FortisAnimo PARASITOLOGY QUCK LECTURE Notes

FORTIS ANIMO
We’re born with strong minds.

SALVADOR C. SAMPAYAN JR.,RMT
PARASITOLOGY QUICK REVIEW NOTES

AUGUST 2021 MTLE
I. INTRODUCTION & IMPORTANT TERMINOLOGIES

 Symbiosis - living together of unlike organisms.
Three most common Symbiotic Relationship:

1. Commensalism- One specie benefits from the relationship w/o harming or benefiting
the other.
Example: Entamoeba coli and Human
2. Mutualism – Two organisms benefit from each other.
Example: Termites and the flagellates inside their digestive system
3. Parasitism - One organism lives in or on another for its survival at the expense of the
host.
Example: Ascaris lumbricoides and Human
 Parasitology - area of biology concerned with the phenomenon of dependence of one

living organism on another
 Medical Parasitology – deals with the parasites that cause human infections and the
diseases they produce; broadly divided into two parts: protozoology and helminthology.
 Medical Protozoology – a branch of medical parasitology that deals with the study of
protozoa, the animal-like” protists which are significant parasites of humans.
 Medical Helminthology – the field of medical parasitology that pertains to the study
of helminths (worms) capable of causing diseases in humans.
PARASITES vs HOSTS vs VECTORS
The PARASITE.
The HOST.
The VECTOR.
WHAT ARE PARASITES? HOW ARE THEY CLASSIFIED?
PARASITES are organisms that take part in Parasitic symbiosis or Parasitism. They are
the organisms that live for its survival at the expense of the host.
They are classified according to (1) habitat, (2) mode of living, (3) duration of
infection/infestation and (4) pathogenicity.
PARASITOLOGY| 1
FORTIS ANIMO
I. ACCORDING TO HABITAT II. ACCORDING TO MODE OF LIVING

ENDOPARASITE: OBLIGATE: Need a host to complete their
A parasite, which lives within the body development
of the host. INFECTION is the term that FACULTATIVE: May exist in a free-living state.
denotes the presence of an
May become parasitic when the need arises.
endoparasite.
ECTOPARASITE: ACCIDENTAL/INCIDENTAL: Parasite that

Those outside the body of the host; those established itself in a host where it does not
on ordinarily live.
body surfaces like skin, surface i.e. lice ERRATIC: Parasite found in an organ w/c is
The presence of an ectoparasite will cause not its usual habitat.
an INFESTATION.
III. ACCORDING TO DURATION ABERRANT: Infect a host where they cannot
develop further
PERMANENT: Remains on or in the SPURIOUS: Passes through the digestive tract
body of the host for its entire life. w/o infecting the host
TEMPORARY: Lives on the host only for a PARTHENOGENETIC: Female parasite
short period of time. capable of reproducing eggs without being
fertilized by a male and whose eggs contain
larva that immediately hatches
IV. ACCORDING TO PATHOGENECITY COPROPHILIC: Able to multiply in fecal matter
outside human body
NON-PATHOGENIC: aka Commensals, HEMATOZOIC: Those parasites that thrives
incapable of causing disease. inside red blood cells (e.g. Plasmodia, Babesia,
Leishmania)
PATHOGENIC: Disease causing parasites. CYTOZOIC: Lives inside cells or tissues (e.g.
Trichinella spiralis)
COELOZOIC: Lives in body cavities (Mansonella
spp.)
ENTEROZOIC: Resides in intestines (Tapeworms,
Entamoeba histolytica)
HOSTS AND THEIR CLASSIFICATIONS
HOSTS are organisms that harbor the parasites. The survival of the parasites depends on
their hosts. Without a host, a parasite cannot live, grow and multiply.
CLASSIFICATION OF HOST
DEFINITIVE/FINAL: Parasite attains sexual INTERMEDIATE: Harbors the asexual/larval
maturity; host in which adult parasite lives. stage of the parasite.
PARATENIC: One in which the parasite does RESERVOIR: Allows the parasite’s life cycle to
not develop further to later stages. Parasite continue and become additional sources of
remains alive and is able to infect another infection.
host.
ACCIDENTAL: Host in which the parasite is
not usually found.
VECTORS AND THEIR CLASSIFICATIONS
VECTORS are organisms that does not cause disease itself but which spreads infection by
conveying pathogens from one host to another.
PARASITOLOGY| 2
FORTIS ANIMO
CLASSIFICATION OF VECTORS
BIOLOGIC: Transmits the parasite only after MECHANICAL/PHORETIC: Those that are
the latter has completed its development only capable of transporting the parasite.
within the host. Example: Cockroaches in Ascariasis
Example: Mosquito in Filariasis.
SOURCES OF INFECTION
SOIL: MOST COMMON. Lack of sanitary WATER: Cysts of amebae or flagellates;
toilets and the use of night soil or human cercaria of schistosomes.
excreta as fertilizer allow the eggs to come in
contact with the soil and form the FOOD: Trematodes (Flukes) and Cestodes
development of specific parasites. (Tapeworms).
Examples: Hookworm, Ascaris lumbricoides, ANIMALS: Cats – direct sources of
Trichuris trichiura, Strongyloides stercoralis Toxoplasma infectioN
(HATS)
ARTHROPODS: ANOTHER INDIVIDUAL: Asymptomatic
Mosquitoes – Malaria, Filarial worms carriers of Entamoeba histolytica working as
Triatoma bugs – Trypanosoma cruzi food handlers.
Phlebotomus sandflies – Leishmania spp.
MODES OF TRANSMISSION
ORAL (FECAL-ORAL) Most common method
Cestodes, Trematodes, Intestinal Protozoans
are foodborne
SKIN PENETRATION Another important mode of transmission
Hookworm and Strongyloides stercoralis enter
upon exposure to soil
Schistosoma spp. is acquired when cercariae
in water penetrate the skin
ARTHROPODS Transmit parasites through their bites
Malaria, Filariasis, Leishmaniasis,
Trypanosomiasis, Babesiosis
CONGENITAL TRANSMISSION Toxoplasma gondii

Trophozoites can cross the placental barrier
during pregnancy
TRANSMAMMARY INFECTION Ancylostoma and Strongyloides
May be transmitted through mother’s milk
INHALATION OF AIRBORNE EGGS Enterobius vermicularis
SEXUAL INTERCOURSE Trichomonas vaginalis
IATROGENIC TRANSMISSION Seen in case of transfusion malaria and
toxoplasmosis after organ transplantation.
OTHER IMPORTANT TERMINOLOGIES IN PARASITOLOGY
Epidemiology Study of patterns, distribution and occurrence of disease

Incidence Number of new cases of infection in a given period of time
Prevalence (%) Number of individuals estimated to be infected w/ a
particular parasite
Cumulative prevalence % of individuals in a population infected w/ at least 1
parasite
Intensity of infection Number of worms per infected person
(Worm burden)
PARASITOLOGY| 3
FORTIS ANIMO
Morbidity Clinical consequences of infections or diseases that affect

an individual’s well-being
Deworming Use of anti-helminthic drugs in an individual
Cure rate (%) Number of previously positive subjects found to be egg-
negative
Egg reduction rate % fall in egg counts after deworming
Selective treatment Individual-level deworming
Targeted treatment Group-level deworming
Universal treatment Population-level deworming
Coverage Proportion of the target population reached by an
intervention
Efficacy Effect of a drug against an infective agent
Effectiveness Measure of the effect of a drug against an infective agent
Information-education- A health education strategy that aims to encourage people

communication to adapt and maintain healthy life practices
Environmental management Planning, organization, performance, and monitoring of
activities for the modification and/or manipulation of
environmental factors
Environmental sanitation Interventions to reduce environmental health risks
Sanitation Provision of access to adequate facilities for the safe
disposal of human excreta
Eradication Permanent reduction to zero of the incidence of infection
caused by a specific agent, as a result of deliberate efforts
Elimination Reduction to zero of the incidence of a specified disease in a
defined geographic area as a result of deliberate efforts
Carrier Harbors pathogen and is asymptomatic
Pre-Patent Period/Biologic Period between infection and evidence of demonstration of
Incubation infection
Clinical Incubation Period Period between infection to development of symptoms
Auto-reinfection Individual becomes infected by his/her own
Nematodes: Capillaria philippinensis, Enterobius
vermicularis, Strongyloides
Cestodes: Taenia solium, Hymenolepis nana
Protozoan: Cryptosporidium hominis, Cryptosporidium
parvum
Superinfection/Hyperinfection Already infected individuals are further infected with same
species (e.g. Strongyloides)
PARASITES AND THEIR COMMON NAMES

Ancylostoma braziliense Cat hookworm
Ancylostoma caninum Dog hookworm
Ancylostoma duodenale Old World hookworm
Anisakis Fish and Marine mammal roundworm
Herring’s Worm
Ascaris lumbricoides Giant Intestinal roundworm
Lumbricus teres
Brugia malayi Malayan filarial worm
Capillaria philippinensis Pudoc worm
Clonorchis sinensis Oriental Liver fluke
Chinese Liver fluke
Dyphyllobothrium latum Broadfish Tapeworm
Dipylidium caninum Dog tapeworm
PARASITOLOGY| 4
FORTIS ANIMO
Double-pored tapeworm
Dirofilaria immitis Dog/Canine heartworm
Dracunculus medinensis Guinea worm
Fiery Serpent of the Israelites
Medina worm
Dragon worm
Echinococcus granulosus Hydatid worm
Echinostoma ilocanum Garrison’s fluke
Enterobius vermicularis Pinworm
Seat worm
Social or Society worm
Oxyuris vermicularis
Fasciola gigantica Giant Liver fluke
Tropical Liver fluke
Fasciola hepatica Sheep Liver fluke
Temperate Liver fluke
Fasciolopsis buski Giant Intestinal fluke
Heterophyes heterophyes Von Siebold’s fluke
Hymenolepis diminuta Rat tapeworm
Hymenolepis nana Dwarf tapeworm
Loa loa African Eye worm
Necator americanus New World hookworm
American hookworm
American murderer
Onchocerca volvulus Blinding worm
Paragonimus westermani Oriental Lung fluke
Schistosoma haematobium Bladder fluke
Schistosoma japonicum Oriental blood fluke
Schistosoma mansoni Profile of a man
Strongyloides stercoralis Thread worm
Taenia saginata Beef tapeworm
Taenia solium Pork tapeworm
Trichinella spiralis Muscle worm
Garbage worm
Trichuris trichiura Whipworm
Toxocara canis Dog ascarid
Toxocara cati Cat ascarid
Wuchereria bancrofti Bancroft’s filarial worm
INFECTIVE STAGES OF DIFFERENT PARASITES

Cyst Protozoans (amoebas)
Trophozoite T. vaginalis
PROTOZOANS Sporozoites Plasmodium
Trypomastigote Trypanosoma
Promastigote Leishmania
Embryonated egg “HATE”
H. nana (CESTODE)
A. lumbricoides
T. trichiura
E. vermicularis
NEMATODES Larva T. spiralis
C. philippinensis
PARASITOLOGY| 5
FORTIS ANIMO
Filariform Larva Hookworm
S. stercoralis
3rd Stage Larva W. bancrofti
B. malayi
A. cantonensis
L. loa
O. volvulus
Mansonella
Cercaria S. japonicum
S. haematobium
S. mansoni
Metacercaria F. hepatica
TREMATODES F. buski
C. sinensis
O. felineus
P. westermani
E. ilocanum
Heterophyids
Cysticercus bovis T. saginata
Cyticercus cellulosae T. solium
CESTODES Plerocercoid larva D. latum
Hydatid cyst E. granulosus
Cysticercoid larva H. diminuta
D. caninum
II. OVERVIEW OF THE METHODS AND STRATEGIES IN PARASITOLOGY
SPECIMEN COLLECTION AND TRANSPORT
Depending on its stage of development in the clinical specimen (adult, larvae, eggs,
trophozoites, cysts, oocysts, spores), a particular parasite may not be able to survive outside
the host. That’s why clinical specimens should be transported immediately to the laboratory
to increase the likelihood of finding intact organisms.
Note: Two ordering/collection/processing/examination situations are considered STAT

orders (i.e., they require immediate attention for potentially life-threatening situations): central
nervous system (CNS) specimens to be examined for free-living amoebae and blood films in
a potential malaria case.
Among the possible specimens, the more common ones are: (1) stool, (2) perianal swab, (3)
blood, (4) sputum, (5) urine and urogenital specimens, (6) tissue aspirate, (7)
cerebrospinal fluid, and (8) tissue biopsy.
PARASITOLOGY| 6
FORTIS ANIMO
DIFFERENT SPECIMENS & SPECIMEN PROCESSING

1. STOOL Stool Processing:
STOOL – most commonly  3 specimens: one specimen collected every other day
submitted sample. or a total of 3 collected in 10 days
The most common procedure
performed is the examination of a  SUITABLE CONTAINER: clean, wide mouthed
stool specimen for Ova and container like a plastic container with a tight fitting
Parasites (O&P). lid, waxed cardboard box (1/2 pint), or matchbox.
Routine stool examination:  Toxic substances to intestinal protozoans: mineral oil,

FORMED WATERY bismuth, antibiotics, antimalarial agents, and non-
Thumb-sized 5-6 table absorbable antidiarrheal preparations. After
size spoons administration of any of these compounds, parasitic
Examined Examined organisms may not be recovered. Specimen collection
w/in: 24 hrs w/in: 30 mins should be delayed after barium (for 5-10 days) or
For Semi-formed stool: examined antibiotics (for at least 2 weeks) are administered.
w/in 1 hour.  By gross examination, tapeworm proglottids and
adult nematodes may be found on the stool sample.
 Temporary storage of fecal samples in a refrigerator

Stool consistency : (3-5°C) may be acceptable just up to 24 HOURS.
Formed Cyst NOTE: Never freeze stool samples nor keep them in
Watery Trophozoites incubators
Soft Cyst and
Trophozoite
Any Helminth eggs and
consistency larva
Stool Preservatives Common Stool Preservatives
 Recommended fixative to  FORMALIN

specimen volume ratio is - All-purpose fixative; usually buffered with sodium
3:1 phosphate to preserve morphological characteristics
 For thorough fixation, - 5% concentration: recommended for protozoan cysts
preservative and the specimen - 10% concentration: recommended for helminth eggs
must be mixed well and larvae
 The specimen must be fixed in - Preserved stool can be concentrated using Formalin-
the preservative for at least Ether/Ethyl Acetate Concentration Technique
30 minutes before processing (FECT/FEACT)
begins.
 SCHAUDINN’S SOLUTION
- Used to preserve fresh stool/fresh fecal specimen in
preparation for staining the stool smears
- Provides excellent preservation of protozoan
trophozoites and cysts
- For many years, considered as the ”gold standard”
- Contains mercuric chloride which is highly toxic to
humans
 SODIUM ACETATE-ACETIC ACID FORMALIN

(SAF)
Advantage: Does not contain mercuric chloride; long shelf-life
- Disadvantage: Images are not as sharp after staining as
compared with those fixed in PVA or Schaudinn’s solution
 MERTHIOLATE IODINE-FORMALIN (MIF)

PARASITOLOGY| 7
FORTIS ANIMO
- Components both fix and provide stain color

- Contains Merthiolate (Thimerosal) and Iodine that act
as staining components
- Formalin acts as a preservative
- Useful for fixation of intestinal protozoans, helminth
eggs, and larvae
- Disadvantages: Contains mercury compounds
(thimerosal)
Staining of preserved stools in MIF yields unsatisfactory
results or not as good as Schaudinn’s fluid
 POLYVINYL ALCOHOL (PVA)

- Plastic resin that serves to adhere a stool sample onto a
slide
- Normally incorporated into the Schaudinn’s solution
- Main advantage: preservation of protozoan cyst and
trophozoites for permanent staining
- Stool preserved in PVA can be concentrated using FECT
- Disadvantage: use of mercuric chloride; some replace
this with cupric sulfate
2. PERIANAL SWAB CELLULOSE TAPE OR SCOTCH TAPE METHOD

- A piece of transparent adhesive tape is pressed firmly
PERIANAL SWAB- Used to
against perianal skin, and the adhesive surface of the tape
recover Enterobius
is spread on a glass slide
vermicularis, Taenia spp., and
- The slide is then placed under microscope and observed
Schistosoma mansoni eggs
for parasitic eggs.
- The Enterobius gravid female
- A drop of toluene or xylol may be placed between the
moves out through the anus at
tape and the slide to clear the preparation.
night time and deposits eggs on
- The specimen should be collected for 3 consecutive days
the perianal skin
at early in the morning before the patient has taken a
- Taenia spp. gravid
bath or before the patient has washed the perineum; can
segments can crawl out of
also be obtained late at night when patient have already
the anus and in the process,
slept for several hours
ova are squeezed out of the
- At least 4 to 6 consecutive negative tapes are required
segment and are deposited on
to rule out the infection.
the perianal skin
3. BLOOD Blood films can be prepared from fresh, whole blood
 Next to feces, the largest collected containing no anticoagulants, anticoagulated
number of parasites are found blood, or sediment from the various concentration
in the blood. procedures.
 Several species of helminthic - In the past the stain of choice was Giemsa stain;
parasites (e.g. filariae) and however, parasites can also be seen on blood films stained
protozoan parasites (e.g. with Wright’s stain or other stains, including rapid
Plasmodium, Trypanosoma, staining options.
Babesia) are in the blood at - Delafield’s hematoxylin stain is often used to stain the
some stage of their life cycle. microfilarial sheath.
- A request for examination of blood films for parasites is
always a STAT request.
PARASITOLOGY| 8
FORTIS ANIMO
BLOOD EXAMINATION TECHNIQUES

1. FINGER PRICK BLOOD a. WET/FRESH PREPARATION
SAMPLE - Microfilariae and Trypomastigotes are large and motile in
fresh blood preparations. Their presence can be easily
Must be free-flowing to prevent detected
dilution of blood with tissue - Species identification is not possible.
fluid which decreases the b. STAINED SMEAR: THICK FILMS
number of parasites. - Larger quantity of blood can be tested
- Increased volume of blood present on thick film may
allow the malaria parasite to be detected even with low
parasitemia.
- Compared with a thin film, a thick film is about 30 times
more sensitive and can detect about 20 parasites/μL of
blood.
- The examination should be performed at low
magnification to detect microfilariae.
- A search for malarial organisms and trypanosomes
should be completed using oil immersion (at least 300
fields)
- The thick blood film is prepared by spreading a few drops
of blood (using a circular motion) over an area
approximately 2 cm in diameter.
- The blood films must be laked before or during staining
(rupture of all RBCs); the only structures that are left on
the blood film are white blood cells, platelets, and
parasites.
- The disadvantages are that the red cells are lysed
(dehemoglobinized) and the morphology of the parasites is
distorted, so that species identification becomes difficult.
- The WBCs on the stained blood film serve as the quality
control
- Reporting (Paniker)
c. STAINED SMEAR: THIN FILMS
- The initial screening should be done with the low-power
microscope objective
- Microfilariae are carried with the smear during
preparation and typically are located at the edges or
feathered end of the thin film.
- Before a smear is reported as negative for the presence of
parasites, a minimum of 300 fields should be examined.
- The thin blood film is routinely used for parasite
identification to the species level.
- The WBCs on the stained blood film serve as the quality
control
- If the smears are prepared from anticoagulated blood,
which is more than an hour old, the morphology of both
parasites and infected RBCs may not be typical.
- Slides are fixed with methanol before staining.
d. STAINED SMEAR: COMBINED THICK AND THIN
FILMS
- Thick smear is first dehemoglobinized and the two are
then stained together.
- Do not allow the methanol to contact the thick film when
fixing the thin film.
PARASITOLOGY| 9
FORTIS ANIMO
- The stained thin smear is examined first. If the thin

smear is negative, the thick smear should be searched for
parasites.
2. CAPILLARY TUBE METHOD a. BUFFY COAT FILMS

