite.

 Travelers must use bottled water r boiled water.

 Don’t using ice cubes in drinks, and

 Peel off fruits and vegetables before cooking.

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Tuberculosis
 Tuberculosis is an ancient disease that was identified in Egypt more than
4400 years ago. During the first half of the 20th century, TB was called
“consumption” or “white plague” because it wasted away the body and make
the patients pale yellow and week.
Tuberculosis is caused by Mycobacterium tuberculosis, the “tubercle”
bacillus first isolated by Robert Koch in 1882. It is a small, aerobic, nonmotile
rod whose cell wall forms a waxy cell surface that greatly enhances resistance
to drying, chemical disinfectants, and many antibiotics and other adverse
environmental factors.
Tuberculosis is caused by mycobacterium tuberculosis mainly but other
species of mycobacterium such as M. bovis, M. kansasii and M. avium
contribute in other animals and primates.

Epidemiology
Tuberculosis is primarily an airborne disease and, as such, the bacilli are
transmitted from person to person. So, it is considered as a highly contagious
disease and a small, aerosolized droplets when a person with active pulmonary
disease sneezes, coughs, spits, or even sings. However, individuals with
prolonged, frequent, or intense contact with a diseased individual are at most
risk of becoming infected, with an estimated 30% infection rate. Thus, crowded
conditions and poor ventilation often contribute to disease spread and people
who live in overcrowded, urban areas often contract TB. Malnutrition and a
generally poor quality of life also contribute to the establishment of disease.
The good news related with the TB declining was reported in 2010 by
WHO that is globally there has been 2% drop in number of Tb cases since 2005
from 9M to 8.8M and decline in TB death cases to the lowest level since 2003
from 1.8M to 1.4M and 40% drop in death rate since 1990.
Still about 2B population worldwide are infected with the T.B infection
including 30% population with latent infection.

Pathogenesis
Unlike many other infectious diseases where an individual becomes ill
after several days or a week, the incubation period for TB is much longer and
has two separate stages:
1. Primary/ Latent infection stage 90%
2. Active/ Clinical disease stage 10%
 If a person has a pulmonary infection, then more than 85% of infections are
of lower respiratory tract and 5% of infections are of upper respiratory tract.
The bacterial cells enter the alveoli where pathogen interactions occur. This
individual is now to have a primary TB infection. If tested, the person would
have a positive tuberculin reaction, but a chest X ray and sputum test would be
negative.
In the alveoli, macrophages respond to the infection by ingesting the bacilli.
Unfortunately, the bacilli are not killed in the macrophages and as more
macrophages arrive, they too phagocytize bacilli but are incapable of destroying
them completely. So, an inflammatory condition are developed after 4-6 weeks,
cell mediated immune response localized the infection forming the central area
of large multicellular giant cell. The recruited lymphocytes and fibroblasts
surround the mass in the lung, forming a hard granuloma called a tubercle,
hence the name tuberculosis arose.
In 90% of primary TB infections, the infection becomes arrested and the
individuals usually have no clinical symptoms of infection.
This dormant form of TB is referred to as a latent TB infection and is
carried by 2 billion people worldwide. Of these, 90% will never develop active
disease and will not be infectious. Up to 10% of individuals who have a primary
or latent TB infection will develop the second stage of the illness, which is
known as a clinical disease.
Primary TB infections can develop into primary active TB disease with 1-2
years. The disease usually become extra pulmonary and is disseminated
throughout the body. Due to the body immune system dysfunction, latent TB
infection undergo reactivation developing into clinically active TB infection.
Individuals become sick and ill within 3 months.
In active TB infection, the immune defenses were unable to keep the
tubercle bacilli in check. Many of the infected macrophages die, releasing
bacilli and producing a caseous (cheese-like) center in the tubercle. Live
bacterial cells rupture from the tubercles and spread and multiply throughout the
lower respiratory tract. These individuals will have a positive tuberculin
reaction, chest X ray, and sputum test and can transmit the diseases to healthy
people effectively. In 2010, a new apparatus can identify TB infection within 2
hours versus 2-3 months, required to verify a positive sputum test for TB by
Acid-Fast staining.