- Capillary tube is broken at the area of the white cell
 Collected using heparinized layer after centrifugation and then stained with Giemsa or
capillary tube Wright’s stain.
 Centrifuged; microfilariae - L. donovani, trypanosomes, and H. capsulatum (a
and trypanosomes are fungus with intracellular elements resembling
visualized at the buffy coat those of L. donovani) occasionally may be detected in the
area examined under a large mononuclear cells found in the buffy coat
microscope - With L. donovani, the nuclear material stains dark red-
purple, and the cytoplasm is light blue.
- H. capsulatum appears as a large dot of nuclear
material (dark red-purple) surrounded by a clear halo.
- Trypanosomes in the peripheral blood also concentrate
with the buffy coat cells.
b. QUANTITATIVE BUFFY COAT (QBC)
- Capillary tube precoated with Acridine Orange and
Potassium Oxalate. After centrifugation, the tube is read
using a UV microscope.
- The DNA of the parasite takes up Acridine Orange
(flurochrome) stain causing fluorescence
3. VENOUS BLOOD SAMPLE a. KNOTT’S CONCENTRATION
- In cases of low microfilaremia
May be concentrated to detect - 1 mL of blood is mixed with 10 mL of 2% Formalin
microfilariae - Supernatant is discarded
- Sediment is studied (smeared and stained)
- The disadvantage of the procedure is that the
microfilariae are killed by the formalin and therefore are
not seen as motile organisms.
- The blood is passed through a polycarbonate filter that
contains a 2-μm pore. Distilled water is passed through
the filter, lysing the red blood cells and improving the
visualization of the parasites.
- Supernatant is discarded
- Sediment is studied (smeared and stained with
Giemsa)
b. MEMBRANE FILTRATION
- Useful when density of microfilariae is low
- Uses Swinney membrane filter where microfilariae is
recovered
- Membrane filtration recovers most species of
microfilariae; however, because of their small size,
Mansonella perstans and M. ozzardi may not be
recovered.
- This is the most sensitive method of detecting small
numbers of microfilariae, but it is expensive for routine
use.
PARASITOLOGY| 10
FORTIS ANIMO
4. SPUTUM Parasites that may be recovered from sputum:

A. Migrating larvae of Ascaris lumbricoides, Strongyloides
 First morning specimen is stercoralis, and Hookworm spp.
considered the best specimen
to examine A-S-H: Heart-To-Lung Migration
 If the patient cannot B. Paragonimus westermani ova – sputum may be viscous,
expectorate, inductants like streaked with blood, and tinged with brownish flecks,
10% NaCl or hydrogen which are clusters of eggs (“iron filings”)
peroxide increase the amount
C. Echinococcus granulosus hooklets from pulmonary
of sputum collection
hydatid cysts: Pulmonary Hydatid Disease
 If the sputum is thick, equal
D. Protozoa such as:
volume of 3% N-acetyl
cysteine or 3% sodium 1. Entamoeba histolytica trophozoites from pulmonary
hydroxide is added to the amebic abscess
sputum to liquefy the 2. Cryptosporidium parvum oocyst
specimen 3. Nonpathogenic Entamoeba gingivalis and Trichomonas
 Concentrated stained tenax
preparations of induced
sputum are commonly used
to detect P. jirovecii and
differentiate trophozoite and
cyst forms from other possible
causes of pneumonia,
particularly in an acquired
immunodeficiency syndrome
(AIDS) patient.
5. URINE & UROGENITAL Parasites that can be recovered:
TRACT SPECIMENS - Trichomonas vaginalis: rounded and globular
 First morning urine is structure exhibiting jerky, tumbling motility
considered best for parasite - Urogenital tract specimens should be diluted with a drop
recovery due to the concentration of saline and examined for motile organisms under low
of parasites overnight power and reduced illumination; as the jerky motility
 Very good specimen for the begins to diminish, the undulating membrane may
diagnosis of Trichomonas possibly be observed under high dry power.
vaginalis (most frequent - Stained smears usually are not necessary for
parasite) identification of T. vaginalis.
- Recovery of Wuchereria bancrofti microfilariae from
chyluric samples have also been reported
- Schistosoma haematobium eggs are also passed out in
urine; associated with hematuria (lacerate bladder)
- Enterobius vermicularis can be seen in cases of fecal
contamination
6. TISSUE ASPIRATES The Duodenal Capsulte Technique (Entero-Test) is a
simple, convenient method for collecting duodenal
- In the Philippines, the most
contents.
common aspirate submitted for
-The terminal end of the yarn should be yellow-green,
parasitic diagnosis comes from
indicating that it was in the duodenum.
the liver to rule out hepatic
- After 4 hours, the yarn is retrieved and the mucoidal
amebic abscess caused by
material clinging to the yarn is examined for parasites
Entamoeba histolytica
including S. stercoralis, G. lamblia, Cryptosporidium
- Also used in the recovery of
spp., microsporidia, and the eggs of Clonorchis sinensis
Echinococcus granulosus
-If the specimen cannot be completely examined within 1
hydatid cyst composed of
hr after removal of the yarn, the material should be
hydatid sand and scolices
preserved in 5% to 10% formalin or PVA-mucus smears
should be prepared.
PARASITOLOGY| 11
FORTIS ANIMO
- Bone marrow aspirates for Leishmania and

Trypanosoma cruzi amastigotes or Plasmodium spp.
require staining with any of the blood stains
- Aspirates from cutaneous ulceration is requested in
cases of Cutaneous Leishmaniasis aka oriental sore.
Positive samples will show the presence of amastigotes
- Material obtained from sigmoidoscopy can be helpful in
the diagnosis of amebiasis that has gone undetected by
routine fecal examinations. If amount is limited, the use of
a fixative with PVA is highly recommended.
- A series of at least three routine stool examinations for
parasites should be done before a sigmoidoscopy
examination is performed.
7. CEREBROSPINAL FLUID - Trypomastigotes of Trypanosoma cruzi, Trypanosoma
(CSF) brucei rhodesiense, Trypanosoma brucei gambiense
- CSF must be centrifuged at - Trophozoites of Naegleria and Parastrongylus larvae
7000 g for 10 minutes may be demonstrated in the CSF
- Examination of the CSF must be within 20 minutes
since trypomastigotes perish and the morphology and
motility of Naegleria trophozoites are affected within the
time period.
8. TISSUE BIOPSY
- Wet mount preparation of A. MUSCLE BIOPSY
lymph node aspirate and - Useful in the diagnosis of Trichinella spiralis infection
chancre fluid are used as rapid - Useful in the diagnosis of larval infection with Taenia
methods for demonstration of solium resulting in cysticercosis or larval infection with
trypanosomes. Spirometra spp. resulting in sparganosis
- Biopsies from liver, spleen, - In trichinosis, muscle biopsy (gastrocnemius, deltoid,
bone marrow, and lymph nodes and biceps) specimen must be examined by compressing
are taken in visceral the tissue between 2 slides and checking the preparation
leishmaniasis for demonstration under low power (10X) objective. This method does not
of Leishman Donovan (LD) become positive until 2–3 weeks after the illness
bodies. B. RECTAL BIOPSY
- All biopsy tissues must be
submitted to the laboratory - Examination of rectal tissues can reveal the presence of
without the addition of formalin deposited eggs of Schistosoma japonicum
fixative. If there is delay in - Rectal Biopsy: Schistosoma mansoni, Schistosoma
transport or processing, the japonicum
specimen should be placed in C. SKIN BIOPSY
polyvinyl alcohol fixative
- Adult filarial worms can - A skin snip can be obtained to diagnose subcutaneous
sometimes be found in section of filariasis (Onchocerca & Mansonella) or leishmaniasis by
biopsied lymph node. grasping with a forceps or elevating a portion of skin with
- Corneal scrapings are useful the tip of needle. Tip of the small cone of the skin is then
in diagnosis of acanthamoeba sliced with a sharp blade or razor.
keratitis.
COMMON DIAGNOSTIC PARASITOLOGY TECHNIQUES

A. DIRECT FECAL SMEAR
- 2 mg of stool + 1 drop of 0.85% NaCl (NSS) + coverslip
- Routine method of stool examination
- Can be stained with Nair’s Buffered Methylene Blue (BMB) solution
- Micrometry is used to measure cysts and ova (ex. differentiation between cysts of Entamoeba
histolytica and E.hartmanni is based entirely on their sizes)
PARASITOLOGY| 12
FORTIS ANIMO
- LPO (x100) of entire 22x22 mm coverslip & HPO (x400) of at least 1/3 of the coverslip area of
both saline and iodine
- OIO (x1000) is not recommended (organism morphology is not clear)
- The use of iodine is optional
- SALINE MOUNT: recovery of trophozoites; IODINE MOUNT: destroys trophozoites
- Results are considered presumptive/preliminary
- Preserved specimens do not require a direct wet preparation; concentration and permanent
stain should be performed instead
- If the feces contains mucus, it is advisable to prepare films using the mucus part.
- Wet saline mounts are particularly useful for detecting live motile trophozoites of E.
histolytica, Balantidium coli, and Giardia lamblia.
o Eggs of helminths are also readily seen.
o Rhabditiform larvae of Strongyloides stercoralis are detected in freshly passed stool.
B. KATO THICK SMEAR

50-60 mg of stool is placed over a glass slide; covered with cellophane paper soaked in a
mixture of glycerin and malachite green solution
- GLYCERIN: clearing solution
- MALACHITE GREEN: gives a pale green color minimizing the brightness of the microscopic
field
- Best examined within 10-20 minutes
- Useful in mass stool examination; technique is simple and economical
- Very good in detecting eggs with thick shells (e.g. Ascaris and Trichuris) but not eggs with
thin shells (e.g. Hookworm)
- Not able to detect protozoan cysts and trophozoites
- The preparation is left for about an hour at room temperature, during which the glycerin
clears the stool, enabling the helminth eggs to be seen distinctly under low power
magnification.
C. SEDIMENTATION CONCENTRATION
-The feces is suspended in a solution with low specific gravity, so that the eggs and cysts get
sedimented at the bottom, either spontaneously or by centrifugation
BEST technique for the recovery of: Schistosoma (heavy spine),Operculated eggs, Trematode
eggs, Cestode eggs, T. trichiura eggs, C. philippinensis.
1. ACID ETHER CONCENTRATION TECHNIQUE (AECT)

- Main Reagents:
o 40% HCl: dissolve albuminous material
o Ether: dissolve neutral fats/lipids and CHO in the stool
- Recommended for the recovery of Trichuris, Capillaria, and trematode eggs, especially
Schistosoma
- Choice if stool material comes from animals like cats and dogs
- Disadvantage: destruction of protozoan cysts.
PARASITOLOGY| 13
FORTIS ANIMO
2. FORMALIN-ETHER/ETHYL ACETATE CONCENTRATION TECHNIQUE (FECT/FEACT)

- Most commonly used
- Main Reagents:
o 10% Formalin: all-purpose fixative
o Ether: dissolve neutral fats/lipids and CHO in the stool;
explosive and flammable
o Ethyl Acetate: alternative for ether
- Useful in the recovery of both helminth eggs and protozoan cysts

- FECT can be done with formalin-preserved and PVA-preserved
samples
- More parasites can be recovered from formalin-preserved samples
- Morphology is also better preserved in formalin than in PVA
- Sediments from FECT can be stored for a long period of time.
D. FLOTATION CONCENTRATION
The feces is suspended in a solution of high specific gravity, so that parasitic eggs and cysts
float up and get concentrated at the surface. Yields a cleaner preparation than sedimentation
technique
BEST technique for recovery of:
- Protozoan cysts
- Nematode eggs except for T. trichiura and C. philippinensis (heavy
due to bipolar mucus plugs)
1. ZINC SULFATE FLOTATION

- operculated and/or very dense eggs such as unfertilized Ascaris
eggs do not concentrate well in the flotation method; sedimentation
technique is recommended
- Main Reagent: 33% Zinc Sulfate solution
- Specific Gravity Range: 1.18-1.20
- FRESH STOOL SPECIMEN: 1.18
- FORMALIN PRESERVED SPECIMEN: 1.20
- If parasites are exposed to high specific gravity, distortion and
shrinkage of protozoan cyst and thin nematode eggs may occur
- To ensure detection of all possible organisms, both the surface film
and the sediment must be examined.
2. BRINE FLOTATION
- uses saturated table salt solution; stools are directly mixed with the brine solution (SG:
1.20)
- Helminth eggs like Hookworm and Schistosoma become badly shrunken
- Not useful for operculated eggs like Clonorchis, Opistorchis, and Heterophyids because these
do not float in brine solution.
3. SHEATHER’S SUGAR FLOTATION
- Boiled sugar solution with phenol
- Best for recovery of coccidian oocysts mainly Cryptosporidium, Cyclospora, and
Cytoisospora
E. STOOL CULTURE
-Stools positive for Hookworm ova or Strongyloides rhabditiform larva can be cultured
until filariform larva develop
-Stools for culture should not be refrigerated.
PARASITOLOGY| 14
FORTIS ANIMO
1.COPRO CULTURE AND BAERMANN FUNNEL TECHNIQUE

- Positive stools are mixed with moistened soil or granulated charcoal.
- Larvae are harvested using the Baermann procedure
- Baermann procedure: based on active migration or movement of larvae from
feces suspended in water
- Advantage: greater amount of fresh stool used; better chance of larval recovery
2. HARADA-MORI OR THE TEST TUBE CULTURE METHOD

- Uses test tubes and filter paper strips
- Positive stool (0.5-1g) is smeared in the middle third of the filter paper and placed
into a test tube with 7 mL (3-4 mL) (1/2 inch) of boiled or distilled water
- Keep the tube at room temperature in the dark for 7-10 days; examine daily
- Filariform larvae will move downwards and be recovered from the water at the
bottom of the tube
- Strongyloides larvae may instead move upwards and accumulate at the upper end of the
strip
- Caution must be exercised in handling the filter paper
3. AGAR PLATE CULTURE FOR Strongyloides stercoralis

- More sensitive
- 2 g of fresh stool is placed in the center of the agar plate
- Plates are sealed with tape to prevent accidental infection and placed in RT for 2 days
- In positive cases, larvae will crawl over the agar, making visible tracks over it.
- Examine microscopically for the evidence of larvae at the ends of tracks away from the stool
4. CULTURE METHOD FOR SOME PROTOZOA

- Boeck and Drbohlav’s diphasic medium (modified by Dobell and Laidlaw)
- Balamuth’s monophasic liquid medium (amebae and other intestinal protozoa)
- Cleveland Collier’s Medium
- Diamond’s Medium (for T. vaginalis)
NNN (Novy-McNeal-Nicolle) Medium for Leishmania and Trypanosoma
Schneider’s Insect Tissue Culture Medium – in vitro culture of Leishmania; more sensitive
than NNN
F. EGG COUNTING PROCEDURES

Semiquantitative assessment of worm burden ; Assess the efficacy of treatment (e.g.
antihelminthics)
1. KATO-KATZ METHOD OR CELLOPHANE-COVERED THICK SMEAR

- Recommended method of WHO
- Uses a neasured amount of stool which has been sieved through a wire mesh
- Uniform amount of stool is examined through the use of a template with a uniform-sized
hole in the middle.
- Allow the cellophane coverslips to soak in the glycerin mixture for about 24 hours
- Allow the preparation to stand for 1 hour at RT to allow clearing of fecal material
- Do not overclear; thin shelled hookworm eggs may disappear
- Clearing time extended to 24 hours for S. mansoni eggs
- Total egg count is multiplied by a factor depending on the amount of stool used
- Recommended: standard multiplication factor of 24 for calculation of eggs/gram feces
- Useful for assessing the intensity of infection with Schistosoma and common soil-
transmitted helminths
- Consistency of the stool is the main determinant of the sensitivity. Well-formed stools yield
higher egg counts than moist ones
- This technique can only be done on fresh formed stools and not on liquid samples
PARASITOLOGY| 15
FORTIS ANIMO
2. STOLL DILUTION EGG COUNT

- Uses 0.1 N NaOH that acts as a stool diluent; saponifies fat and frees eggs from debris
- The amount of diluted stool used for egg counting is measured by stoll pipettes
- Total egg count is multiplied by a factor depending on the amount of stool used
- Routine: 4 g feces; multiply by factor 100 to obtain # of eggs/gram stool
- Sensitivity is determined by the consistency of the stool
3. DIRECT SMEAR METHOD OF BEAVER

- Easiest to use
- 2 mg of stool is smeared
- Egg counts on direct smear are reported as eggs/smear
MCMASTER’S EGG COUNTING CHAMBER
- Eggs in 20 mg stool are concentrated by salt flotation on the squared grid on the roof of
the chamber which can be counted
WHO CLASSIFICATION OF
INTENSITY OF INFECTIONS
ORGANISM LIGHT MODERATE HEAVY
INTENSITY INTENSITY INTENSITY
Schistosoma japonicum 1-99 epg 100-399 epg ≥ 400 epg
Schistosoma mansoni
Trichuris trichiura 1-999 epg 1,000-9,999 epg ≥ 10,000 epg
Hookworm spp. 1-1,999 epg 2,000-3,999 epg ≥ 4,000 epg

Ascaris lumbricoides 1-4,999 epg 5,000-49,999 ≥ 50,000 epg
epg
G. STAINING
1. PERMANENT STAINED SMEARS
- Most reliable
- The two most commonly used are the Wheatley modification of the Gomori tissue trichrome
stain and the iron-hematoxylin stain
- Permanent stained smears are examined using oil immersion objectives (×600 for
screening, ×1000 for final review of 300 or more oil immersion fields)
- The permanent stained smear is the most important procedure performed to confirm the
diagnosis of intestinal protozoan infections.
- MODIFIED ACID-FAST: recommended for intestinal coccidia
- MODIFIED TRICHROME: recommended for intestinal microsporidia
2. WHEATLEY’S TRICHROME STAIN FOR FECAL SPECIMENS

- Fixative: PVA
- Expected results: Background debris will be green and protozoa will show blue-green to
purple cytoplasm. The nuclei and inclusions will be red or purple-red and sharply
delineated from background.
3. MODIFIED TRICHROME STAIN FOR MICROSPORIDIA (WEBER-GREEN)

- Fixative: 5-10% Formalin or SAF
- Expected results: Spores: ovoid, refractile; spore wall is bright pinkish red
Polar tube: seen as a stripe or as a diagonal line across the spore
Bacteria and debris: stain green, some stain red
4. MODIFIED TRICHROME STAIN FOR MICROSPORIDIA (RYAN-BLUE)

- Specimen: Fresh stool or fixed (5-10% Formalin or SAF)
- Expected results: Spores: ovoid, refractile; spore wall is bright pinkish red
PARASITOLOGY| 16
FORTIS ANIMO
Polar tube: seen as a stripe or as a diagonal line across the spore

Bacteria and debris: stain blue, some stain red
- If the stool is semiformed or formed, the amount of artifact material is much greater, and
the spores are much harder to detect and identify.
The number of spores varies according to the stool consistency (the more diarrheic the stool,
the more spores that are present).
5. MODIFIED ACID-FAST FOR COCCIDIANS