Symptoms
Chronic cough, Chest pain, Night sweating, High fever, Fatigue, Chills, Weight
Loss, Continuous need to expel sputum that accumulates in the lower
respiratory tract, often sputum is of light or dark rusted color that indicates that
blood has entered the lung cavity by rupturing the alveolar cells.

Treatment
Tuberculosis is an extremely stubborn disease especially with the
development of antibiotic resistance. TB has been traditionally treated with such
first-line drugs as isoniazid and rifampin. Ethambutol, pyrazinamide, and
streptomycin also are used to help delay the emergence of resistant strains.
Second line drugs are very effective in about 19.8% controlling or managing
capability of MDR-TB including Fluoroquinolones and Kanamycin. This will
be given to the patients for 6-9 months depending on the disease condition of
the body.

Precautions
 Vaccination
 Don’t stay in crowdy places
 Isolation in hospital

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Factors affecting Immune System

The immune system is the most important system of the body when it comes
to preventing diseases. We are all born with different levels of immune systems.
Some have a stronger immune system than others. But there are many things
that can weaken an adequately strong immune system.
The immune system defends the body from developing potentially harmful
diseases and conditions caused by bacterial, parasitic, fungal and viral
infections. The immune system also restricts tumors and cancerous growths
inside the body. However, problems with the immune system can lead to
illnesses and infections. Immune responses can be weakened by various
external influences.

1. Stress
Stress has a major influence on your immune system. Chronic stress caused
by stressful situations or events that last over a long period of time. It raises
cortisol levels of the body which decreases the production of 'good'
prostaglandins.
'Good' prostaglandins are localized hormone like cellular messengers that
support immune function, dilate blood vessels, inhibit 'thick' blood and are anti-
inflammatory.
Chronic stress can make you more susceptible to colds and the flu, as well as
more serious health problems like heart disease, diabetes and other diseases.
We can reduce the stress by practicing stress-reducing activities like yoga,
meditation and laughter, don’t interfere with others’ activities unnecessarily.

2. A poor diet
Prolonged and excessive consumption of refined sugars and highly
processed foods containing pesticides, chemical additives, and preservatives,
which can weaken the immune system and make a person vulnerable to
developing chronic conditions of body. A healthy diet should include plenty of
fruits, vegetables, whole grains, and low-fat milk.
According to a study published, the ability of white blood cells to kill
bacteria is significantly hampered for up to 5 hours after eating 100 gm of sugar
(equivalent to three cans of sweetened soft drink).

3. Excessive alcohol
Alcohol consumed in excess can reduce the ability of white blood cells to
kill germs. Damage to the immune system increases in proportion to the
quantity of alcohol consumed which make the body susceptibility to infectious
diseases and distortedness such as cancer and cirrhosis.

4. Inadequate sleep
Without adequate sleep, the immune system doesn't get a chance to
rebuild, and it becomes weak. Poor sleep is associated with reduced number of
T-cells. White blood cells that help the body fight disease is minimizing if not
get proper sleep by the body.
The research reports say that people who don't get a good night's sleep or who
don't get enough sleep (sleeping under seven to eight hours a night), their
immune system become weaker and will be more susceptible to infectious
diseases.

5. Obesity
Obesity may affect body immune system. Obesity can lead to a weakened
immune system. It can affect the ability of white blood cells to multiply,
produce antibodies, and prevent inflammation. So, the body will be exposed to
various infectious diseases.

6. Inactivity of Body
During moderate exercising, blood flow increases which promotes
circulation of antibodies and white blood cells that are important for fighting off
infections. Appropriate light or medium exercise is recommended for
30minutes.
According to one research report, inactive people took twice as many sick
days as compared to active people.

7. Excessive use of Medications

Most of prescription and non-prescription drugs are major toxins that
many put into the bodies. Excessive use of antibiotics and cold and fever
fighting medications weakens our immune system.
Researchers found that certain people taking antibiotics has reduced
levels of cytokines, the hormone messengers of the immune system to produce
active antibodies.

8. Lack of hygiene
Lack of proper hygiene habits exposes the body to the maximum
microbes thus leading to a weak immune system.
Habits like brushing your teeth twice daily, washing your hands properly
before eating and keeping your nails neat and tidy can go a long way keeping
infections at bay.
9. Radiation exposure
Chemical exposure, UV rays, α, β, and γ rays and exposure to other types of
radiation damage the body immune system.