- Kinyoun’s Method of Acid-Fast Staining is recommended
- Weaker decolorizer (2% H2SO4) compared to the original Acid-Fast Staining method
- The oocyst of the coccidians stain pink to red with a blue or green background
RESULTS AND PATIENT REPORTS FROM THE TRICHROME STAINING METHOD

The following quantitation chart can be used for examination of permanent stained smears
with OIO
QUANTITATION OF PARASITES, YEASTS, CELLS & ARTIFACTS
QUANTITY NO. per OIF
Few <2
Moderate 3-9
Many > 10
H. RECOVERY OF THE TAPEWORM SCOLEX

Rarely requested and no longer clinically relevan.
- Requires mixing a small amount of feces with water and straining the mixture through a
series of wire screens (graduated from coarse to fine mesh) to look for scolices and
proglottids.
- The appearance of scolices after therapy is an indication of successful treatment.
- If the scolex has not been passed, it may still be attached to the mucosa; the parasite is
capable of producing more segments from the neck region of the scolex, and the infection
continues.
- If this occurs, the patient can be retreated when proglottids begin to reappear in the stool.
III. PROTOZOANS
GENERAL CHARACTERISTICS
- Unicellular, eukaryotic organisms
- Animal-like protists
- No cell wall
- Two regions of cytoplasm: ectoplasm (outer) and endoplasm (inner)
- Contains at least one and some several nuclei
- Some contain vacuoles
- With special organs for locomotion
- INFECTIVE STAGES: CYSTS; VEGETATIVE STAGE: TROPHOZOITES
- Requires wet environment for feeding, locomotion, osmoregulation, and reproduction
CLASSIFICATION: According to LOCOMOTORY ORGANELLES
A. SARCODINA/RHIZOPODA B. MASTIGOPHORA/FLAGELLATA
Organ: Pseudopodia Organ: Flagella
Example: Amebae Example: Flagellates
PARASITOLOGY| 17
FORTIS ANIMO
C. CILIOPHORA/CILIATA D. SPOROZOANS
Organ: Cilia No definite locomotory organelle
Example: Balantidium coli (eg. Plasmodium, Babesia)
CLASSIFICATION: Based on TAXONOMY
PHYLUM SARCOMASTIGOPHORA PHYLUM SARCOMASTIGOPHORA
SUBPHYLUM SARCODINA SUBPHYLUM MASTIGOPHORA
Acanthamoeba castellani ATRIAL FLAGELLATES
Endolimax nana Chilomastix mesnili
Entamoeba coli Dientamoeba fragilis
Entamoeba dispar Giardia lamblia
Entamoeba gingivalis Trichomonas hominis
Entamoeba histolytica Trichomonas tenax
Iodamoeba butschlii Trichomonas vaginalis
Naegleria fowleri
HEMOFLAGELLATES
Leishmania braziliensis
Leishmania donovani
Leishmania tropica
Trypanosoma brucei
PHYLUM APICOMPLEXA PHYLUM MICROSPORA
Babesia spp. Encephalitozoon
Cryptosporidium hominis Enterocytozoon
Cyclospora cayetanensis Pleistophora
Cystoisospora belli Nosema
Plasmodium spp. Brachiola
Toxoplasma gondii Vittaforma
Trachipleistophora
Microsporidium
PHYLUM CILIOPHORA
Balantidium coli
A. CLASS SARCODINA/RHIZOPODA
-Have protoplasmic processes, or pseudopodia, for locomotion
-Possess in their life cycle the: trophozoite stage > precystic stage > cystic stage > metacystic
stage
-With cystic stage except for Entamoeba gingivalis
-Inhabit the large intestine except for Entamoeba gingivalis
-Commensals except for Entamoeba histolytica
- If the organism is genus Entamoeba (true ameba) – peripheral chromatin (visible nuclear
membrane in both trophozoite and cyst)
and chromatoidal bodies in cysts only
- If the organism is genus Endolimax or Iodamoeba (other ameba) – neither peripheral
chromatin nor chromatoidal bodies
CYST TROPHOZOITE
Non-motile Motile
Non-feeding stage Feeding stage
INFECTIVE STAGE Vegetative stage
Frequently found in formed stools Found in diarrheal and liquid stools
Transmission of cyst stage by Ameba excreted as trophozoites cannot
fecally contaminated food or water mature to cysts
Excystation occurs in the lower intestine and
organisms begin to multiply as trophozoites
PARASITOLOGY| 18
FORTIS ANIMO
May be studied in fresh condition by staining

with D’ Antoni’s Iodine stain, but more
satisfactory method is to stain permanent
preparations with iron hematoxylin
1. Entamoeba histolytica
- The only pathogenic ameba
- INFECTIVE FORM: Mature quadrinucleate cyst
- MODE OF TRANSMISSION: Ingestion of food and water contaminated with the cysts
PATHOGENESIS
- Causes intestinal and extraintestinal amebiasis; amebic colitis is characterized by
abdominal cramping, anorexia, fatigue, and diarrhea
- The typical amoebic ulcer is flask-shaped in cross section, with mouth and neck being
narrow and base large and rounded.
- Occassionally, a granulomatous pseudotumoral growth may develop on the intestinal wall
from a chronic ulcer. This amoebic granuloma or amoeboma may be mistaken for are
malignant tumor.
- The typical manifestation of intestinal amoebiasis is amoebic dysentery.
- In fulminant colitis, there is confluent ulceration and necrosis of colon
EXTRAINTESTINAL AMEBIASIS
- Hepatic involvement is the most common extraintestinal complication of amebiasis. The
center of the abscess contains thick chocolate brown pus (anchovy sauce pus), which is
liquefied necrotic liver tissue.
- Pulmonary amebiasis usually occurs very rarely; hepatobronchial fistula usually results with
expectoration of chocolate brown sputum
- Involvement of the CNS leads to Secondary Amebic Meningoencephalitis
- The prepuce and glans are aff ected in penile amoebiasis which is acquired through anal
intercourse.
DIAGNOSIS
- A special media known as TYI-S-33 supports E. histolytica in culture
- Serologic testing for intestinal disease is rarely recommended unless the patient has true
dysentery
- Serological tests include:
o Indirect Hemagglutination Test (IHA): serum with antibody titer of 1:256 or more by IHA is
diagnostic of amoebic hepatitis.
o Latex Agglutination Test
o Enzyme-Linked Immunosorbent Assay (greater sensitivity)
Entamoeba histolytica VS Entamoeba coli

STRUCTURE Entamoeba histolytica Entamoeba coli
(PATHOGENIC) (NONPATHOGENIC)
- Moves in one direction - Tries to move in several
(unidirectional) directions at the same time –
- Only one pseudopod thrusted out sluggish motion
in explosive manner - Sends out several pseudopods at
- Pseudopods thrusted out in an the same time
explosive manner - Pseudopods thrusted out slowly
TROPHOZOITE - Endoplasm contains RBCs but no - Endoplasm contain bacteria,
bacteria or cell detritus yeasts, and cell detritus
- Nuclues not visible when stained; - Stained nucleus contains a
nucleus consists of thin nuclear thicker nuclear membrane with
membrane with layer of uniformly layer of variously sized chromatin
sized fine chromatin granules granules unevenly distributed
PARASITOLOGY| 19
FORTIS ANIMO
distributed along inside border of along the inside broder of nuclear

nuclear membrane membrane
- Fine, centrally located karyosome - Large, eccentrically located
Can occur free in the lumen of the karyosome
intestine as a commensal and is
known as its minuta form
CYST - Coffin-shaped chromatoidal bars Splinter-like chromatoidal bars
- Mature cyst with 4 nuclei - Mature cyst with 8 nuclei
2. NON-PATHOGENIC AMOEBA
AMOEBA CYST TROPHOZOITE
A. Entamoeba coli - Measures 10-35 μm in - Larger than E. histolytica
- same life cycle with E. diameter measuring 15-50 μm in diameter
histolytica except that it - Possess 1-8 nuclei depending - Bacteria and cellular debris are
remains as a on maturity; occasionally large usually found in the endoplasm
commensal cysts containing 16 or more - Movement is sluggish
nuclei may be present - Pseudopodia usually blunt and
- Splinter-like chromatoidal granular
bars - Eccentric karyosome
B. Endolimax nana - Measure 7-10 μm in diameter Average size of 7-10 μm in
- shows more nuclear - Spherical, ovoid, or ellipsoid diameter
variation than any of - 1-4 nuclei but most common - Sluggish, nonprogressive
the other amebae, and form is with 4 nuclei motility accomplished by blunt,
occasionally can mimic - With a large, blotlike hyaline pseudopods
D. fragilis or E. karyosome, usually centrally - Karyosome is large, irregular;
hartmanni. located; no peripheral blotlike
chromatin - Absence of peripheral
- No chromatoidal bars chromatin
- Cytoplasm is granular and
vacuolated and usually contains
bacteria
C. Entamoeba NO CYSTIC STAGE Ranges in size from 8-20 μm
gingivalis - Active motility; varying
- The first ameba of pseudopod appearance
humans discovered by - Single nucleus containing a
Gros in 1849. centrally located karyosome
- The only ameba that - Finely granular cytoplasm;
ingests WBCs. inclusions include WBCs,
epithelial cells, bacteria
D. Iodamoeba butschlii - Average size of 5-22 μm - Varies from 8-20 μm in
- May be ovoid, ellipsoid, diameter
triangular and other shapes - Fairly active motility
- Only have one nucleus when - Cytoplasm is granular
mature containing numerous vacuoles
- Large, eccentric karyosome; with ingested debris and bacteria
peripheral chromatin is absent - On the permanent stained
- Coarsely granular cytoplasm smear, the nucleus may appear
- Most prominent feature: large to have a halo and chromatin
iodine-staining glycogen vacuole granules fan out around the
karyosome.
*If granules are on one side, the
nucleus may appear to have a
“basket nucleus” arrangement
of chromatin (commonly seen in
the cyst stage)
PARASITOLOGY| 20
FORTIS ANIMO
Entamoeba dispar
- Morphologically identical with Entamoeba histolytica and impossible to distinguish the two
based on morphology alone.
- Speciation requires specialized testing methodologies that include DNA probes and
electrophoresis techniques designed to target enzymes.
Entamoeba moshkovskii
- First detected in sewage
- Morphologically indistinguishable from E. histolytica and E. dispar, but differs from them
biochemically and genetically
- Physiologically unique: it being osmotolerant, able to grow at room temperature (25-30°C
optimum); able to survive at temperatures ranging from 0-41°C
Entamoeba hartmanni
- Occurs wherever E. histolytica is found
- “Small-race” Entamoeba histolytica
- Trophozoites contain only one nucleus and unlike E.histolytica, they do not ingest RBCs.
- Cysts resemble that of Endolimax nana
- Mature cysts of E. hartmanni also retain their chromatoidal bars, a characteristic not
usually seen in E. histolytica/E. dispar.
- At the species level, differentiation between E. hartmanni and E. histolytica/E. dispar depends
on size.
Entamoeba polecki
- Primarily considered a parasites of pigs and monkeys; rarely does it infect humans
- Ingestion of the E. polecki cyst is most likely responsible for the onset of infection.
- Human to human as well as pig to human are the major routes of parasite transmission.
- Like E. coli, motility of trophozoites is sluggish; a small karyosome is centrally located in
the nucleus
- Distinguished from E. histolytica: cyst is consistently uninucleated and chromatoidal bars
are frequently angular or pointed.
3. OPPORTUNISTIC AMOEBA (FREE LIVING)

- Infections caused by small, free-living amebae belonging to the genera Naegleria,
Acanthamoeba, and Balamuthia.
- Acanthamoeba spp. and B. mandrillaris can cause cutaneous infections in humans.
- Sappinia pedata: a free-living ameba normally found in soil contaminated with the feces of
elk and buffalo, was identified in an excised brain lesion from a 38-year-old immunocompetent
man who developed a frontal headache, blurry vision, and loss of consciousness following a
sinus infection.
- Paravahlkampfia francinae: recently isolated from the cerebrospinal fluid (CSF) of a patient
with a headache, sore throat, and vomiting, symptoms typical of primary amebic
meningoencephalitis (PAM) caused by Naegleria fowleri from the environment.
A. Naegleria fowleri
- Major causative agent of Primary Amebic Meningoencephalitis (PAM)
- Only ameba with known three morphologic forms: ameboid trophozoite, flagellate, and cysts
- Trophozoite can assume limax form or become amoeboflagellate.
- The amebae may enter the nasal cavity by inhalation or aspiration of water
(diving or swimming during hot weather in brackish or fresh water), dust, or aerosols
containing the trophozoites or cysts.
- N. fowleri is incapable of survival in clean, chlorinated water.
- The ameboid form organisms change to the transient, pear-shaped flagellate form when
they are transferred from culture or teased from tissue into water and maintained at a
temperature of 27° to 37° C.
PARASITOLOGY| 21
FORTIS ANIMO
- PAM resembles acute bacterial meningitis, and these conditions may be difficult to
differentiate.
- A confirmed diagnosis is made by the identification of amebae in the CSF or in biopsy
specimens
- Specimens should never be refrigerated before examination, and CSF should be
centrifuged at a slow speed (250× g).
- If N. fowleri is the causative agent: only trophozoites are seen
- If Acanthamoeba spp. is the causative agent: trophozoites and cysts are seen
- Organisms can be cultured on nonnutrient agar plated with Escherichia coli.
- In tissue, the amebae can be identified using indirect immunofluorescence and
immunoperoxidase techniques.
B. Acanthamoeba spp.
- A. culbertsoni (formerly, Hartmanella culbertsoni) is the species most often responsible
for human infection but other species like A. polyphagia, A. castellanii
(responsible for most CNS and eye infections), and A. astromyx have also been reported.
- It differs from Naegleria in not having a flagellate stage and in forming cysts in tissues
- The trophozoite is large, 20–50 μm in size and characterized by spine-like pseudopodia
(acanthopodia).
- The cysts are usually round with a single nucleus. The double wall is usually visible, with
the slightly wrinkled outer cyst wall and what has been described as a polyhedral inner
cyst wall. This cyst morphology is identifiable in organisms cultured on agar plates.
- Human beings acquire by inhalation of cyst or trophozoite (GAE), ingestion of cysts, or
through traumatized skin or eyes (keratitis).
- Causes Granulomatous Amebic Encephalitis (GAE) primarily in immunosuppressed,
chronically ill, or otherwise debilitated individuals.
o Unlike PAM caused by N. fowleri, both trophozoites and cysts are found throughout the
tissue.
o Also, dissemination to other tissues such as the liver, kidneys, trachea, and adrenals can
occur in immunocompromised individuals.
- Acanthamoeba spp. also cause keratitis (Acanthamoeba keratitis) and corneal ulceration.
o These infections are often due to direct exposure of the eyes to contaminated materials or
solutions. Use of contact lenses is the leading risk factor for keratitis.
o Acanthamoeba keratitis may be present as a secondary or opportunistic infection in patients
with herpes simplex keratitis.
o It is important to note that unlike N. fowleri, which is associated with swimming or bathing
in contaminated water, Acanthamoeba spp. infection is not associated with water but rather
with contaminated saline.
- Acanthamoeba shares many characteristics with the gram-negative bacteria Pseudomonas

aeruginosa, but they are usually not recovered simultaneously from the same patient.
- It is believed that P. aeruginosa inhibits the activity of Acanthamoeba spp.
- The most effective culture approach uses non-nutrient agar plates with Page’s saline
and an overlay growth of Escherichia coli on which the amebae feed.
- In infections caused by Acanthamoeba spp., periodic acid-Schiff stains the cyst wall red
and methenamine silver stains
C. Balamuthia mandrillaris
- The life cycle is similar to that of Acanthamoeba spp.; like Acanthamoeba spp., Balamuthia
does not have a flagellated stage in the life cycle.
- Both trophozoites and cysts are found in CNS tissue, and their sizes are similar to those of
Acanthamoeba trophozoites and cysts.
- Using electron microscopy, the cysts are characterized by having three layers in the cyst
wall: an outer wrinkled ectocyst, a middle structure–less mesocyst, and an inner thin
endocyst.
PARASITOLOGY| 22
FORTIS ANIMO
- The disease is very similar to GAE caused by Acanthamoeba spp. The clinical presentation
is subacute or chronic and is usually not associated with swimming in freshwater.
- B. mandrillaris does not grow well on E. coli–seeded nonnutrient agar plates. However,
these organisms can be cultured in mammalian cell cultures using monkey kidney cells and
MRC, HEp-2, and diploid macrophage cell lines.
- Differentiated from Acanthamoeba by the presence of many nucleoli on its nucleus
B. CLASS MASTIGOPHORA
- Possess whiplike locomotory organelle called flagella
- Motor component: flagella and axonemes
- Neuromotor apparatus: kinetoplast which consist of blepheroplast and parabasal body
(energizing portion)
- UNDULATING MEMBRANE: a finlike structure connected to the outer edge of some
flagellates
- AXOSTYLE: a rodlike support structure found in some flagellates
- Majority live in the large intestine except for Trichomonas tenax and Trichomonas
vaginalis
- Lumen-dwelling flagellates: flagellates found in the alimentary tract and urogenital tract
- Hemoflagellates: flagellates found in blood and tissues
- Most luminal flagellates are nonpathogenic commensals. Two of them cause clinical diseases—Giardia
lamblia, which can cause diarrhea and Trichomonas vaginalis, which can produce vaginitis and urethritis.
INTESTINAL FLAGELLATE CYST TROPHOZOITE
Enteromonas hominis - May be oval to elongated - Pear-shaped or ovoid; may
- On first inspection of these also be seen in the form of a
organisms, yeast cells may half-circle
often be suspected. - Exhibit jerky motility;
- 1-4 nuclei; binucleated single nucleus
forms are more common - No cytostome, undulating
- A high frequency of membrane, and axostyle
binucleated cysts seen on a - 4 flagella: three are
stained preparation indicates directed anteriorly and one
probable E. hominis. directed posteriorly
Retortamonas intestinalis - Lemon to pear-shaped - Ovoid that exhibits jerky
- One nucleus motility
- Two fused fibrils resembling - Single, large nucleus
a bird’s beak - Characteristic cleftlike
cytostome may be seen near
the nucleus
- 2 anterior flagella
Chilomastix mesnili - Lemon-shaped and - Pear-shaped; has spiral
possess a clear, anterior, boring, jerky motility
hyaline knob - Large, spherical nucleus
- One, large nucleus
PARASITOLOGY| 23
FORTIS ANIMO
- The well-defined cytostome, - 4 flagella: 3 extend out of