10. Smoking
Cigarettes contain over 4,000 chemicals, all of which are extremely toxic
to the body. And, more the amount of toxic substance in your body, weaker is
the immune system.
Even exposure to secondhand smoke (passive smoke) can affect your
immune system. It can trigger an asthma attack and aggravate symptoms in
people with allergies.

11. Dehydration
It is vital to maintain a good level of hydration to assist in eliminating
byproducts of any illness and help the immune system fight off infection.
Dehydration can affect the body energy and body sleep, and the ability to get
toxins/waste material out of the body.
In addition to that we can support our body immune system by taking certain
vitamins and supplementary food and to control more fast food, cold drinks etc.
and by changing change can strengthen body immune systems.
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Echinococcosis

Echinococcosis is a parasitic infection caused by Scientific classification

Echinococcus granulosus. Echinococcosis is a
zoonotic larval infection that infects humans globally. Kingdom: Animalia
There are 64 species of Echinococcosis, four of Phylum: Platyhelminthes
which are of concern in humans:
Class: Cestoda
1. Echinococcus granulosus: infections cause cystic
echinococcosis, also called hydatidosis. Order: Cyclophyllidea

Family: Taeniidae

Genus: Echinococcus

Species: E. granulosus
2. Echinococcus multilocularis: infections cause alveloar echinococcosis in
lungs and hydatidosis in liver.
3. Echinococcus vogeli: infections cause polycystic echinococcosis.
4. Echinococcus oligarthrus: infections cause polycystic echinococcosis.
The new and latest species of echinococcus are E. shiquicus and E. felidis.
E. felidis cause infection in lions and isolated from lions but transmission in
human is yet not known.
Echinococcus granulosus, also called the hydatid worm, hyper tape-
worm or dog tapeworm, is a cyclophyllid cestode that dwells in the small
intestine of canids as an adult, but which has important intermediate hosts such
as livestock and humans, where it causes cystic echinococcosis, also known as
hydatidosis.
Hydatidosis results from a larval infection of the tapeworm
(cestode) Echinococcus granulosus. The disease characteristically demonstrates
the growth of hydatid cysts (metacestode) in internal organs of intermediate
hosts, including humans. The definitive hosts of the cestode are carnivores such
as dogs, cattle and a few lions. Humans and other hosts ingest eggs or gravid
proglottids that are excreted in the definitive host's feces, causing the infection.
As humans ingest the eggs of the tapeworm, an oncosphere larva releases
from the egg, which can penetrate the lamina propria of the intestine. Once it
penetrates, it gets passively transported via blood to the liver (75%), lungs
(18%), and brain (3-4%) where they develop into hydatid cysts, in human
beings known as metacestode larvae. These cysts have an inner germinal layer
and an outer laminated layer surrounded by a fibrous capsule derived from the
host. In humans, cysts grow slowly and can be up to multiple liters in volume
and contain thousands of protoscolices. 
The hydatic cyst is mainly found in the liver (75% of the cases) and
remaining in other sensitive parts of body such as lungs (18%), brain (3-4%)
and in spleen and intestine, being asymptomatic in most cases and discovered
accidentally on a routine abdominal ultrasound.
Liver and lungs cyst echinococcus infection is more in males than in
females and much more common in children as compared to adults, particularly
the cystic lesion of brain is more in small children.

Transmission
 Humans can be exposed to eggs of causal agent of echinococcus by “hand-
to-mouth” transfer or contamination.
1. By ingesting food, water or soil contaminated with stool from infected dogs.
This might include grass, herbs, greens, or berries gathered from fields.
2. By petting or handling dogs infected with the Echinococcus granulosus
tapeworm.

Symptoms
 Pain in the upper right part of the abdomen (liver cyst)
 Increase in size of the abdomen due to swelling (liver cyst)
 Bloody sputum (lung cyst)
 Chest pain (lung cyst)
 Cough (lung cyst)
 Severe allergic reaction (anaphylaxis) when cysts break open
 Liver enlargement
 Cyst on bile duct and in blood vessels

Treatment
Cyst puncture, and PAIR (percutaneous aspiration, injection of chemicals
and re-aspiration) have been used to replace surgery as effective treatments for
cystic echinococcosis. However, surgery remains the most effective treatment to
remove the cyst and can lead to a complete cure. 
If cyst is less than 5mm, no need for PAIR, for 5mm or more than 5mm,
surgery is needed.
After surgery, medication such as Albendazole (15mg/kg/day and
Mebendazole (50mg/kg/day) are effective ones and initial course is of about 2
weeks. These are well-tolerated but show different efficiency in various living
organisms. Albendazole is more effective than Mebendazole in the treatment of
Echinococcosis and cyst, particularly liver cyst or liver echinococcosis.
In severe case, Benzimidazole will be given to the patient as
10mg/kg/day.
……………………………………………………………..