with its accompanying fibrils, the anterior end; the fourth
may be found to one side of is shorter and extends
the nucleus posteriorly
- Has a single nucleus and a
typical curved cytostomal
fibril, called the shepherd’s
crook
Giardia lamblia/ - Ovoid - Pear or teardrop-shaped
Giardia intestinalis - 2 (immature) – 4 (mature) - Exhibits falling-leaf
nuclei motility
- Most common cause of - Median bodies: two in - Bilaterally symmetrical
intestinal infection worldwide immature cyst or four in (only protozoan)
(Bailey’s) fully mature cyst - With sucking disk: does
- It is the most common - Resistant to routine not invade the tissue but
protozoan pathogen and is chlorination procedures remains tightly adhered to
worldwide in distribution.
LABORATORY DIAGNOSIS: intestinal epithelium by
(Paniker’s)
- Stool Exam (multiple means of the sucking disc.
- The only protozoan parasite
found in the lumen of the human specimens) - Four pairs of flagella: one
small intestine - Duodenal Aspirate pair of laterally crossed
- Man acquires infection by - String Test (Entero-test): flagella, one pair of central
ingestion of cysts in contaminated also for Strongyloides flagella, a lateral pair of
water and food. stercoralis uncrossed flagella, and one
- Person-to-person contact through - Fecal antigen detection pair of posterior flagella
oral-anal sexual practices or via by EIA and ELISA - Rod-shaped, deeply
the fecal-oral route may also staining organelle believed
transfer G. intestinalis to be the parabasal body
- There are several known animal
reservoir hosts, including beavers,
found in the center
muskrats, and water voles. - 2 nuclei, each with a large
- Giardiasis: the most common karyosome lying within the
cause of diarrhea in patients with sucking disk
immunodeficiency syndromes - OLD MAN’S FACE/OLD
-Malabsorption/Steatorrhea (also MAN WITH EYEGLASSES
Capillaria philippinensis) APPEARANCE
- Traveler’s Diarrhea (like ETEC) - “Someone looking at you”
- Gay Bowel Syndrome (Bailey’s)
Dientamoeba fragilis
- Initially classified as an ameba; now an ameboflagellate based on electron microscope
study; without external flagella
- It is seen worldwide and is reported to be the most common intestinal protozoan parasite in
Canada.
- NO CYST STAGE
- The D. fragilis trophozoite is characterized as having one nucleus or two nuclei (binucleate
trophozoite more common).
- The nuclear chromatin usually is fragmented into three to five granules, and normally no
peripheral chromatin is seen on the nuclear membrane.
- In some organisms the nuclear chromatin tends to mimic that of E. nana, E. hartmanni, or
even C. mesnili, particularly if the organisms are overstained with trichrome or iron
hematoxylin stain.
- The cytoplasm is usually vacuolated and may contain ingested debris and some large,
uniform granules.
- Stain of choice for distinguishing the individual chromatin granules in the nuclei is iron
hematoxylin
PARASITOLOGY| 24
FORTIS ANIMO
- Hakansson phenomenon: when mounted in water preparations, D. fragilis returns to

normal size after swelling unlike the other amebic trophozoites; diagnostic for its
identification
- The life cycle and mode of transmission of D. fragilis are not known, although transmission
in helminth eggs (e.g., Ascaris and Enterobius spp.) has been postulated.
- The most common symptoms in patients infected with this parasite appear to be
intermittent diarrhea and fatigue.
Trichomonas spp.
- exist only in the trophozoite stage; no cystic stage
- pear-shaped
- Has an undulating membrane: for locomotion (2T: Trichomonas, Trypanosoma)
- Jerky, tumbling motility
A. Trichomonas vaginalis
- Infection is acquired primarily through sexual intercourse.
- Trichomoniasis (Ping-Pong Disease): primary non-viral sexually transmitted disease
worldwide
- Infective stage: trophozoite
- Trophozoites exhibit rapid, jerky motility brought about by its four to six flagella
- T. vaginalis trophozoites thrive in a slightly alkaline or slightly acidic pH environment
such as that commonly seen in an unhealthy vagina.
- The most common infection site of T. vaginalis in males is the prostate gland region and the
epithelium of the urethra.
- Parasite causes petechial hemorrhage (strawberry mucosa), metaplastic changes, and
desquamation of the vaginal epithelium.
- Intracellular edema and so called chicken-like epithelium, is the most characteristic feature
of trichomoniasis.
- Asymptomatic cases most frequently occur in men; symptomatic men often experience
persistent or recurring urethritis
- Persistent vaginitis, found in infected women, is characterized by a foul-smelling,
greenish-yellow liquid vaginal discharge after an incubation period of 4 to 28 days.
- The identification of T. vaginalis is often based on the examination of wet preparations of
vaginal and urethral discharges, urine, and prostatic secretions (must be performed within 10-
20 minutes after collection)
- Giemsa or Papanicolaou stain can be used for permanent stained smears.
- Culture is recommended when direct microscopy is negative and is considered as a 'gold
standard' as well as the most sensitive (95%) method for the diagnosis of T. vaginalis infection.
HEMOFLAGELLATES
- Include the Trypanosomes and Leishmanias
- May infect the blood, lymph nodes, muscles, and RES
- Four morphologies or stages: Amastigote (Leishman-Donovan body) or Leishmanial form
Promastigote or Leptomonal form
Epimastigote or Crithidial form
Trypomastigote or Trypanosomal form
PARASITOLOGY| 25
FORTIS ANIMO
MORPHOLOGY ILLUSTRATION
AMASTIGOTE
Appearance: Round to oval
Nucleus: One, usually off center
Features: Kinetoplast present consisting of a
dotlike blepharoplast
NO FLAGELLA
PROMASTIGOTE
Appearance: Long and slender
Nucleus: One, located in or near center
Features: Kinetoplast, located in anterior
end
Single free flagellum extending from
anterior end
EPIMASTIGOTE
Appearance: Long and slightly wider than
promastigote form
Nucleus: One, located in posterior end
Features: Kinetoplast located anterior to
the nucleus
Undulating membrane - extending half of
body length
Free flagellum - extending from anterior
end
TRYPOMASTIGOTE
Appearance: C,S or U shape often seen in
stained blood films; long and slender
Nucleus: One, located anterior to the
kinteoplast
Features: Kinetoplast located in the
posterior end
Undulating membrane – extending entire
body length
Free flagellum – extending from anterior
end
GENERAL MORPHOLOGY AND LIFE CYCLE NOTES
- Amastigotes and Trypomastigotes are the two forms routinely found in human specimens.
- Amastigotes are found primarily in tissue and muscle as well as the CNS within
macrophages where they multiply
- Trypomastigotes reproduce and are visible in the peripheral blood
- Promastigote stage may be seen only if a blood sample is collected immediately after
transmission
- Epimastigotes are found primarily in the vector
Leishmania spp.
- Leishmania spp. exist as the amastigote in humans and as the promastigote in the insect
host.
- Depending on the species involved, infection with Leishmania spp. can result in cutaneous,
diffuse cutaneous, mucocutaneous, or visceral disease.
- Vector: Sandfly (Phlebotomus spp.)
- Diagnostic stage: Amastigotes
- Infective stage: Promastigotes
- Modes of Transmission: insect vector, congenitally, blood transfusion,
contamination of bite wounds, direct contact with contaminated specimens
PARASITOLOGY| 26
FORTIS ANIMO
- Life cycle: Promastigotes in proboscis of sandfly are injected into blood,

multiplying in bloodstream and become amastigotes
- Montenegro Skin Test: a screening test similar to that of the tuberculin
skin test used for screening large populations at risk for
infections caused by Leishmania spp.
BLOOD AND VECTOR RESERVOIR DISEASE PATHOLOGY

TISSUE HOSTS ASSOCIATION
FLAGELLATE
Large ulcers in the oral
or nasal mucosa areas
(mucocutaneous)
Mucocutaneous develop after the initial
Leishmaniasis invasion of the RES.
Chiclero Ulcer - Edema and secondary
Leishmania Lutzomiya, Dogs and Espundia bacterial infections,
braziliensis Psychodopyg forest Forest Yaws combined with
complex us sandflies rodents Pian Bois numerous mucosal
Uta lesions, may cause
WEEPING disfigurement of the
LESIONS patient’s face.
- Death is usually
attributed to a
secondary bacterial
infection.
- Characterized by a
single pus-containing
ulcer, which is generally
self-healing.
- Approximately 40% of
Leishmania Lutzomiya Forest New World infections affect the ear
mexicana spp. sandfly rodents Cutaneous and can cause serious
complex Leishmaniasis damage to the
Chiclero Ulcer surrounding cartilage.
Bay Sore - Infected patients
initially
develop a small red
papule, located at the
bite
site, which is typically 2
cm or larger in diameter
and may cause pruritis.
Old World Ulcer characteristics
Cutaneous similar to Leishmania
Leishmaniasis mexicana complex
Leishmania Phlebotomus Rock hyrax, Oriental Sores - Thick plaques of skin,
tropica spp. sandfly dogs, Delhi boils along with multiple
complex gerbils, Baghdad boils lesions or nodules,
other Aleppo button usually result.
rodents Jericho boil
DRY LESIONS
PARASITOLOGY| 27
FORTIS ANIMO
Leishmania Visceral Leishmaniasis:

donovani Patients develop a
complex Visceral nondescript abdominal
Phlebotomus, Dogs, cats, Leishmaniasis illness and
Diagnosis Lutzomiya foxes, Kala-azar hepatosplenomegaly
(Leishmaniasis) sandflies jackals, Dumdum Fever - Early stages of disease
Gold standard: porcupines BLACK FEVER may resemble malaria or
demonstration of typhoid fever with the
Leishman development of fever and
Donovan bodies chills.
(amastigotes - Advanced stages of
inside disease result in kidney
macrophages) – damage (e.g.,
preferred glomerulonephritis) and
specimen: bone granulomatous areas of
marrow skin.
Skin Test - A characteristic
(Montenegro): darkening of the skin
Positive – may be noted.
induration of ≥ 5
mm
Culture: NNN,
Scheider’s
Medium
A. Trypanosoma spp.
A. Trypanosoma brucei complex
- discovered by David Bruce; causative agent of the trypanosomal disease known as nagana (a
cattle disease) and sleeping sickness
Trypanosoma brucei rhodesiense and Trypanosoma brucei gambiense

- Causes of African sleeping sickness (African Trypanosomiasis)
- Trypanosoma rhodesiense: East African Sleeping Sickness (more rapid and fatal)
- Trypanosoma gambiense: West African Sleeping Sickness
- Vector: Tsetse fly (Glossina morsitans for T. brucei gambiense and
Glossina palpatis for T. brucei rhodesiense)
- Mode of Transmission: Bite of insect vector, other blood sucking insects,
needle prick, placental
- Life Cycle: In salivary glands of Tsetse fly, trypomastigotes multiply and develop
into epimastigotes and transform in infective metacyclic trypomastigotes
- Infective Stage: Metacyclic Trypomastigotes
- Diagnostic Stage: Trypomastigotes
- Characterized by an acute phase in which peripheral blood and lymph nodes are invaded,
followed by a chronic phase in which the CNS is invaded, resulting in meningoencephalitis;
comatose state develops commonly known as ”sleeping sickness”
- Pathology: Chancre (central eschar) – earliest sign
Winterbottom’s Sign – inflammatory swelling of the lymph nodes
Kerandel’s Sign – delayed sensation to pain
Somnolence – excessive sleepiness
Comatose
- Laboratory Diagnosis: Febrile stage – blood and lymphatics
Sleeping Sickness stage (CNS) – CSF
Presence of IgM in serum and/or CSF is generally considered diagnostic
PARASITOLOGY| 28
FORTIS ANIMO
B. Trypanosoma cruzi
- Agent of American Trypanosomiasis or Chagas’ Disease

- Described by a young medical student in Brazil named Carlos Chagas
- Vector: Triatoma (kissing bugs, Reduviid bugs, Assassin bugs, cone nose bugs)
- Mode of Transmission: Contamination of the bite wound with the feces from the reduviid
bug.
- Life Cycle: Metacyclic trypomastigotes will invade macrophages; amastigotes
will emerge and form trypomastigotes
- Infective Stage: Metacyclic Trypomastigotes
- Diagnostic Stage: Trypomastigotes, Amastigotes
- Pathology: Chagoma: erythematous nodule at the site of infection
Romaña’s Sign: unilateral edema of the eyelids
Myocarditis
Megacolon: enlargement of the colon
Megaesophagus
Hepatosplenomegaly
Cardiomegaly: enlargement of the heart
- Laboratory Diagnosis:
Demonstration of trypomastigotes in thin and thick smears prepared from peripheral blood or
CSF (C/U-shaped)
Xenodiagnosis (also T. spiralis): Test Animal – Reduviid bugs (stool exam of bugs: examine
for trypomastigotes)
C. CLASS CILIOPHORA/CILIATA
- Includes species that move by means of cilia, or short extensions of cytoplasm that cover the
surface of the organism.
- Have two different types of nuclei, one macronucleus and one or more micronuclei.
Balantidium coli
Balantidium coli
- Only human pathogen
- Rare infection
- Largest parasitic protozoan
- Mode of Transmission: Ingestion of infective cysts
in contaminated food or water (probably from feces of swine)
- Natural Host: Pigs
PARASITOLOGY| 29
FORTIS ANIMO
- Accidental Host: Man

- Reservoirs: Pig, monkey, and rat
- Infective Stage: Cysts
- Disease: Balantidiasis
Symptoms: often resemble amebic dysentery; abscesses and ulcers may form in the mucosa
and submucosa of the large intestine, followed by secondary bacterial infection. Acute
infections are characterized by up to 15 liquid stools daily containing pus, mucus, and
blood.
- Trophozoite: Two kinds of nuclei: kidney-shaped macronucleus, dot-like micronucleus;
cilia, oral cytostome
Cytostome: Mouth
Cytopege/Cytopyge: Anus
Macronucleus: Vegetative Function
Micronucleus: Sexual Reproduction
- Motility: Thrown-Ball Motility
- Cysts: refractive double wall enclosing cilia
Stained cysts typically reveal only the macronucleus; other structures are not apparent
D. CLASS SPOROZOA/APICOMPLEXA
- Phylum Apicomplexa
- Presence of apical complex to invade the host cell
- Obligate, intracellular parasite
- No apparent means of locomotion
- Life cycle includes
o Sexual reproduction (sporogony) in arthropod vector (DH)
o Asexual reproduction (schizogony) in man (IH)
Plasmodium spp.
- Cause of malaria (“Bad Air”)
- Malaria remains the leading parasitic disease that causes mortality worldwide
- Most important parasitic disease
- The four species that are important to humans are P. falciparum,
P. vivax, P. ovale, and P. malariae; the first two are responsible
for over 90% cases of human infections
- P. falciparum – most common in the Philippines
- P. vivax – most common in the world
- Mixed infection with P. falciparum and P. vivax
- Drug of choice: Chloroquine, Atabrine, Mepacrine (anti-malarial drugs); Yellow Urine
- Vector: Anopheles minimus var. flavirostris (definitive host)
ASEXUAL CYCLE (SCHIZOGONY) [MAN: IH] [IS TO MAN: SPOROZOITES]
1. Female Anopheles mosquito (DH) bites man, injecting sporozoites (IS) into bloodstream
2. Cryptozoites develop in liver cells to merozoites, completing exoerythrocytic stage
3. Merozoites enter circulating RBCs to become ring trophozoites which mature to schizont
4. Schizont contains merozoites, released on red cell rupture, each free to invade new cells
5. After a number of erythrocytic cycles, some merozoites develop into gametocytes
(microgametocyte: male; macrogametocyte: female)
SEXUAL CYCLE (SPOROGONY) [FEMALE ANOPHELES MOSQUITO: DH] [IS TO MOSQUITO:
GAMETOCYTES]
1. Microgametocyte and microgametocyte ingested by Anopheles in blood meal from man
2. Gametes released in gut and unite to form zygote (motile ookinete)
3. Encystment in gut wall produces oocysts
4. Infectious sporozoites released from oocsysts migrate to salivary glands of mosquito
awaiting delivery to man
SYMPTOMS AND PATHOLOGY
1. Recurrent fever, chills, and sweating (synchronized rupture of red cells)
PARASITOLOGY| 30
FORTIS ANIMO
- Every 36 hours: Malignant Tertian Malaria – Plasmodium falciparum

- Every 48 hours: Benign Tertian Malaria – Plasmodium ovale, Plasmodium vivax
- Every 72 hours: Quartan Malaria – Plasmodium malariae
2. Anemia (red cell destruction), large spleen, and joint pain
3. Plasmodium falciparum infection most likely fatal
Cerebral Malaria – red cells, organisms, and pigment block brain vessels
Blackwater Fever – sudden massive intravascular hemolysis resulting to hemoglobinuria
RESISTANCE TO MALARIA (Incompatible with parasite survival)
1. Fy (a-b-)
Marker for African Black race
Resistant to P. vivax and P. knowlesi
2. M-N-
Resistant to P. falciparum merozoites
3. G-6-PD Deficiency
4. Sickle Cell Anemia
Plasmodium vivax (Benign Tertian Malaria)
- Single, large ring succeeded by amoeboid form in pale large red cell
- Schuffner’s dot (condensed hemoglobin) in red cells
- Only reticulocyte invaded (young RBCs)
- Infected RBCs: Enlarged
- Gametocyte: Round
- Trophozoite: Amoeboid
- Stages seen in peripheral blood: ALL STAGES
- Hypnozoites: resting stage from a secondary schizogony that occurred in the liver
- Fy6-: important for invasion
Plasmodium malariae (Quartan Malaria)
- Single, large compact ring or band forms
- Ziemann’s dots
- Invades old RBCs (mature RBCs)
- Infected RBCs: Normal size
- Schizont with merozoite arranged around a central pigment (fruit pie)
- Trophozoite: Band
- Merozoite: Rosette/Fruit Pie/ Daisy Head
- Gametocyte: Ovoid
- Stages seen in peripheral blood: rings, trophozoite, schizonts
Plasmodium ovale (Benign Tertian Malaria)
- Single, compact ring
- James’ dots/Schuffner’s dots
- Invades young RBCs
- Infected RBCs: Larger than normal; serrated and fimbriated
- Large pale red cells with Schuffner’s dots/James’ dots which may be oval and fimbriated
- Hypnozoites: resting stage from a secondary schizogony that occurred in the liver
Plasmodium falciparum (Malignant Tertian Malaria)
- Small ring forms (1/6 diameter red cell), applique forms/accole/marginal, double nuclear
dots
- Multiple parasitization of red cells: Multiple Ring infection
- Maurer’s dots (Stephen Christopher’s dots/Cuneiform dots)
- Invades all stages of RBCs
- Gametocytes: Crescent/Banana-shaped
- Black Water Fever (most prominent feature); intravascular hemolysis: black urine
- Cerebral Malaria
- Only one that causes cytoadherence
Plasmodium knowlesi (Simian Malaria)
Fifth Human malaria parasite; normally a parasite of long-tailed macaques (Macaca
fascicularis) but humans working in nearby forest fringe are at great risk of infection
PARASITOLOGY| 31
FORTIS ANIMO
- Described in humans in the Philippines and Southeast Asia