Ascariasis
History Scientific classification
A. lumbricoides was originally called
Kingdom: Animalia
Lumbricus teres and was first described in detail by
Edward Tyson in 1683. The genus Ascaris was Phylum: Platyhelminthes,
originally described as the genus for Ascaris Nematoda
lumbricoides by Carl Linnaeus in 1758. Ascaris suum
was described from pigs by Johann August in 1782. Class: Chromadorea

Introduction Order: Ascaridida

Ascaris Lumbricoides is one of several species Family: Rhabditea,
of Ascaris and is the most common parasitic worm in Ascarididae
humans. This organism is responsible for the disease
ascariasis, a type of helminthiasis and one of the group Genus: Ascaris
of neglected tropical diseases (NTD). Ascaris
lumbricoides, along with whipworm and hookworm, is a type of parasite known
as a soil-transmitted helminth (STH).
Ascaris lumbricoides, also known as roundworm or whipworm, infects a
person's small intestine and acts as a parasite, getting nutrients from its host's
intestinal tract and completes its life cycle there.
An estimated one-sixth of the human population is infected by A.
lumbricoides or another roundworm. Ascariasis is prevalent worldwide,
especially in tropical and subtropical countries. Ascariasis is one of the most
common human parasitic infections worldwide, especially in developing
countries that lack widespread, modern sanitation. In some rare cases, ascariasis
may cause serious consequences even sudden death.

Morphology
Ascaris lumbricoides is characterized by its great size.
 Males are 2–4mm in diameter and 15–31cm long. The male's posterior end is
curved ventrally and has a bluntly pointed tail.
 Females are 3–6 mm wide and 20–49 cm long.
The vulva is located in the anterior end and accounts for about one-third of
its body length. Uteri may contain up to 27 million eggs at a time, with 200,000
being laid per day. Fertilized eggs are oval to round and are 45–75μm long and
35–50μm wide with a thick outer shell.

Life Cycle
 The roundworm lays eggs, which then pass in the person's stool, or poop.
If a person ingests the eggs of Ascaris lumbricoides, the roundworm will
progress through its life cycle within the host's body.
The stages of a roundworm's life are as follows:
1. Eggs hatch into larvae in the host's intestine.
2. The larvae move through the body via the bloodstream to the lungs.
3. The larvae will mature in the lungs before entering the throat.
4. A person will either swallow or cough out the larvae.
5. If swallowed, the larvae move into the intestine and mature into adult
worms.
6. A female worm will produce about 200,000 eggs per day.
7. The eggs will leave the body in a person's stool.

Symptoms
Most infected people have mild cases with no symptoms. But heavy
infestation can lead to serious symptoms and complications to other parts of
body and blockage of intestine.
Ascariasis may not cause symptoms at first. However, as the infestation
inside the small intestine grows, a person may start to notice symptoms,
including:
 Abdominal pain or discomfort
 Loss of appetite
 Worms visible in stool
 Vomiting
 Impaired growth in children
 Weight loss
 Nausea
 Diarrhea
In more advanced infestations, the worms can travel to the lungs. If this
occurs, a person may also experience symptoms, including:

 High fever
 Discomfort in the chest
 Gagging cough
 Bloody mucus
 Shortness of breath
 Wheezing
 Aspiration pneumonia
 Loffler’s syndromic lungs
 Inflammation of abdomen
 Eosinophilia
 Intestinal Ulcer

Transmission
Human feces can cause contamination if an infected person defecates
near a farming field or water source, or if they use untreated feces as a fertilizer
for crops.
A person can contract ascariasis by eating or drinking contaminated food
or water, especially if they do not adequately wash the food or their hands.
Transmission doesn’t occur by direct contact or from fresh feces.
Children may be contaminated by playing with soil or plants and putting
their hands in their mouths.