- Microscopically indistinguishable from P. malariae and differentiation is only achieved
through PCR assay and molecular characterization.
- The early stages mimic P. falciparum, whereas the later stages mimic P. malariae
MALARIA LABORATORY METHODS/EXAMINATION
1. Examination of blood film
A. Thick Blood Film
- Screening
- Preferred (if low # of organisms; sensitive)
- Dehemoglobinized: dipped in water
- Stained with Giemsa (pH: 7.2)
B. Thin Blood Film
- Identification of Specimen (specific)
- Fixed with Methanol (toxic; permanent blindness)
- Stained with Giemsa
2. QBC Technique (Quantitative Buffy Coat): Flurochrome used – Acridine Orange
3. Immunologic
A. Optimal Assay
- Test for parasitic LDH
- Produced by all four species of Plasmodia
B. Malaquick
- HRP II (Histidine Rich Protein II)
- For P. falciparum
Babesia (Babesia microti and Babesia divergens)
- Causes Texas cattle fever/Red Water fever/Tick fever/Nantucket fever
- Vector: Ixodes spp. ticks
- Definitive Host: Ixodes spp. ticks
- Intermediate Host: Man or other mammals
- Reservoir Hosts (B. divergens): Cattle and rabbits
- Mode of Transmission: 1) Bite of the vector; 2) Blood transfusion
- Although the life cycle of Babesia spp. is similar to that of Plasmodium spp., no
exoerythrocytic stage has been described
- Diagnostic Tetrads: Maltese Cross (merozoites)
- The trophozoites of Babesia can mimic P. falciparum rings but can be differentiated by:
1. Lack of malarial pigment
2. Lack of growing trophozoite
3. Vector: Ticks
- Symptoms and pathology: clinically similar to malaria, and symptoms include high fever,
myalgias, malaise, fatigue, hepatosplenomegaly, and anemia.
- It is also not uncommon to see a patient coinfected with Lyme disease and/ or human
granulocytic ehrlichiosis.
COCCIDIA
- Unicellular protozoa; live intracellularly, at least during a part of their life cycle
- All coccidian have a sexual sporogonic phase and an asexual schizogonic phase.
- Frequent association with HIV infection.
- Schizogony (asexual) in a variety of nucleated cells
- Sporogony (sexual) in intestinal mucosa of DH: infective oocyst excreted in feces
- Infective Stage: oocyst
Isospora belli
- Definitive Host: Man
- Only coccidial parasite that does not have an intermediate host
- Infective Stage: sporulated oocyst
- Mode of Transmission: Ingestion of infective mature (also known as sporulated) oocysts in
contaminated food or water
PARASITOLOGY| 32
FORTIS ANIMO
- Two sporocysts each containing four sausage-shaped sporozoites can be recovered from the
fecal specimen
- Symptoms: The more commonly noted clinical symptoms include weight loss, chronic
diarrhea, abdominal pain, anorexia, weakness, and malaise. Fecal fat levels of these stool
samples may be increased (in severe cases)
- Detection: 1) Stool Exam; 2) Modified Acid-Fast Stain and 3) Unizoite Cysts in variety of
tissues in extraintestinal infections of AIDS patients
Cyclospora cayetanensis
- Man serves as the only host
- Infective Stage: sporulated oocyst (each sporocyst contains two sporozoites);
twice the size of Cryptosporidium
- Mode of Transmission: Ingestion of infective mature (also known as sporulated)
oocysts in contaminated food or water
- Outbreaks linked to contaminated water and various types of fresh produce
(raspberries, basil, baby lettuce leaves, and snow peas) have been reported.
- Symptoms: Similar to those seen in cases of cryptosporidiosis. The notable difference among
infections caused by these two organisms in adults is that C. cayetanensis produces a longer
duration of diarrhea. There is no known connection between C. cayetanensis infection and
immunocompromised patients.
- Detection: 1) Stool Examination; 2) Modified Acid Fast; 3) Concentration Method without the
use of Formalin fixative
- Exhibits autofluorescence (bright blue at 365 nm; mint green at 450-490 nm)
Cryptosporidium spp.
- C. parvum (mammals, including humans) and C. hominis (primarily humans)
- Host: Man
- Reservoir: Man, cattle, cat, and dog
- Infective Stage: sporulated oocyst (does not contain sporocysts; consists of four small
sporozoites in a thick cell wall)
o Thin-shelled oocyst: responsible for autoinfections
o Thick-shelled oocyst: environmental contamination
- Mode of Transmission: Ingestion of infective mature (also known as sporulated) oocysts in

contaminated food or water; autoinfection
- Associated with watery, frothy diarrhea with oocysts shed in feces
- Immunocompromised patients
- Diarrhea in AIDS patients
- G. lamblia, D. fragilis, and Cryptosporidium have been implicated in nursery school
outbreaks of diarrhea
- G. lamblia and Cryptosporidium have been implicated in waterborne outbreaks of
diarrheal disease
- Detection: Stool Exam (oocysts must be differentiated from yeasts)
Sugar floation (Sheather’s Sugar Flotation)
Modified Acid-Fast Stain: Acid-Fast (+) oocyst: (+) purple-red-pink
Sarcocystis spp.
- S. hominis (transmitted through cattle), S. suihominis (transmitted through pigs),
and S. lindenmani
- Man serves as the definitive host (S. hominis, S. suihominis) and as the
intermediate host (S. lindenmani)
- Infective Stage: sarcocyst (oocyst morphology similar to oocysts of I. belli; contain four
sporozoites)
- Modes of Transmission: Ingestion of uncooked meat containing sarcocyst (man serves as DH)
Ingestion of oocysts from stool sources of animals other than cattles or pigs (man serves as IH)
- Intestinal sarcocystosis is usually asymptomatic. Patients may have nausea, abdominal
pain, and diarrhea.
PARASITOLOGY| 33
FORTIS ANIMO
- Muscular sarcocystosis is also usually asymptomatic but may cause muscle pain,
weakness, or myositis, depending on the size of the cyst
- Most sarcocysts in humans have been found in skeletal and cardiac muscle however,
muscles in the larynx, pharynx, and upper esophagus have also been involved.
Blastocystis hominis
- Previously considered to be a yeast but now reclassified to be a protozoan
- The current recommendation is to report the presence of B. hominis and quantitate
from the permanent stained smear (i.e., rare, few, moderate, many, packed)
- B. hominis consists of four major forms.
o Cyst form: Thick-walled cysts are thought to be responsible for external transmission
through the fecal-oral route; thin-walled cysts are thought to cause autoinfection.
o Central vacuole form/vacuolated (central body form): most common form found in stool
samples; large, central, fluid-filled vacuole that consumes almost 90% of the cell. 10%
assumes the periphery; it consists of a ring of cytoplasm in which two to four nuclei are
typically present.
o Amoeboid form: rarely seen.
o Granular form: seen in cultures of B. hominis
- Mode of Transmission: Fecal-oral route from infective forms in the feces: ingestion, sexual
practices, fomites, flies and cockroach (mechanical transmission)
- B. hominis can cause diarrhea, cramps, nausea, fever, vomiting, abdominal pain, and
urticaria and may require therapy.
- Routine stool examinations are very effective in recovering and identifying B. hominis; the
permanent stained smear is the procedure of choice.
Pneumocystis jiroveci (formerly Pneumocystis carinii)
- Now considered a fungus; causes Atypical Interstitial Plasma Cell Pneumonia
- One of the characteristic opportunistic infections seen in AIDS patients.
- The leading cause of death in AIDS patients
- Trophozoite: most commonly seen form; ovoid and ameboid
- Cyst: contains four to eight intracystic bodies, also referred to in some sources as nuclei
and may be arranged in an organized fashion (in a rosette shape) or unorganized (scattered
about the organism).
- Infective Stage: Cyst
- Mode of Transmission: Inhalation of thick-walled mature cysts (direct person-to-person
contact)
- In immunosuppressed adults and children, this condition results in a nonproductive cough,
fever, rapid respirations, and cyanosis.
- AIDS persons infected with P. jiroveci often also suffer from Kaposi’s sarcoma
- Specimens that may be submitted for P. jiroveci examination vary and include sputum
(usually obtained on individuals who are immunocompromised), bronchoalveolar lavage,
tracheal aspirate, bronchial brushings, and lung tissue.
- Successful diagnosis of P. jiroveci is usually done using histologic procedures, particularly
Gomori’s (Grocott’s) Methenamine Silver Nitrate Stain.
MICROSPORIDIA
- Obligate, intracellular, spore-forming parasites; now considered highly derived fungi
- Infective Stage: Spore
- Modes of Transmission: Ingestion or inhalation of infective spores (mature spores contain a
polar tube)
- The most well-known member is Enterocytozoon bieneusi, which causes enteritis in AIDS
patients. Other Microsporidia that has caused infections in humans include
Encephalitozoon, Pleistophora, Microsporidium, and Nosema.
- Microsporidia have been known to develop enteritis, keratoconjunctivitis, and myositis.
- Thin smears stained with trichrome or acid-fast stain may show the desired spores.
- Microsporidia stain Gram-positive and show partial positive staining when treated with
acid-fast stain or the histologic stain periodic acid-Schiff (PAS).
PARASITOLOGY| 34
FORTIS ANIMO
Toxoplasma gondii
- Obligate, intracellular coccidian parasite
- Definitive Host: Cats (Sporogony)
o Oocyst in feces may infect man (Infective Stage: Oocyst)
- Intermediate Host: Man and other mammals (rodents) (Schizogony)

- Mode of Transmission: Ingestion of mature oocysts (from cat feces); ingestion of
contaminated undercooked meat from cattle, pigs, or sheep; transplacental and blood
transfusion (rare)
- Oocyst: similar to I. belli but smaller; each oocyst contains two sporocysts each with four
sporozoites
- Tachyzoites: actively-dividing, crescent-shaped trophozoite; one end appears more
rounded than the other end; Giemsa is the stain of choice (cytoplasm is pale-blue and
nucleus is red)
- Bradyzoites: same physical appearance with tachyzoites; slow-growing forms that gather in
clusters inside a host cell, develop a surrounding membrane, and form a cyst in a variety of
host tissues and muscles outside the intestinal tract.
o Cysts are formed in chronic infections and the bradyzoites within are strongly PAS positive
- Pathogenesis: Once inside the human, T. gondii tachyzoites emerge from the ingested cyst
and begin to grow and divide rapidly. The tachyzoite form is responsible for the tissue damage
and initial infection. The tachyzoites migrate to a number of tissues and organs, including the
brain, where cysts filled with bradyzoites then form.
- Toxoplasmosis: This acute form of the disease is characterized by fatigue, lymphadenitis,
chills, fever, headache, and myalgia. In addition to the symptoms mentioned, chronic disease
sufferers may develop a maculopapular rash as well as show evidence of encephalomyelitis,
myocarditis, and/or hepatitis.
- Congenital Toxoplasmosis: Transmission of the disease occurs when the fetus is infected (via
transplacental means) unknowingly by its asymptomatic infected mother. Ultimately leads to mental
retardation, severe visual impairment, or blindness.
- Cerebral Toxoplasmosis: one of the first apparent clinical symptoms of patients with AIDS
may be that of central nervous system (CNS) involvement by T. gondii. T. gondii organisms
remain confined within the CNS.
- Diagnosis: The most common method of diagnosis for toxoplasmosis is serologic testing for
T. gondii– specific antibodies (IFA).
o Other procedures include PCR; examination of biopsy specimens, buffy coat cells, or
cerebrospinal fluid; or isolation of the organism in tissue culture or in laboratory animals.
o Double-sandwich ELISA method: recommended method for determination of IgM present in
congenital infections
o Sabin-Feldman Dye Test: Methylene Blue staining of tachyzoites inhibited by prior
addition of patient serum containing antibodies to Toxoplasma (inhibition mechanism)
Trophozoites + Patient Serum (Antibodies) Methylene Blue Dye
(+) Trophozoites did not absorb the dye

(-) Trophozoites absorbed the dye
IV. METAZOANS
PHYLUM NEMAHELMINTHES
NEMATODES (ROUND WORMS)
GENERAL CHARACTERISTICS:
GENERAL CHARACTERISTICS
1. Adult nematodes are elongated, cylindrical worms, primarily bilaterally symmetrical
PARASITOLOGY| 35
FORTIS ANIMO
2. Anterior end may be equipped with hooks, teeth, plates, and papillae for purpose of
abrasion, attachment and sensory responses
3. Supporting body well consists of (1) an outer, hyaline, noncellular cuticle; (2) subcuticular
epithelium and (3) a layer of muscle cells
4. Alimentary tract is a simple tube extending from mouth to anus. Complete digestive tract
and a muscular pharynx that is characteristically triradiate. There is no circulatory system.
Mouth: Entry; Anus: Disposal
5. Equipped with complete reproductive system
6. Life cycle: Egg stage >>> Larval stage >>> Adult stage
7. They are provided with separate sexes (dioecious) although some may be parthenogenetic
Parthenogenetic: may or may not require a male for copulation/reproduction (Strongyloides

stercoralis)
Female: larger, pointed posterior, no spicule found
Male: small, curved posterior, with spicule
Female worms produce eggs
A. Oviparous – lay immature/unembryonated/unsegmented eggs (e.g. Ascaris)
B. Oviviparous/Ovoviviparous – lay embryonated/mature eggs; lay eggs in segmented
stage
(e.g. Enterobius vermicularis)

C. Viviparous/Larviparous – lay larva not eggs (e.g. Trichinella spiralis
8. There are sensory organs (chemoreceptors) in the anterior and posterior ends of the worm
called amphids (cephalic chemoreceptors) and phasmids (caudal chemoreceptors)
Aphasmid/Adenophorea (without caudal chemoereceptors): Trichuris, Trichinella, and

Capillaria
Phasmid/Secernentia (with caudal chemoreceptors): the rest of the nematodes
CLASSIFICATION BASED ON HABITAT OF ADULT WORMS
Small Intestine Ascaris Extraintestinal Filarial worms
Duodenum lumbricoides Nematode Wuchereria bancrofti
Jejunum Hookworms Lymph Node and Brugia malayi
Ileum Strongyloides Lymph Vessel
stercoralis Eyes and Angiostrongylus/Parastrongylus
Capillaria Meninges cantonensis
Trichinella spiralis
adult Encysted in the Trichinella spiralis larva
Large Intestine Trichuris trichiura host muscle
Enterobius
vermicularis
I. INTESTINAL NEMATODES
Ascaris lumbricoides
- Common Name: Gian Intestinal Roundworm
- Most common intestinal nematode of man; occurs most frequently in the tropics
- Vector of Ascaris: Flies and Cockroaches (mechanical vectors)
- Member of Soil Transmitted Helminths (STH): HATS
- Member of Unholy Three: HAT
- Member of parasites having Heart-Lung Migration: ASH
Habitat: Small Intestine
Final Host: Man
Diagnostic Stage: Ova found in the stool (fertilized/unfertilized)
Infective Stage: Embryonated Egg
Mode of Transmission: Ingestion of embryonated eggs (fecal-oral transmission);
embryonates in soil
PARASITOLOGY| 36
FORTIS ANIMO
If not embryonated, it will not cause infection

Adult
- White, cream, or pinkish yellow when fresh
- Head is provided with 3 lips and a triangular buccal cavity/trilobate lips
Eggs
- Become infective 2-6 weeks after deposition
- Survive harsh environments: dry/freezing temperatures
- Either fertile or infertile
Lecithin granules is present in unfertilized egg
- Egg shell consists of 3 layers:
Inner Vitelline/Lipoidal/Lecithin later (not found in unfertilized egg)
Middle Glycogen layer
Outermost Mammillation/Corticated layer: Albumin coat for protection
Both fertilized and unfertilized egg can be corticated/decorticated
Life Cycle
1. Adult lives in the small intestine
2. Undeveloped eggs in feces, embryonates in warm, moist soil
3. Embryonated egg ingested by man
4. Larvae hatch in small intestine and begin larval migration (intestine wall > blood vessels >
liver > blood vessels > lungs > alveoli > bronchioles > pharynx > small intestine) and then
mature into adult
Symptoms and Pathology

1. Pneumonia, cough, fever, eosinophils during larval migration
2. Vomiting and abdominal pain
3. Intestinal perforation is possible
Larva: Heart-Lung Migration (ASH)

Resembling Loeffler’s Syndrome (eosinophilia)/Ascaris pneumonitis
(pneumonia-like symptoms)
Increased Eosinophils (greatest increase in EO: Trichinella spiralis)
Charcot-Leyden crystals: Eosinophil degradation products
Adult: Erratic (migrate to extraintestinal sites)
Group of adult worms: Bolus
Hepatic Ascariasis, migration to other tissues: kidney, appendix, and pleural cavity
Prevention and control measures for soil-transmitted helminthes (STH) infection involve
the provision of safe water, environmental sanitation, hygiene education, and regular
deworming which are the components of WASHED (Water, Sanitation, Hygiene, Education,
Deworming framework)
Laboratory Diagnosis
Stool Exam (DS: Eggs)
If (-) Stool Exam:
a. No infection
b. Early infection (no eggs laid yet)
c. All male worm infection
Additional Notes
Ascaris suum (large roundworm of pigs): human infection is rare; eggs are morphologically
identical to A. lumbricoides
Adult worms have characteristic toothed lip at the anterior end
Toxocara cati: Cat Ascarid
Toxocara canis: Dog Ascarid
- Can be ingested by man (accidental) and cause Visceral Larva Migrans/Ocular Larva
Migrans
Visceral Larva Migrans: larva will hatch but will not mature into adult worms
PARASITOLOGY| 37
FORTIS ANIMO
Treatment: Albendazole, Mebendazole or Pyrantel Pamoate

Enterobius vermicularis (Oxyuris vermicularis)
- Common Names: Pinworm, Seatworm, Social Worm, Society Worm
(has familial or group tendency; active transmission within the household)
Habitat: Large Intestine
Final Host: Man
Diagnostic Stage: Embryonated Egg
Mode of Transmission: Inhalation, Ingestion, Autoinfection (External), Sexual
Transmission has been reported
Adult
- Small, whitish, or brownish in color
- Anterior end with lateral wings or cephalic alae
- Male: dies after copulation
- Female: will go to the perianal region oviposit dies autoinfection
Possesses a clear, pointed tall that resembles a pinhead (pinworm)
Eggs
- Elongated, flattened on one side, D-shaped; Embryonated
- Double layered: albuminous layer and lipoidal layer; no glycogen layer
- “tadpole-like embryo”
Life Cycle
1. Adults in colon
2. Gravid female migrates to perianal region to deposit eggs
3. Egg ingested, hatch in small intestine, releasing larvae and develop into adult worms

1. Pruritus ani/Nocturnal Pruritus ani
2. Hemorrhagic colitis
3. Extraintestinal enterobiasis: vagina, uterus, fallopian tube
4. Autoinfection: External
The only nematode that cannot be controlled through sanitary disposal of human feces
because the eggs are deposited in the perianal region instead of the intestinal lumen. Personal
cleanliness and hygiene are essential.
1. 5% survival in stool
2. Perianal swab
3. Scotch Tape Swab/Cellulose Tape Swab
4. Diagnostic Stage: Embryonated Egg
Additional Notes
Most Common Helminth to Infect Man
Harr (Worldwide): Enterobius vermicularis
Belizario (Philippines): Ascaris lumbricoides
Treatment: Mebendazole, Albendazole
Trichuris trichiura
- Common Name: Whipworm
- Other species: T. suis (pig whipworm) and T. vulpis (dog whipworm)
Habitat: Large Intestine
Final Host: Man
Diagnostic Stage: Ova found in stool
Mode of Transmission: Ingestion of embryonated egg (fecal-oral)
Adult
PARASITOLOGY| 38
FORTIS ANIMO
- Flesh colored or pinkish gray worms, slender or attenuated in the anterior

- Anterior is attenuated and slender resembling a whip
- Anterior 3/5 portion is traversed by a narrow esophagus resembling “string of beads”
Eggs
- Barrel-shaped (football-shaped) with bipolar mucus plug
- Prominent hyaline polar plug
- Resembling Japanese Lantern
Life Cycle
1. Adults in the colon
2. Undeveloped eggs in feces, embryonates in warm, moist soil
3. Embryonated egg ingested by man
4. Larvae hatch in small intestine, penetrate and develop in villi, return to lumen and migrate
to cecum and then mature into adults.

Diseases: Trichuriasis, Trichocephaliasis, Whipworm Infection
1. Bloody or mucoid diarrhea
2. Weight loss, abdominal pain
3. Rectal Prolapse: Heavy Infection
4. Petechial Hemorrhage: provide good site for Entamoeba histolytica
Laboratory Diagnosis: Stool Exam (DS: Egg)

Additional Notes: Unholy Three/Parasitic Triad [HAT]: Hookworm, Ascaris lumbricoides,
Trichuris trichiura
Treatment: Mebendazole, Albendazole
Capillaria philippinensis
- Discovered by Dr. Nelia P. Salazar in 1963
- Common Name: Pudoc Worm/Mysery Worm: Pudoc Disease/Mystery Disease (from
Pudoc, Ilocos Sur)
- Close relative of Trichuris trichiura
Final Host: Man
True Definitive Host: Migratory birds
Intermediate Host: Freshwater Fish/Brackish Water Fish
Ipon (Hypselotris bipartita), Birot, Bagsang, Bagtu, Biyang Bato, Guppy
Diagnostic Stage: Larva and/or ova found in stool
Infective Stage: Filariform Larva
Mode of Transmission: Ingestion of raw/undercooked fish/seafood bearing the infective
larva
Adult
Typical Egg Atypical Egg
- Delicate, tiny worms
- immature eggs - segmented egg
- Male with chitinized spicule - unembryonated - embryonated egg
eggs - hatch inside the
- Females usually have eggs in utero - will go to stool small intestine
Eggs - will go to freshwater - responsible for
- With flattened bipolar mucus plugs, where the autoinfection
striated, and embryonation (similar to S.
smaller than Trichuris egg process occur stercoralis)
- Guitar, peanut-shaped - eaten by fish
To differentiate from Trichuris egg: 1) smaller and striated and 2) mucus plugs are not as
protruded
1. Malabsorption (also Giardia lamblia) Steatorrhea
PARASITOLOGY| 39
FORTIS ANIMO
2. Borborygmi: peculiar abnormal gurgling sound

3. LBM alternating with constipation (abdominal pain and diarrhea)
Laboratory Diagnosis: Stool Exam: Egg/Larva (DS)

Treatment: Albendazole, Mebendazole
Capillaria hepatica
- Causes hepatic capillariasis
- Egg: shell of egg is striated with shallow polar prominence
- Adult: slender, anterior narrow and swelled posterior; rarely seen intact, dies in
parenchyma
- Pathogenesis: Prefers to infect livers, egg deposition in liver parenchyma,
larval migration in lungs, kidneys or organs; humans are accidental
- Infective Stage: Embryonated Eggs (requires air and soil)
- Diagnostic Stage: Liver Biopsy – unembryonated eggs, adults (rare)
- Mode of Transmission: Ingestion of embryonated eggs
Hookworms
- Second most common helminthic infection reported in humans
- Known to have a worldwide distribution with two species to infect humans:
Ancylostoma duodenale and Necator americanus
1. Ancylostoma duodenale: Old World Hookworm (2 pairs of teeth)
2. Necator americanus: American Hookworm, American Murderer or New World Hookworm
(semilunar cutting plates)
3. Ancylostoma braziliense: Cat Hookworm (2 pairs of teeth)
4. Ancylostoma caninum: Dog Hookworm (3 pairs of teeth)

Final Host: Man
Diagnostic Stage: Egg/Larva
Infective Stage: L3/Filariform Larva (Sheathed)
Mode of Transmission: Skin Penetration (direct penetration) (e.g. unprotected feet)
Eggs
- Same for all species (indistinguishable)
- Ovoidal, thin-shelled, and colorless
- Inside is a germ cell in fragmentation: 2-8 Blastomeres
- “Morula Ball” formation
Adult
Hookworm N. americanus A. duodenale
Common Name New World Hookworm Old World Hookworm
American Murderer
Shape S-shaped C-shaped
Buccal Cavity Semilunar cutting plate 2 pairs of teeth
Copulatory Bursa Bipartite (2 digits) Tripartite (3 digits)

Barbed/Bristle-like Simple, not barbed
Larva
LI RHABDITIFORM LARVA L3 FILARIFORM LARVA
1st stage larva 2nd stage larva
Short and stout Long and slender
Open Mouth: Feeding Stage Closed Mouth: Nonfeeding Stage
Long Buccal Cavity Sheathed, pointed tail
Short/Small Genital Primordium
PARASITOLOGY| 40
FORTIS ANIMO
Life Cycle
1. Adults live in small intestine
2. Egg in feces, develops rapidly to rhaditiform larva and hatches in soil
3. After 2 molts (molting twice), become filariform larva
4. Filariform larva penetrate skin of man, begins larval migration (enters lymphatics and blood
> lung > alveoli > bronchioles > pharynx > small intestine) and then matures into adult

1. Larval Penetration
A. Human Hookworm
Allergic Reaction: Ground itch/Dew itch/Water sore/Mazza Mora

Severe itching at the site of larval penetration of skin
Erythematous popular rash
B. Animal Hookworm
A. braziliense and A. caninum: Creeping Eruption or Cutaneous Larva Migrans (CLM)

2. Larval Migration
Heart-to-lung migration (ASH): pneumonitis
Pulmonary lesions and hemorrhage: Wakana Disease
Pneumonia and alveolar hemorrhage, bloody sputum
3. Adult
Tissue damage at the site of attachment
Enteritis and pain; blood loss and anemia (Necator: 0.03 mL blood/day; Ancylostoma: 0.26
mL blood/day)
Chronic blood lost> Iron Deficiency Anemia; Microcytic, Hypochromic Anemia
Acute gastrointestinal phase demonstrates increased eosinophilia
Ancylostoma duodenale May be associated with vertical transmission and congenital
infections
Eosinophilia peaks in approximately 1 month in GI phase
Necator americanus Skin-associated symptoms as described for hookworms
Eosinophilia peaks in approximately 2 months in GI phase
Laboratory Diagnosis: 1) Stool Exam (DS: Eggs); 2) Harada Mori Culture Technique/Filter
Paper Culture Technique (H, SS larvae)
Strongyloides stercoralis
- Common Name: Threadworm
- Smallest nematode infecting man
- Can be a free-living organism
- Facultative nematode
1. Free-living: Soil
2. Parasitic (Female): Small Intestine
Final Host: Man
Diagnostic Stage: Rhabditiform/Filariform Larva (egg signifies heavy infection)
Infective Stage: L3 Larva/Filariform Larva (unsheathed)
Mode of Transmission: Skin Penetration, Internal Autoinfection: chronic and hyperinfection
Larva:
LARVA HOOKWORM THREADWORM
Rhabditiform larva
Buccal Cavity Long Short
Genital Primordium Small/Inconspicuous Prominent/Conspicuous
PARASITOLOGY| 41
FORTIS ANIMO
Filariform Larva
Sheath Sheathed Unsheathed
Tail Pointed Notched
Eggs
- Rarely found; diagnosed as “Hookworm egg” (indistinguishable)
> slightly smaller than Hookworm egg; well-developed larvae almost always contained in the
egg
Chinese Lantern appearance
Strongyloidiasis, Cochin-China Diarrhea
1. Larval Penetration: Allergic reaction at the site of larval penetration
“Larva Currens” tracks under skin from worm migration

2. Larval Migration: Heart Lung Migration – Pneumonia (signs and symptoms resembling
broncopneumonia)
3. Adult: Cochin China Diarrhea, Vietnam Diarrhea (Intermittent Diarrhea)
Honeycomb appearance of the intestinal mucosa

4. Autoinfection (internal): Infective larva will penetrate the intestinal mucosa
1. Stool Exam (DS: Rhabditiform Larva)
> Rhabditiform larvae are usually passed in the feces

> Rhabditiform larva is the primary diagnostic stage for strongylodiasis in human through
microscopic examination of stool
2. Baermann Funnel Technique
3. Harada Mori Filter Paper Culture Technique: recommended culture method
Strongyloides fuelleborni – a primate parasite that has been isolated from a human in
Africa
- Causes Swollen Belly Syndrome: a serious life threatening condition characterized by
diarrhea,
respiratory distress, and protein losing enteropathy, hypoalbuminemia, and edema.
- Diagnosed by detecting the eggs (smaller than S. stercoralis) in stool
Anisakis simplex (Fish and Marine Mammals Roundworm)
- Sometimes called “Herringworm,” “Codworm,” or “Sealworm”
- Causes Herring Disease; common in Japan
- Definitive Host: Whales/Dolphins
- 1st Intermediate Host: Copepods
- 2nd Intermediate Host: Smaller Fishes
- 3rd Intermediate Host: Larger Fishes (Salmons)
- Mode of Transmission: Ingestion of raw fish infected with larva (e.g. Sashimi)
- Symptoms and Pathology: Abdominal pain and granuloma around migrating larva in
intestinal wall
UNCOMMON INTESTINAL NEMATODES
A. Trichostrongylus spp. – similar to Hookworm eggs but has pointed eggs; an intestinal
nematode of herbivores
> Human infection is usually acquired by ingestion of leafy vegetables carrying the third-
stage larva.
B. Oesophagostomum spp. – worms resemble Hookworms; causes unilocular disease/
“dapaong tumor” (turtle in the belly)
PARASITOLOGY| 42
FORTIS ANIMO
C. Baylisascaris procyonis (Raccoon Roundworm) – causes fatal visceral larva migrans in

infants; acquires infection from ingestion of infective eggs
D. Eustrongyloides spp. – parasite of wading birds; human infection reported through
ingestion of ”sushi” and bait minnows
E. Gongylonema spp. – IH: cockroaches and other insects; human infection is through
ingestion of these insects or contaminated water; G. pulchrum – “Gullet Worm” or “Stitch
Worm”
F. Acanthocephala spp. – thorny-headed worms (Moniliformis moniliformis,
Macracanthorhynchus hirudinaceus, Macracanthorhynchus ingens, Bolbosoma); IH: arthropods
(beetles, cockroaches); also accidentally through sashimi
II. TISSUE NEMATODES
Trichinella spiralis
- Common name: Muscle Worm/Trichina Worm/Garbage Worm
- Greatest increase in Eosinophils
- All stages of development, including the larval and adult stages occur within a single host
- Habitat
Adult: Small Intestine
Larva: Encysted in striated muscle (skeletal muscle)
A striated muscle cell, nurse cell, surrounds the coiled larva
- Final Host: Pigs and other mammals that are omnivores/carnivores
- Accidental Host/Dead-end Host: Man
- Diagnostic Stage: Encysted Larva (muscle biopsy)
- Infective Stage: Encysted Larva
- Mode of Transmission: Ingestion of undercooked raw meat with encysted larva
Adult
Male: with conical papillae (aid in copulation); after copulation, male dies
Female: with club-shaped uterus; viviparous/larviparous
Life Cycle
1. Infection for man: Ingestion of undercooked larvae-containing striated muscle (pig, bear)
2. Larvae digested out of muscle in intestine, mature to adults
3. Adult in small intestine
4. Viviparous female releases larvae which penetrate intestinal mucosa and disseminate into
bloodstream (no egg stage)
5. Larvae encyst in striated muscle

- Trichinosis, Trichiniasis, Trichinellosis
- Great Imitator: can mimic other diseases
1. Larva (Muscle)
Larval Migration: Fever, Facial Edema, Eosinophilia
Muscle pain at the site of encystations, edema (eyelid edema)
Usually arms and legs
Difficulty in swallowing and breathing
2. Adult (Small Intestine): Diarrhea and abdominal pain
1. Muscle Biopsy (DS: Encysted Larva)
2. Immunotests
Bentonite Flocculation Tests (also for Echinococcus granulosus)

Bachman Intradermal Test
Beck’s Xenodiagnosis (Test animals: Albino mice/Rats)
Additional Notes
- Man: both definitive and intermediate host
- Freezing destroys Trichinella spiralis larvae
PARASITOLOGY| 43
FORTIS ANIMO
- Thorough cooking of meats, especially from animals known to habor T. spiralis, is paramount
to the eradication of this parasite. It has been determined that proper storage of these meats,
AT BELOW-ZERO TEMPERATURES (i.e. -15°C for 20 days or -30°C for 6 days) will greatly
decrease the viability of the organism. Furthermore, the avoidance of feeding pork scraps to
hogs is also necessary to break its life cycle.
Treatment: 1) Removal of muscle with encysted larvae and 2) Thiabendazole, Prednisone
Parastrongylus (Angiostrongylus) cantonensis (Cerebral Angiostrongyliasis)
- Common Name: Rat Lungworm
- Natural Host/Definitive Host: Rats
- Intermediate Hosts: Molluscs, slugs, and snails [Pila luzonica (Kuhol);
Brotia asperata (Suso)]
- Infective Stage: Filariform Larva (L3)
- Mode of Transmission: Ingestion of Intermediate Host by man containing infective larva
Migrate to the brain and spinal cord causing Eosinophilic Meningoencephalitis
- Adult
Female worm: Barber’s pole appearance; looping of whitish uterus to the red digestive tract
- Symptoms and Pathology
Eosinophilia and symptoms of meningitis (CSF contains increased WBCs plus eosinophilia)
- Laboratory Diagnosis: Increased eosinophil count in CSF
Dracunculus medinensis
- Longest nematode of man (up to 1 meter)
- Common Names: Guinea Worm, Fiery Serpent of the Israelites, Medina Worm,
Dragon Worm, Serpent Worm
- Charcteristic: Thick cuticle and a large uterus that fills the body cavity and contains
rhabditoid larvae
- Habitat: Subcutaneous Tissue (subcutaneous infection: drancunculiasis)
- Intermediate Host: Aquatic Crustacean (Copepods) – Cyclops
- Mode of Transmission: Ingestion of inected copepods (usually through drinking unfiltered
water containing the copepods)
- No treatment, removal only: worms are attached to a stick and slowly retracted from the
host by gradual turning of the stick and removal of the worm; as of 2018, according to CDC,
global eradication is within reach
- Life Cycle
1. Intermediate host is aquatic crustacean (copepods) – Cyclops
2. Infection: Accidental ingestion of crustacean with larva
3. Larva digested free in the intestine, penetrates wall, and develops in body cavity or
connective tissues
4. Gravid female migrates to subcutaneous tissues and causes ulcer
5. Ulcer, or contact with water, releases larvae
III. BLOOD NEMATODES (FILARIAE)
- Adult worms live in tissue or the lymphatic system and produce larvae known as
microfilariae (detected in the blood)
> Microfilariae may exhibit periodicity (parasites are present in the bloodstream during a
specific time period)
> Diurnal Periodicity: occurring during the day
> Nocturnal Periodicity: occurring during the night
> Subperiodic: timing of occurrences not clear-cut
- Two characteristics used in speciating the microfilariae:
> Distribution of nuclei within the tail
> Presence or absence of a sheath (a delicate transparent covering)
- Habitat
Adult: Lymphatic System (for Loa loa, Onchocerca volvulus: subcutaneous tissue)
Microfilaria: Blood except for Onchocerca
- Final Host: Man
- Intermediate Host: Mosquito (vector-transmitted)/Arthropods
PARASITOLOGY| 44
FORTIS ANIMO
- Diagnostic Stage: Microfilaria

- Infective Stage:
To Intermediate Host: Microfilaria
To Final Host: Filariform Larva (L3)
- Mode of Transmission: Bite of an infected arthropod
- Life Cycle (same for all members)
1. Infective larvae are injected by arthropod vector upon blood meal
2. Once inside the body, the larvae migrate to the tissues where they complete their
development
3. Fertilized adult female worms then lay live microfilariae which take up residence in the
blood or dermis
4. Microfilariae exit the body via a blood meal by the arthropod vector (IH)
- Primary mechanism of filariasis:
> Lymphagiectasia: dilation of lymph vessels due to pre-formed saliva that enlargers to
accommodate the adults
> Lymphagiogenesis: formation of new lymph vessels by the saliva
> Wolbachia spp.: endosymbiont bacterium of filarial worms needed for development,
viability, and fertility
Larva: Tropic Pulmonary Eosinophilia
Patients residing in endemic tropical regions for filarial parasites may present with a syndrome
referred to as tropical pulmonary eosinophilia (TPE)
Adult: Lymphatic Filariasis

Elephantiasis
Hydrocoele: inflammation of the scrotum
Upper Lymphatics: Brugia malayi
Lower Lymphatics: Wuchereria bancrofti
Chyluria: lymphatic rupture and fluid entering the urine; milky white appearance
Occult Filariasis
With pulmonary/asthmatic symptoms
No microfilariae are found in the blood
Hidden deep in the body such as the lungs
1. Knott’s Technique
- done if there are low number of microfilaria
- for isolation of microfilaria
- 1 mL blood + 9 mL 2% formalin centrifuge ate 500 g for 1 minute stain with Giemsa
2. Capillary Blood
- 2 thick smear stained with Giemsa
- Giemsa stained blood (method of choice)
Treatment: Diethylcarbamazine, Ivermectin
Wuchereria bancrofti
- Other Name: Bancroft’s Filarial Worm
- More prevalent; common in the Philippines
- Most common identified species of filarial worms that infect humans
- Show nocturnal periodicity (seen in large numbers in the blood between 10 PM to 4 AM)
- Vectors: Female mosquitoes (Aedes, Anopheles, Culex)
- Pathogenesis:
> Weingarten’s Syndrome (Pulmonary Eosinophilia)
> Meyers Kouwenaar Syndrome: microfilaria in spleen, liver, and lymph node
that leads to hepatosplenomegaly and lymphadenopathy
Brugia malayi
Other Name: Malayan Filarial Worm, Brugian Filariasis
PARASITOLOGY| 45
FORTIS ANIMO
- Shows nocturnal periodicity

- Vectors: Aedes, Anopheles, Mansonia (nocturnal);
Coquillettidia (subperiodic)
Brugia timori: nocturnal; vector (Anopheles); sheath unstained in Giemsa; microfilarie tend
to be longer
CHARACTERISTICS Wuchereria bancrofti Brugia malayi
Movement Graceful/Smooth Kinky/Stiff appearance
Nuclei Not overlapping Overlapping
Sheath Sheathed Sheathed
Terminal Nuclei No Terminal Nuclei With 2 Terminal nuclei;
bulge around 2 nuclei
Onchocerca volvulus (Convoluted Filaria)
- Other Names: River Blindness Worm/Blinding Worm
- Vector: Simulium spp. (Black Fly/Buffalo Gnat)
- Pathogenesis: Onchocerciasis (River Blindness) – second major cause of blindness in the
world
Lizard/Leopard skin (chronic onchocercal dermatitis); Hanging Groin
SOWDA (localized onchocercal dermatitis)
“Snowflake Opacities” presentation in keratitis
- Diagnosis: 1) Skin snips/skin biopsies and 2) Mazzoti skin test (done only in skin
infections)
Loa loa (African Eye worm)
- Exhibits diurnal periodicity (during the midday hours, between 10:15 AM and 2:15 PM)
- Vector: Chrysops spp. (Fruit Fly/Mango Fly/Tabanid Fly/Deer Fly)
- Pathogenesis: Fugitive/Calabar Swelling – localized areas of transient angioedema
Encephalopathy, cardiomyopathy, nephropathy may also occur
- Definitive diagnosis: identification of adult worm from the eye, in tissue or in peripheral
blood
- Sheath does not stain with Giemsa
- Treatment of choice: Surgical removal of the worms
Mansonella spp.
- Generally not associated with serious infections
- Vector: Culicoides spp. /Midge
A. Mansonella streptocerca: may be found in the skin; nuclei extends to tip of tail bent in the
form of shepherd’s crook
B. Mansonella perstans: resides in the pericardial, pleural, peritoneal cavities; blood is the
specimen of choice
C. Mansonella ozzardi (Ozzard’s filariasis): common name: New World filaria; can also use
Simulium spp. as vector
SUMMARY OF BLOOD NEMATODES:
PARASITOLOGY| 46
FORTIS ANIMO
IV. OTHER MEDICALLY SIGNIFICANT BLOOD/TISSUE NEMATODES