Treatment
Anti-helminthic medication, such as Albendazole and Mebendazole are
choices of drugs for ascariasis as a single dose or maximum up to 3-7 days
depend on the severity of disease. Albendazole is not given in pregnancy but
Pyrantel pamoate is prescribed.
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Enterobiasis Scientific classification

Enterobiasis, also called Pinworm or threadworm Kingdom: Animalia
infection is a human parasitic infection caused
by Enterobius vermicularis. This disease spread among Phylum: Nematoda
people by pinworm eggs or larvae.
Class: Chromadorea
Eggs initially occur around the anus and can
survive up to 20 days in the environment without Order: Rhabditida

Family: Oxyuridae

Genus: Enterobius

Species: Vermicularis
finding host. Egg/ Ova are 50-30µm in size and female pinworms are 8-13mm
long, and males are 2-5mm long.
Enterobius vermicularis also known as definitive host parasite is one of
the most common infectious nematodes in the world. The worms are tiny,
thread-like, and whitish. The worm is named after the characteristic pin-like
tail present on the posterior part of female worms.

Etiology
Infection usually occurs in children and spread within the same families
whereas every individual is susceptible to E. vermicularis infection. People
from tropical climates and school-aged children are the most vulnerable.
Infection is caused by ingestion of the pinworm eggs through the fecal-oral
route.

Epidemiology
The male to female infection frequency is 2 to 1. However, a female
predominance of infection is seen in those between the ages of 5 and 14 years. It
most commonly affects children younger than 18 years of age. It is also
commonly seen in adults who take care of children, institutionalized children,
the people working at daycare centers and center of disease control or sweet
homes.

Pathophysiology
Enterobius vermicularis is an organism that primarily lives in ileum and
cecum. Once E. vermicularis eggs are ingested, they take about 1 to 2 months
to develop into adult worms which happens in the small intestine. The female
adult worms and ova migrate to the anal area mostly at nighttime and deposit
thousands (10,000-15000) of eggs per day in the perianal area. Eggs hatch near
the anal area causing itching, scratching and this causes perianal pruritus. This
leads to contamination of the fingers and results in ingestion of the eggs and this
process is known as autoinfection and restarting of the life cycle of the worm.
Occasionally, the larvae migrate back into the rectum and to the small intestine
and begin the life cycle and is known as retro infection.

Symptoms
 Frequent and strong itching of the anal area
 Restless sleep due to anal itching and discomfort
 Pain, rash, or other skin irritation around the anus or vagina
 The presence of pinworms in the area of your child’s anus
 The presence of pinworms in stools
 Insomnia
 Intermittent Abdominal pain
 Nausea
 Nervous irritability

Complications
In rare cases, if it is left untreated, free worms lead to urinary tract
infection in the females. Occasionally a superficial bacterial infection can occur
at the scratching sites due to intense perianal pruritus. Other complications
reported are female genitourinary infections like vulvovaginitis, urinary tract
infection in young girls. Appendicitis has also been reported as a consequence
of longstanding pinworm infestation.

Transmission
Transmission can occur via contact with contaminated clothes, bedding,
personal care products, and furniture. Fecal-oral is the most common mode of
transmission. Rarely, transmission can occur via inhalation mode when eggs are
inhaled and then subsequently swallowed.

Treatment
Treatment consists of the following anti-helminthic medications:
1. Albendazole: Given on an empty stomach, a 400-mg, one-time dose
followed by a repeat dose in 2 weeks.
2. Mebendazole: A 100-mg, one-time dose followed by a repeat dose in two
weeks.
3. Pyrantel Pamoate:  Dose of 11 mg/kg up to a maximum 1 gm given 2
weeks apart.
Other medications which have been used to treat Enterobiasis are
ivermectin and piperazine, although the latter has lower efficacy and higher
toxicity. In pregnant patients, pyrantel pamoate is preferred over other
medications.

Preventions
Preventive strategies recommended are:
1. Washing hands regularly, particularly before eating, after changing diapers
2. Taking a bath early in the morning to prevent egg contamination should be
encouraged in at-risk patients.
3. Trimming of fingernails should be encouraged.
4. Children should be advised to avoid sucking their fingers and touching their
perianal area.
5. Mop all the living area in the early morning.
……………………………………………………………..