Dirofilaria immitis
- Common Name: Dog Heartworm
- A very common filarial parasite of dogs
- Infective Stage: Filariform Larva (L3)
- Diagnostic Stage: Adult
- Vector: Aedes mosquito
- Almost all human infections come to medical attention as solitary, peripheral nodules in
the lung (coin lesions) or as subcutaneous nodule
- In man, causes coin lesion in the lungs
Gnathostoma spinigerum
- Definitive host: Dog, cat and other carnivorous animals
- First intermediate host: Cyclops
- Second intermediate host: Fresh water fish and frog
- Paratenic host: Birds and humans
- Infective Stage: Filariform Larvae (L3)
- Mode of Transmission: Ingestion of undercooked fish containing the L3 larvae
OTHERS:
Syngamus laryngeus: parasite of upper respiratory tract of ruminants; eggs similar to
Hookworm
Dioctophyma renale: giant kidney worm of carnivores (IS: L3 Larva; DS: Unembryonated
Egg; MOT: Ingestion of frog/fish)
E. Thelazia callipaeda: Oriental Eye Worm [IS: L3 in fly mouth; DS: Adults; MOT: Fly
(Musca/Fannia) feeding in lacrimal secretion]
PHYLUM PLATYHELMINTHES
TREMATODA (FLUKES/FLATWORMS)
1. All flukes appear flat and leaf-like except for Schistosomes (blood flukes) –
elongated/cylindrical
2. All are hermaphroditic (monoecious) except for Schistosomes – separate sexes
(dioecious)
3. All eggs are operculated except for Schistosomes – non-operculated
4. Life Cycle of Trematodes:
Egg Larva Adult
Larva: Miracidium Sporocyst Redia Cercaria Metacercaria
*Except for Schistosomes: No Metacercaria
5. Infective Stage to the final host: Metacercaria except for Schistosomes: Cercaria
6. Mode of Transmission: Ingestion except for Schistosomes: Skin Penetration (Forked-
tail Cercaria)
7. Require 2 Intermediate Hosts
1st Intermediate Host: Snail (Cercaria)

2nd Intermediate Host: Fish, Crab, Plant, Snail, Ant (Metacercaria)
Fish: Heterophyes heterophyes, Clonorchis sinensis, Opistorchis felineus
Crab: Paragonimus westermani
Plant/Vegetation: Fasciola hepatica, Fasciola gigantica, Fasciolopsis buski
Snail: Echinostoma ilocanum
Ant: Dicrocoelium dendriticum, Eurytrema pancreaticum
Except for Schistosomes – only 1 Intermediate Host: Snail (Cercaria)
PARASITOLOGY| 47
FORTIS ANIMO
8. Adults attach themselves to the host by means of 2 suckers: oral sucker and ventral sucker
(acetabulum) except for Heterophyes heterophyes having 3 suckers: genital sucker/gonotyle
9. Egg
A. Mature when laid (SHOC)

Schistosoma
Heterophyes
Opistorchis
Clonorchis
B. Immature when laid (PEFF)
Paragonimus
Echinostoma
Fasciola
Fasciolopsis
OPERCULATED, UNEMBRYONATED EGGS Fasciola, Fasciolopsis, Paragonimus
OPERCULATED, EMBRYONATED EGGS Clonorchis, Opistorchis, Heterophyes
NON-OPERCULATED, EMBRYONATED EGGS Schistosoma
10. Possess alimentary canal without anus (incomplete)
Possess complex reproductive structures: testes, ovary, uterus

11. Treatment: Praziquantel
A. LIVER FLUKES
Fasciola hepatica
- Common Name: Sheep Liver Fluke/Temperate Liver Fluke
- Sheep liver fluke causing sheep liver rot
- Prevalent in sheep raising countries
- Habitat: Biliary duct/passages of liver
- Final Host: Sheep
- 1st IH: Snail
- 2nd IH: Plant/Vegetation (e.g. kangkong, water spinach)
- Infective Stage: Metacercaria
- Mode of Transmission: Ingestion of 2nd Intermediate Host
- Egg: large, operculated, unembryonated, yellowish brown egg resembling F. gigantica and
F. buski egg
Resembling Hen’s egg shape
- Adult: Cephalic cone, well-developed shoulder
Fasciola gigantica
- Common Name: Giant Liver Fluke/Tropical Liver Fluke
- Infects cattles in the Philippines
- Dominant species affecting cattle and water buffaloes in the Philippines
- Habitat: Biliary Passages of Liver
- Final Host: Cattle
- 1st IH: Snail
- 2nd IH: Plant/Vegetation (e.g. kangkong, water spinach)
- Egg: Similar to F. hepatica egg
- Adult: Longer cephalic cone, less developed shoulder
Almost same with F. hepatica but is bigger
Clonorchis sinensis
- Common Name: Chinese Liver Fluke/Oriental Liver Fluke
- Most important liver fluke of man
PARASITOLOGY| 48
FORTIS ANIMO
- Habitat: Bile duct/Gallbladder

- Final Host: Man
- 1st IH: Snail
- 2nd IH: Fish
- Egg: Operculated, mature; eggs like an old-fashioned electric light bulb; pitcher-like
appearance
- Pathogenesis: 1) desquamation of epithelial cells; 2) hyperplasia; 3) adenomatous tissue
formation; 4) pancreatitis and
5) cholangiocarcinoma
Opistorchis felineus
- Common Name: Cat Liver Fluke/Siberia Liver Fluke
- Habitat: Liver, Bile passages of the liver
- Final Host: Cats
- 1st IH: Snail
- 2nd IH: Fish
- Egg: Operculated, mature
- Opistorchis viverrini: Southeast Asian Liver Fluke
- Pathogenesis: cholangiocarcinoma
DIFFERENCE Clonorchis sinensis Opistorchis felineus Opistorchis viverrini
TESTES Branched Slightly lobulated Deeply lobulated
Dicrocoelium dendriticum/lanceolata
- Common Name: Lanceolate/Lancet Fluke
- Cirrhosis/Fibrosis of the liver
- Habitat: Biliary passages of the liver
- Final Host: Cattle/Sheep
- 1st IH: Snail (Mass of Cercaria: Slime ball/Germ ball)
- 2nd IH: Ants
- Egg: Brownish, thick-walled, operculated, embryonated
- Adult: Lancet-shaped
B. INTESTINAL FLUKES (Small Intestine)
Fasciolopsis buski
- Common Name: Giant Intestinal Fluke
- Largest fluke parasitizing man
- Habitat: Small Intestine
- Final Host: Man
- Reservoir Hosts: Pigs, Dogs, Rabbits
- 1st IH: Snail
- 2nd IH: Plant/Vegetation (e.g. chestnuts, caltrop)
- Egg: Operculated, immature; indistinguishable from Fasciola eggs
Echinostomids
- Characterized by horseshoe shaped collar of spines around their oral suckers; reservoir
hosts: rats
1. Echinostoma ilocanum
PARASITOLOGY| 49
FORTIS ANIMO
- Common Name: Garrison Fluke (discovered among Bilibid prisoners)

- Final Host: Man
- Reservoir Hosts: Rats
- 1st IH: Snail
- 2nd IH: Snail
- Egg: Operculated, immature; germ ball egg
2. Artyfechinostomum malayanum
- Reservoir Hosts: Rats
- 1st IH: Snail
- 2nd IH: Snail
- Egg: Larger, golden brown, operculated, immature
Heterophyids
- Pathogenesis: excessive mucus production; most common clinical manifestations: peptic
ulcer disease and acid peptic disease
1. Heterophyes heterophyes
- Common Name: Von Siebold’s Fluke
- Teardrop-shaped fluke
- Smallest fluke of man/deadliest fluke
- Final Host: Man
- Reservoir Hosts: Dogs, cats, birds
- 1st IH: Snail
- 2nd IH: Fish
- Egg: Operculated, mature; resembles C. sinensis egg; appears old-fashioned light bulb
- Adult: Presence of genital sucker (gonotyle)
2. Metagonimus yokogawai
- Final Host: Man
- Reservoir Hosts: Dogs, cats, birds
- 1st IH: Snail
- 2nd IH: Fish
C. LUNG FLUKES
Paragonimus westermani
- Common Name: Oriental Lung Fluke
- Causing endemic hemoptysis
- TB-like symptoms
- Common in Sorsogon (endemic)
- Habitat: Lungs
- Final Host: Man
- 1st IH: Snail
- 2nd IH: Crabs, crayfish, lobster
- Mode of Transmission: Ingestion of 2nd Intermediate Host with Metacercaria
- Egg: Operculated with shoulders; immature/unembryonated
Opposite the operculum is an abopercular thickening
PARASITOLOGY| 50
FORTIS ANIMO
Similar to Diphyllobothrium latum egg

- Adult: Resembles coffee bean
- Pathogenesis: 1) Causes granulomatous reaction that proceeds into fibrotic encapsulation
2) Dry cough that processes into rust-colored sputum with foul-fish odor
3) Cerebral involvement: most serious complication; causes jacksonian epilepsy
Laboratory Diagnosis: Specimen: Sputum (added with 3% NaOH to improve recovery)/Stool
Diagnosis is based on sputum and stool examination for characteristic eggs
Charcot-Leyden crystals may be observed in sputum or lung tissue specimens
- Additional: Paragonimus mexicanus
> Found in areas of Mexico and South America
> Formation of subcutaneous or lower abdominal nodules
> Egg: operculated with shoulders, thick-shelled, brownish-yellow, unembryonated
D. PANCREATIC FLUKES
Eurytrema pancreaticum
- Common Name: Pancreatic Fluke
- Causing cholecystitis, pancreatitis
- Habitat: Pancreatic ducts
- Final Host: Sheep, cattle
- 1st IH: Snail
- 2nd IH: Ant, grasshopper, mantis, crickets
- Mode of Transmission: Ingestion of 2nd Intermediate Host with Metacercaria
- Egg: Operculated, embryonated (mature)
E. BLOOD FLUKES
SCHISTOSOMES
Schistosomes (formerly called Bilharzia)
- Adult stages are in the blood vessels
- Females are long and slender with body circular in section
- Males are flattened behind ventral sucker; cylindrical and incurved ventrally to form
gynecophoral canal in which female reposes
- Infective Stage: Forked-tail Cercaria (nocturnal activity)
- Mode of Transmission: Skin Penetration
- Schistosomule: cercaria minus tail; remains in subcutaneous tissue for 2 days
- Laboratory Procedures: 1) DFS, Kato Katz, FEACT: Stool exam for eggs of S. japonicum and
S. mansoni
2) Urine analysis using 24-hour unpreserved urine (centrifugation) for S. haematobium
2) Faust and Meleney’s Egg Hatching Technique
3) Circumoval Precipitin Test of Oliver and Gonzales: confirmatory test for
Schistosomiasis
Reagent: Lyophilized S. japonicum eggs from a rabbit (reservoir host)
Specimen: Serum
Principle: Detection of antibodies that react with eggs
Positive result: Bleb Formation
4) Antibody testing for schistosomes: Increased IgE, IgG4 (ELISA)
5) Antigen detection: Circulating Cathodic Antigen (urine); Circulating Anodic Antigen
(serum)
- Treatment: Praziquantel (2-3 doses in a single day)
- Infection with S. mansoni may require a larger dose than that for the other species
- An alternative treatment for S. haematobium infections is metrifonate (Bilarcil), an
organophosphorus compound, given once every other week in a total of three doses
1. Schistosoma japonicum
- Common Name: Oriental Blood Fluke
- Causes Oriental Schistosomiasis or Katayama’s Disease
- Habitat: Superior Mesenteric Vein in the Small Intestine
PARASITOLOGY| 51
FORTIS ANIMO
- Final Host: Man

- Reservoir Host: Dogs, Cats, Carabaos, other mammals
- Intermediate Host: Snail (Oncomelania hupensis quadrasi)
- Infective Stage: Cercaria (Forked-tail cercaria)
- Mode of Transmission: Skin Penetration Allergic Reaction: Swimmer’s Itch
- Egg: Unoperculated, embryonated (mature)
Smallest egg among blood flukes
With a small knob-like or small-lateral spine (recurved hook on one side)
- Pathogenesis: 1) Chronic infection: hepatic (most serious) and pulmonary cirrhosis
2) CNS involvement may occur
3) Secondary bacterial infection with Salmonella
4) Colorectal and liver carcinoma
2. Schistosoma mansoni
- Common Name: Manson’s Blood Fluke
- Smallest ADULT Blood Fluke
- Causes Intestinal Bilharziasis
- Habitat: Inferior Mesenteric Vein of the Colon and the Rectum
- Final Host: Man
- Reservoir Host: Nonhuman primates
- Intermediate Host: Snail (Biomphalaria spp.)
With prominent lateral spine
3.Schistosoma haematobium
- Common Name: Vesical Blood Fluke
- Causes Urinary Bilharziasis/ Urinary Schistosomiasis (Bloody Urine), Egyptian Hematuria
- Habitat: Vesical/Uterine Plexus near the Urinary Bladder
- Final Host: Man
- Reservoir Host: None
- Intermediate Host: Snail (Bulinus spp.)
With prominent terminal spine
- Specimen: 24-hour unpreserved urine sample
- Optimize recovery in urine: between noon and 2 PM
- Pathogenesis: Chronic infections: Bladder Carcinoma,
Obstructive Uropathies, Granuloma/fibrous damage in organs
Additional:
Schistosoma intercalatum
- Egg: resembles egg of S. haematobium, but Acid-Fast Positive
- Adult: located in the venules of colon
- Has a diamond body (diamond schistosome)
4. Schistosoma mekongi
- Egg: resembles egg of S. japonicum but smaller
- Adult: located in the venules of small intestine
5. Schistosoma malayensis
- Found in peninsular Malaysia; also resembles S. japonicum
F. UNCOMMON HUMAN TREMATODES
A. Nanophyetus salmincola – causes “salmon poisoning” – a fatal diseases of dogs, wolves,

and foxes.
PARASITOLOGY| 52
FORTIS ANIMO
- it harbors the rickettsia “Neorickettsia heminthoeca”

B. Philophthalmus – “eyeflukes”
C. Acanthoparyphium – intestinal parasite of ducks
D. Alaria – acquired through ingestion of frogs/infected meat
E. Gymnophalloides – parasite of shore birds
F. Metorchis conjuctus –parasite of sled dogs
G. Watsonius watsoni – trematode of monkeys
H. Gastrodiscoides hominis – only fluke inhabiting the large intestine; eggs and life cycle
similar to F. buski . Adults are pyriform shaped and have conical anterior portion.
PHYLUM PLATYHELMINTHES
CESTODA (TAPEWORMS)
1. White, yellowish in color/creamy white in color
2. Adult is flat/ribbon-like
3. Segmented unlike trematodes which are nonsegmented, flat, and leaflike
4. Monoecious/Hermaphroditic
5. No gastrointestinal tract/alimentary canal (no mouth, no anus)
6. No circulatory system
7. Entry of nutrients and exit of waste: Integument
8. With well-developed reproductive organs: testes, ovary, uterus
9. Mode of Transmission: Oral Route
10. Habitat: Small Intestine
11. Cestode body consists of:
a. Scolex
- Anterior attachment organ
- Attach to the lining of the small intestine
- Globular (circular) or pyriform
- Spoon-like (almond)
- Nonrecovery of scolex would mean unsuccessful treatment
> Rostellum
- Protrusible structure
- Armed (with hooks) or unarmed (without hooks)
> Suckers “Grooves” “Acetabula”
- Majority: with 4 cuplike suckers
- Diphyllobothrium latum: with 2 slitlike suckers
b. Neck
- Region of growth
- Point of proliferation for the next set of segments
c. Proglottids
- Chain of segments/Strobila
- Stained with India Ink
> Immature: found nearest to the neck
> Mature: at the middle portion where reproductive structures are formed and found
> Ripe/Gravid: filled with eggs; presence of eggs in the uterus
farthest from the head; can be detached (apolysis)
- Alcohol Ingestion: Irritates the tapeworm; proglottid activates and become infectious
Other structures:
d. Uterine Pore
PARASITOLOGY| 53
FORTIS ANIMO
- Found at the medial surface

- Found in Diphyllobothrium latum
- Where egg exits
e. Genital Pore
- Site at where the male and female organs meet

- Where the other eggs will exit
12. Eggs: All eggs are unoperculated and mature (embryonated) except for
Diphyllobothrium latum
> Oncosphere: protects the embryo; contains 6 hooklets

> Hexacanth Embryo: embryo with 6 hooklets
13. Adult: found in the intestines of the definitive host
14. Larva: encysted in the tissues of the intermediate host
15. Two Main Orders:
a. Order Pseudophyllidean
- False Tapeworm
- Diphyllobothrium latum (DH: Humans)
- Spirometra (IH: Humans) Sparganosis (plerocercoid larva)
- Proglottid: Anapolytic
b. Order Cyclophillidean
- True Tapeworm
- Species which require vertebrate IH: T. solium, T. saginata
- Species which require invertebrate IH: D. caninum
- Species which may or may not require IH: H. nana
16. Life Span
Up to 25 years: D. latum, T. saginata, and T. solium

Usually <1 year: D. caninum and H. diminuta
Perhaps many years as a result of autoinfection: H. nana
17. Treatment: Praziquantel; Cysticercosis and Hydatid Disease: Albendazole,
Mebendazole
DIFFERENCE PSEUDOPHYLLIDEAN CYCLOPHILLIDEAN