Ancylostomiasis & Necatoriasis

Hookworm infection is caused by the blood-feeding nematode parasites
of the species Ancylostoma duodenale and Necator americanus. Organisms
that play a lesser role include 
 Ancylostoma ceylonicum,
 Ancylostoma braziliense, (hookworm of wild and domestic dogs and cats) is
the most common cause. It can be found in the central and southern United
States, Central America, South America.
 Ancylostoma caninum (dog hookworm) is found in Australia and affect not
more than 5%.
Together, the hookworms infect an estimated 740M individuals today of
which 80M are severely infected.  The morbidity associated with severe
infection includes intestinal blood loss, anemia, and protein malnutrition.  The
burden of infection is concentrated mostly among
Scientific classification
the world’s poorest who live on less than $2 a
day.  A particularly vulnerable population is Kingdom: Animalia
children in low and
Phylum: Nematoda
middle income countries as infection with
hookworm can stunt growth and physical fitness Class: Secernentea
and impair an intellectual and cognitive
development. Order: Strongiliodae

Reservoir and Vector Family: Ancylostomatidae

Humans are the definitive hosts for both Genus: Necator,

Necator americanus and Ancylostoma duodenale. Ancylostoma

Species: N. americanus
Ancylostoma
duodenale
Ancylostoma caninum primarily infects carnivores especially dogs, but humans
can be dead-end hosts that prevent the larvae from completing their life cycle.

Morphology
Adult A. duodenale worms are grayish white or pinkish with the head
slightly bent in relation to the rest of the body.  This bend forms a definitive
hook shape at the anterior end for which hookworms are named.  They possess
well developed mouths with two pairs of teeth.  While males measure
approximately 1cm by 0.5mm, the females are often longer and
stouter.  Additionally, males can be distinguished from females based on the
presence of a prominent posterior copulatory bursa. Average life span of
Ancylostoma duodenale is 1 year.

Difference between both

N. americanus is very similar in morphology to A. duodenale.  N.
americanus is generally smaller than A. duodenale with males usually 5 to 9
mm long and females about 1 cm long.  Whereas A. duodenale possess two
pairs of teeth, N. americanus possesses a pair of cutting plates in the buccal
capsule.  Additionally, the hook shape is much more defined in Necator than
in Ancylostoma. N. americanus larvae only infect through penetration of
skin, A. duodenale can infect both through penetration as well as orally. 

Life Cycle
N. Americanus and A. duodenale eggs can be found in warm, moist soil
where they will eventually hatch into first stage larvae, or L1.
 L1, the feeding non-infective rhabditiform stage, will feed on soil microbes
and eventually molt into second stage larvae, L2.
 L2, which is also in the rhabditoform stage, will feed for approximately 7
days and then molt into the tertiary stage larvae, or L3.
 L3 is the filariform stage of the parasite, that is, the non-feeding infective
form of the larvae. The L3 larvae are extremely motile and will seek higher
ground to increase their chances of penetrating the skin of a human host. The
L3 larvae can survive up to 2 weeks without finding a host.
 After the L3 larvae have successfully entered the host, the larvae then travel
through the subcutaneous venules and lymphatic vessels of the human host.
Eventually, the L3 larvae enter the lungs through the pulmonary capillaries
and break out into the alveoli. They will then travel up the trachea to be
 coughed and swallowed by the host. After being swallowed, the L3 larvae
are then found in the small intestine where they molt into the L4, or adult
worm stage. The entire process from skin penetration to adult development
takes about 5-9 weeks.
 The female adult worms will release eggs (N. Americanus about 9,000-
10,000 eggs/day and A. duodenale 25,000-30,000 eggs/day) which are
passed in the feces of the human host. These eggs will hatch in the
environment within several days and the cycle with start anew.

Symptoms
 Abdominal pain
 Colic, or cramping
 Excessive discomfort leads to crying in infants at night
 Nausea
 Fever
 Blood in stool
 Loss of appetite
 Itchy rash
 Diarrhea
 Fatigue

Transmission
Hookworm infection occur in both children and adults but are less
common in adults. They are rarely fatal. Hookworm infection is a soil-
transmitted helminthiasis and classified as a neglected tropical disease.
Hookworm infection is mainly acquired by walking barefoot on contaminated
soil. It can also be transmitted through the ingestion of larvae. A person with a
light infection may have no symptoms.

Treatment
Treatment consists of the following anti-helminthic medications:
1. Albendazole: Given on an empty stomach, a 400-mg, single dose
2. Mebendazole: A 100-mg, twice a day for 3 days
3. Pyrantel Pamoate:  Dose of 11 mg/kg for 3 days
4. Levamisole: 2.5mg/kg single dose or can be repeated after 7 days, in severe
cases.
 ……………………………………………………………..

Newly Emerging Parasitic Infections

Emerging diseases have been described as those diseases that are being
recognized and isolated for the first time, or the diseases that are already
recognized and recorded but their frequency and geographical range is being
increased tremendously worldwide. Emergence of new diseases may be due to
several factors such as the spread of a new infectious agent, recognition of an
infection that has been in existence but undiagnosed, or when it is realized that
an established disease has an infectious origin. Emerging infections are
compounding the control of infectious diseases and huge resources are being
channeled to alleviate the rising challenge of parasitic infections. 
Globally occurring parasitic infections may be brought by number of
factors including Climate change and global warming, changes in biodiversity,
population mobility, movement of animals, globalization of commerce/trade
and food supply, social and cultural factors such as food eating habits, religious
beliefs, farming practices, trade of infected healthy animals, reduction in the
available land for animals, immune-suppressed host and host density and
misuse or over use of some drugs leading to drug resistance of parasites.
Parasitic diseases can be broadly divided into two classes, namely animal
health parasitic diseases which affect animals and human health parasitic
diseases which affect humans. However, there is no clear distinction between
them in the case of the zoonotic parasites which have the potential to infect both
man and animals, thereby affecting the health of both classes.
-
-
-
Later, parasitic diseases and their causal agents are as follows:

Sr Common name of Causal Body parts

# organism or disease Agents affected
1. Acanthamoeba keratitis  Acanthamoeba spp. Eye, brain, skin

2. Granulomatous Balamuthia
Brain, skin
amoebic encephalitis mandrillaris
Sr Common name of Causal Body parts
# organism or disease Agents affected
3. Babesia equi, B.
Babesiosis RBCs
microfti, 

4. Balantidiasis Balantidium coli Intestinal mucosa

5. Cryptosporidium spp
Cryptosporidiosis Intestines
.

6. Entamoeba
Amoebiasis Colon and Liver
histolytica

7. Lumen of the small
Giardiasis Giardia lamblia
intestine

8. Epithelial cells of small
Isosporiasis Isospora belli
intestines

9. Cutaneous, mucocutaneous
Leishmaniasis Leishmania spp.
, or visceral

10. Malaria Plasmodium species RBCs, Liver

11. Rhinosporidiosis Rhinosporidium

Nose, Nasopharynx
seeberi

12. Sarcocystosis Intestinal vessels

Sarcocystis hominis
and Mucosa

13. Toxoplasmosis  Toxoplasma gondii Eyes, Brain, Heart, Liver

14. Trichomoniasis Trichomonas

Female urogenital tract
vaginalis

15. Sleeping sickness Trypanosoma brucei Brain and Blood

16. Colon, Esophagus, Heart,

Chagas disease Trypanosoma cruzi Nervous system, Muscle
and Blood
Sr Common name of Causal Body parts
# organism or disease Agents affected
17. Diphyllobothriasis  Diphyllobothrium
Intestines and Blood
latum

18. Echinococcosis  Echinococcus

Liver, Lungs, Kidney
multilocularis, 

19. Cysticercosis Taenia solium Brain, muscle, Eye

20. Bertielliasis Bertiella mucronata Intestines

21. Clonorchiasis Gall bladder ducts and

Clonorchis viverrini
Liver

22. Fasciolosis Fasciola hepatica,  liver, gall bladder

23. Opisthochrosis Opisthorchis

Bile duct
felineus, 

24. Schistosomiasis  Schistosoma Intestine, Liver, Spleen,

japonicum Lungs, Skin

25. Elephantiasis  Wuchereria

lymphatic system
bancrofti

26. Ehrlichiosis Gastrointestinal tract and

Ehrlichia equi
Liver
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