(FALSE TAPEWORM) (TRUE TAPEWORM)
- Spoon-shaped (spatula) or - Globular/Pyriform
Almond - Quadrate: with four cuplike
- With slit-like sucking grooves suckers
Scolex (Bothria) - With Rostellum
- No hooklets Armed: with hooks
Unarmed: without hooks
Strobila - Anapolytic (not shedding - Apolytic (shedding segments)
segments) - Recover in stool: eggs and
- Recover in stool: eggs only segments
Ova Oval, operculated, immature Spherical, non-operculated,
embryonated (hexacanth
embryo)
Larval Stages Coracidium > Procercoid > Cysticercoid, Cysticercus,
Plerocercoid (Infective Stage) Hydatid
Cysticercoid: D. caninum
Hymenolepis
Railletina
PARASITOLOGY| 54
FORTIS ANIMO
Cysticercus: Taenia
Hydatid: Echinococcus
Intermediate Host Two Intermediate Hosts: Only one, usually lower forms
1st IH: Crustaceans (Copepods), of mammal or arthropod
Cyclops Some do not require an IH: H.
2nd IH: Freshwater Fish nana
Gravid Proglottid All reproductive structures are Uterus can only be seen
seen Uterus: in different
Uterus: Rosette-like appearance shapes/patterns
A. ORDER PSEUDOPHYLLIDEAN
Diphyllobothrium latum
- Common Name: Broad/Fish Tapeworm
- LARGEST tapeworm of man
- Scolex is spatulate/spoon-shaped/diamond-shaped with sucking organ called bothrium
- Uterus with characteristic rosette formation (highly-coiled uterus)
- Eggs are operculated, immature
- Larval stages: coracidium > procercoid > plerocercoid
- Final Host: Man
- Reservoir Host: Dogs, cats, rats, and other fish-eating mammals
- 1st Intermediate Host: Copepods (Cyclops)
- 2nd Intermediate Host: Freshwater Fish (Small Fishes)
- Paratenic Host: Carnivorous Fish (Bigger Fishes: usually eaten by man)
- Infective Stage: Plerocercoid Larva
- Diagnostic Stage: Egg/Scolex (complete/successful treatment); NO SEGMENTS SEEN
(anapolytic)
- Mode of Transmission: Ingestion of raw or undercooked fish with plerocercoid larva
- Adults: confused with Spirometra spp.
- Eggs: confused with Paragonimus westermani
- Pathology: Causes hyperchromic, megaloblastic anemia with thrombocytopenia and
leukopenia; competes with Vitamin B12 for humans (content is about 50 times than T.
saginata)
Spirometra spp.
- Medically important species: S. mansoni, S. theileri, S. erinacei
- Can accidentally infect man and cause disease called as sparganosis (caused by sparganum:
plerocercoid larva)
- Definitive Host: Dogs, cats
- 1ST Intermediate Host: Copepods (Cyclops)
- 2nd Intermediate Host: Snakes, frogs, fishes
- Adults are mistaken for adult Diphyllobothrium latum
- Modes of Transmission: 1) Drinking water containing copepods infected with sparganum
2) Eating frogs, snakes infected with larvae
3) Applying larvae infected products from frogs or snakes into open sores/wounds
B. ORDER CYCLOPHILLIDEAN
Taenia saginata
- Common Name: Beef Tapeworm
- LONGEST tapeworm of man
- Length: up to 25 meters
- 15-20 lateral branches: Dichotomous/Tree-like
- Scolex: cuboidal, with 4 acetabula; no hooklets and rostellum (unarmed)
- Proglottid: Taller than wide
- Final Host: Man
PARASITOLOGY| 55
FORTIS ANIMO
- Intermediate Host: Cattles, Cows, Camels

- Infective Stage: Cysticercus Bovis
- Mode of Transmission: Ingestion of raw or undercooked beef
- Eggs: Spherical, striated, embryonated eggs with oncosphere
(indistinguishable with T.solium egg); ACID-FAST
- Laboratory: Stool Examination: Eggs and Proglottids; Perianal Swab
Double Slide Compression Technique – inject dye (India Ink)
[count the uterine branches]
- Pathology: Causes Taeniasis bovis: mild epigastric pain, obstruction in appendix, bile, and
pancreatic ducts
Taenia solium
- Common Name: Pork Tapeworm
- Length: shorter < 7 meters
- 7-13 lateral branches: Dendritic/Finger-like
- Proglottid: Wider than tall
- Final Host: Man
- Intermediate Host: Pig (Intestinal Taeniasis); Man (Cysticercosis)
- Infective Stage: Cysticercus Cellulosae (Intestinal Taeniasis);
Embryonated Eggs (Cysticercosis)
- Mode of Transmission: Ingestion of measly pork (intestinal taeniasis)
and embryonated eggs (cysticercosis)
- Eggs: Spherical, striated, embryonated eggs with oncosphere
(indistinguishable with T.saginata egg)
- Laboratory: Stool Examination: Eggs and Proglottids; Perianal Swab
Double Slide Compression Technique – inject dye (India Ink)
[count the uterine branches]
- Pathology: Causes Taeniasis
Autoreinfection (external, internal)
Cysticercosis
> Any organ or tissue may be involved, the most common
being subcutaneous tissues and muscles.
> The cysticercus is surrounded by a fibrous capsule
> Neurocysticercosis is the most common and most serious form
> Ocular Cysticercosis: cysts are found in vitreous humor, subretinal space and conjunctiva
The above table shows the comparison between T. saginata and T. solium.
Taenia asiatica: 3rd Taenia spp.
closely related to T. saginata
PARASITOLOGY| 56
FORTIS ANIMO
- Has been reported in Taiwan, Korea, Thailand, and Indonesia. In contrast to T. saginata,
the cysticercus larvae (IS: cysticercus viscerotropica) were found in the liver of various
intermediate hosts that include pigs, cattles, goats, wild boards, and monkeys.
- Drinking Alcohol: irritates adult Taenia; contributes to passing of proglottids
Hymenolepis nana
- Common Name: Dwarf Tapeworm
- SMALLEST tapeworm of man
- MOST COMMON cestode of man
- TRUE HUMAN Tapeworm
- Final Host: Man (Children)
- Reservoir Hosts: Mice, Rats
- Intermediate Host:
Direct: Do not require IH; Ingestion of Embryonated Egg
Indirect: Require IH (Flea/Bettle)
- Infective Stage:
Direct: Embryonated Egg
Indirect: Cysticercoid Larva
- Mode of Transmission: Ingestion of embryonated egg (direct); Accidental ingestion of IH
containing larva (indirect)
- Eggs: Contain an oncosphere with two polar thickenings from which arise 4-8 polar
filaments
- Pathogenesis: Light infections, autoreinfection may occur through fecal-oral route
Hymenolepis diminuta
- Common Name: Rat Tapeworm
- Final Host: Rat
- Intermediate Host: Rat Flea, Flour Beetle, Cockroach
- Infective Stage: Cysticercoid Larva
- Mode of Transmission: Ingestion of IH
- Eggs: Contain an oncosphere with polar thickenings but without filaments; sunny side-
up/fried egg appearance
COMPARISON: Hymenolepis nana VS Hymenolepis diminuta
DIFFERENCE Hymenolepis nana Hymenolepis diminuta
Common Name Dwarf Tapeworm Rat Tapeworm
Smallest tapeworm infecting
man
May or may not require IH
Most common cestode of man
Scolex With rostellum armed with a With an unarmed rostellum
ring of 20-30 spines
Eggs Contain an oncosphere Contain an oncosphere
enclosed in an inner membrane enclosed in an inner
with two polar thickenings, membrane with two polar
from each of which arise 4-8 thickenings but without
polar filaments filaments
”Sunny Side/Fried Egg
Appearance
Infective Stage Eggs (direct) Cysticercoid Larva
Cysticercoid larva (indirect)
Intermediate Host Only human tapeworm that Insects
does not require an IH to Rat Flea
complete its natural life cycle, Flour Beetle
Cockroach – Blata americana
PARASITOLOGY| 57
FORTIS ANIMO
however insects may act as an

IH in some occasions:
Dog flea – Ctenocephalides
canis
Human flea – Pulex irritans
Rat flea – Xenopsylla cheopsis
Final Host Man Rat
Dipylidium caninum
- Common Name: Dog Tapeworm/Double-Pored Tapeworm (Flea Tapeworm)/Cucumber
Tapeworm
- Proglottids have double set of reproductive organs and genital pore on each side of the
lateral margin
- The only parasite with two sets of reproductive organs
- Mature and gravid proglottids are typically shaped like melon seeds/pumpkin seeds/rice
grains/cucumber
- Common tapeworm of the dog and cat; man is an accidental host (ingestion of fleas
containing the larva)
- Final Host: Dog
- Intermediate Host: Flea
Ctenocephalides canis – dog flea
Ctenocephalides felis – cat flea
Pulex irritans – human flea
- Mode of Transmission: Ingestion of the flea
- Eggs: Enclosed in an egg capsule/egg packets (8-15 embryonated eggs; looks like Taenia
egg)
- Adult Scolex: Conical shaped, armed rostellum
Raillietina garrisoni
- No common name (so far)
- Common tapeworm of rats
- Final Host: Rats
- Intermediate Host: Flour Beetle
- Mode of Transmission: Ingestion of flour beetle
- Adult Scolex: Armed rostellum with two alternating hammer-shaped hooks
- Adult Gravid Proglottid: Rice Grain Appearance
- Eggs: Enclosed in an egg capsule with 1-4 spindle shaped eggs
Echinococcus granulosus
- Formerly known as Taenia granulosus
- Common Name: Hydatid Worm
- SHORTEST tapeworm of man, with only three segments: immature, mature, gravid
- Causes Hydatid Disease (Anti-P1)
- Habitat: Small Intestine (Final Host); Connective Tissues (Man/Accidental Intermediate
Host)
- Final Host: Dog (Canine, Foxes)
- Intermediate Host: Sheep (Herbivores)
- Accidental Intermediate Host: Man
- Infective Stage:
To Final Host: Hydatid Cyst
To Intermediate Host: Egg
- Mode of Transmission: Ingestion of egg (will develop into hydatid cyst in man)
PARASITOLOGY| 58
FORTIS ANIMO
- Adult Scolex: Prominent armed rostellum with 4 cuplike suckers

- Adult Proglottid: 3 proglottids: Immature, Mature, Gravid
- Eggs: Embryonated like Taenia spp.; cannot be differentiated from the eggs of Taenia
Hydatid Cyst
> Fluid-filled
> Has a germinal layer with thousands of scolices known as daughter cysts (brood capsules),
which attach to the germinal layer or free-float in the cyst.
> The scolices in the hydatid fluid resemble grains of sand and are called hydatid sand
- Laboratory:
> Eggs are not recovered in man
> Roentgenogram (x-ray)
> Immunologic tests
o Bentonite Flocculation Test (also Trichinella spiralis)
o CASONI’S INTRADERMAL TEST
> Surgery
Exploratory Cyst Procedure (PAIR)
Puncture
Aspirate
Inject (protoscolicidal: hypertonic solution)
Reaspirate
- Pathogenesis: 70% of cases affect liver; 20-30% affect lungs and 10% for brain and eye
Treatment: Albendazole, Mebendazole
Additional:
Echinococcus multilocularis
- Causes ALVEOLAR HYDATID DISEASE which is a fatal form of echinococcosis
- Most lethal of all helminthic diseases
- Cyst is extremely dangerous because it lacks a laminated membrane and develops a series of
connected chambers; the chambers contain little or no fluid and rarely contain a scolex
- Morphology of the cyst is very similar to that of E. granulosus but the adult organisms are
much smaller
- Definitive Host: Foxes, coyotes, and dogs
- Intermediate Host: Rodents, squirrels, voles, mice
- Occasionally transmitted to humans through ingestion of contaminated food or water and
by handling infected animals
Echinococcus vogeli & Echinococcus oligarthus
- Definitive Host: Wild felids like wild cats, jaguars, and pumas (E. oligarthus) or brush dogs
(E. vogeli)
- Intermediate Host: Rodents like paca, spiny rats and opossum
- Infective Stage: Embryonated Egg (ingested) hydatid cyst (intestine)
- Diagnostic Stage: Cyst
Taenia multiceps (Multiceps multiceps)
- Causes COENUROSIS in humans
- Coenurus (larval form) may cause destructive damage or death but is a rare disease in
humans
- Coenurus is a unilocular cyst similar to cysticercus although the worm has multiple
scolicies; daughter cysts may also be seen
- Adult worm is typically found in dogs and other canids
- Definitive Host: Dog, wolf, fox
- Intermediate Hosts: Sheep, cattle, deer
- Animals become infected through the ingestion of eggs while grazing
- Humans can also serve as an intermediate host; infection occurs from accidental
ingestion of dog feces containing eggs
- Pathogenesis: Gid (unstable gait and giddiness) – occurs mainly in sheep and other
herbivores affecting CNS
PARASITOLOGY| 59
FORTIS ANIMO
V. ARTHROPODS
- 85% of known animals are arthropods
- Bilaterally symmetrical invertebrate animals with segmented bodies, jointed appendages, and
hard outer coverings/exoskeletons
Metamorphosis: change in form/structure of an arthropod during period of development:
Gradual/Incomplete: Three stages: egg > nymph > adult: cockroaches, grasshoppers, lice,
bugs
Complete: Four stages: egg > larva > pupa > adult: mosquitoes, flies, butterflies, moths,
ants, bee, beatles, wasps
EXTERNAL ANATOMY
HEAD
- Single/Ocelli
- Compound – large, round, oval and with outer surface called facets
Chewing Mouthpart: cockroach/silverfish
Sponging Mouthpart: sucking liquid (e.g. housefly)
Piercing (sucking): mosquitoes, fleas
Chewing (lapping mouthpart): honeybee
THORAX – where the wings are attached
- 3 segments: prothorax, mesothorax, metathorax
ABDOMEN: eleven segments
- Eight and ninth: external male sex organ and laying device for female
- 11th: has cerci (finger like projections)
MYIASIS: Human tissue infestation of by fly larvae
ECTOPARASITES
ORDER EXAMPLES
Diptera Mosquitoes, Flies
Anoplura Head Louse (Pediculus humanus capitis)
Crab Louse (Phtirus pubis)
Siphonaptera Intermediate hosts of Dipylidium caninum
Hemiptera Hemiptera
Acatina Chigger Infection (Mite: Leptotrombidum spp.)
Scabies (Sarcoptes scabiei)
Follicle Mite Infection (Demodex spp.)
Cheese Mite (Acarus spp.)
Soft Tick (Argasid spp.)
Hard Tick (Ixodes spp.)
FLIES
A. Sarcophaga: “flesh fly” – checkerboard in appearance
B. Calliphora: “blue bottle fly”
C. Lucilia: “green bottle fly”
D. Muscina: robust – “non biting stable fly”
E. Fannia: “iatrine fly
COCKROACHES
A. Periplaneta americana: American cockroach
B. Blattella germanica: German cockroach
C. Blatta orientalis: Oriental cockroach
MOSQUITO-BORNE DISEASES
A. Dengue: Aedes aegypti – Tiger Mosquito (Urban Dengue); Aedes albopictus (Rural Dengue)
B. Malaria: Anopheles flavirostris, Anopheles litoralis, Anopheles balabacensis
PARASITOLOGY| 60
FORTIS ANIMO
C. Filariasis: Anopheles flavirostris, Aedes poecilus, Mansonia bonnae, Mansonia uniformis

D. Japanese Encephalitis: Culex tritaeniorynchus
REFERENCES:
Mandanas, J.A.H. (2019). TopRank Review Academy: Parasitology Review Module for Medical
Technologists.
Liwanag, M.C. (2020). TopRank Review Academy: Parasitology Lecture Notes.
Manaban, M.R.S. (2020). Parasitology Review Notes for March 2020 Medical Technologists.
Paniker, CK. J. (2013). Paniker’s textbook of medical Parasitology (7th ed.). New Delhi, IND. Jaypee Brothers
Medical Publishers LTD.
Tille, P.M. (2014). Bailey & Scott’s diagnostic Microbiology (13th ed.). St. Louis, MO: Elsevier Mosby.
Zeibig, E. (2013). Clinical Parasitology: A practical approach (2nd ed.). St. Louis, MO: Elsevier Saunders.
FAITH OVER
FEAR!
“WORRY ENDS WHEN FAITH BEGINS.”
2 Corinthians 5:7
____________________________________________, RMT
In God’s Perfect time!
HEY FUTURE RMT! Tired? Suffering? You know, it’s really okay to not be okay
sometimes. But what’s not okay is to run away from your dreams just because you
are being tested. YOU ARE MORE CAPABLE THAN WHAT YOU THINK! A lot of
people are cheering and praying for you. You are not alone in this battle! Have
faith in God! For He is in control. Have faith in your loved ones, for they truly
believe in you. And, have faith in yourself, for you’re born for this! GO GO GO!!!
-Buddy Sensei
PARASITOLOGY| 61

FortisAnimo PARASITOLOGY QUCK LECTURE Notes

Uploaded by

Copyright:

Available Formats

FortisAnimo PARASITOLOGY QUCK LECTURE Notes

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

FortisAnimo PARASITOLOGY QUCK LECTURE Notes

Uploaded by

Copyright:

Available Formats

FORTIS ANIMO

We’re born with strong minds.

PARASITOLOGY QUICK REVIEW NOTES

I. INTRODUCTION & IMPORTANT TERMINOLOGIES

Three most common Symbiotic Relationship:

 Parasitology - area of biology concerned with the phenomenon of dependence of one

PARASITES vs HOSTS vs VECTORS

WHAT ARE PARASITES? HOW ARE THEY CLASSIFIED?

I. ACCORDING TO HABITAT II. ACCORDING TO MODE OF LIVING

ECTOPARASITE: ACCIDENTAL/INCIDENTAL: Parasite that

HOSTS AND THEIR CLASSIFICATIONS

VECTORS AND THEIR CLASSIFICATIONS

CONGENITAL TRANSMISSION Toxoplasma gondii

OTHER IMPORTANT TERMINOLOGIES IN PARASITOLOGY

Epidemiology Study of patterns, distribution and occurrence of disease

Morbidity Clinical consequences of infections or diseases that affect

Information-education- A health education strategy that aims to encourage people

PARASITES AND THEIR COMMON NAMES

INFECTIVE STAGES OF DIFFERENT PARASITES

II. OVERVIEW OF THE METHODS AND STRATEGIES IN PARASITOLOGY

SPECIMEN COLLECTION AND TRANSPORT

Note: Two ordering/collection/processing/examination situations are considered STAT

DIFFERENT SPECIMENS & SPECIMEN PROCESSING

Routine stool examination:  Toxic substances to intestinal protozoans: mineral oil,

 Temporary storage of fecal samples in a refrigerator

 Recommended fixative to  FORMALIN

 SODIUM ACETATE-ACETIC ACID FORMALIN

 MERTHIOLATE IODINE-FORMALIN (MIF)

- Components both fix and provide stain color

 POLYVINYL ALCOHOL (PVA)

2. PERIANAL SWAB CELLULOSE TAPE OR SCOTCH TAPE METHOD

BLOOD EXAMINATION TECHNIQUES

- The stained thin smear is examined first. If the thin

2. CAPILLARY TUBE METHOD a. BUFFY COAT FILMS

4. SPUTUM Parasites that may be recovered from sputum:

- Bone marrow aspirates for Leishmania and

COMMON DIAGNOSTIC PARASITOLOGY TECHNIQUES

B. KATO THICK SMEAR

1. ACID ETHER CONCENTRATION TECHNIQUE (AECT)

2. FORMALIN-ETHER/ETHYL ACETATE CONCENTRATION TECHNIQUE (FECT/FEACT)

- Useful in the recovery of both helminth eggs and protozoan cysts

1. ZINC SULFATE FLOTATION

1.COPRO CULTURE AND BAERMANN FUNNEL TECHNIQUE

2. HARADA-MORI OR THE TEST TUBE CULTURE METHOD

3. AGAR PLATE CULTURE FOR Strongyloides stercoralis

4. CULTURE METHOD FOR SOME PROTOZOA

F. EGG COUNTING PROCEDURES

1. KATO-KATZ METHOD OR CELLOPHANE-COVERED THICK SMEAR

2. STOLL DILUTION EGG COUNT

3. DIRECT SMEAR METHOD OF BEAVER

Hookworm spp. 1-1,999 epg 2,000-3,999 epg ≥ 4,000 epg

2. WHEATLEY’S TRICHROME STAIN FOR FECAL SPECIMENS

3. MODIFIED TRICHROME STAIN FOR MICROSPORIDIA (WEBER-GREEN)

4. MODIFIED TRICHROME STAIN FOR MICROSPORIDIA (RYAN-BLUE)

Polar tube: seen as a stripe or as a diagonal line across the spore

5. MODIFIED ACID-FAST FOR COCCIDIANS

RESULTS AND PATIENT REPORTS FROM THE TRICHROME STAINING METHOD

H. RECOVERY OF THE TAPEWORM SCOLEX

May be studied in fresh condition by staining

Entamoeba histolytica VS Entamoeba coli