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PARASITOLOGY

HELMINTHES

FLAT WORMS

PLATYHELMINTHES

HELMINTHES
Platyhelminthes (platy flat,
helminthes worm)
2 Classes:
Cestoda (tape worms)
Rounded head scolex
(+) suckers, hooks, or sucking grooves
Flat body of multiple segments proglottids
Grows by adding new proglottids next to
the scolex
Distal end of proglottids produce many
eggs excreted in the feces
Acquired by eating undercooked flesh
containing larvae

Trematoda (flukes)

CESTODES
(Flatworms)

Taenia
solium
(pork
tapeworm)

Diseases:

Adult worm Taeniasis;


Larvae Cysticercosis
Important Properties:

Transmission: Eating raw or undercooked pork


containing larvae (cysticerci)

Humans definitive host

Pigs Intermediate host

Cysticercosis:
Person ingests the eggs in food or water
hatches in the small intestine blood vessel
disseminate eyes, brain encyst cysticerci

Taeniasis

Cysticercosis

Pathogenesis:

Adult tapeworm little damage


Cysticerci becomes large in the brain space
occupying lesion

Clinical Findings:

Adult tapeworm asymptomatic; anorexia and diarrhea


Cysticercosis

Brain - Headache, vomiting and seizures


Eyes Uveities or retinitis; larvae can be visualized
floating in the vitreous

Lab. Diagnosis:

Proglottids in stool
(+) Cyst in x-ray or CT scan

Treatment: Praziquantel or Albendazole , surgical


excision
Prevention:

Cook pork adequately


Dispose waste properly
Proper hygiene

Taenia saginata

Disease: Taeniasis
Characteristics:
Beef tapeworm
Terminal proglottids detach
pass in feces eaten by
cattle blood vessels
skeletal muscles
cysticerci
Transmission: Eating raw or
undercooked beef
Lab. Diagnosis: Proglottids
seen in stool exam
Treatment: Praziquantel

Prevention: Adequate
cooking of beef. Proper
disposal of human
waste.

Diphyllobothrium latum

Disease: Diphyllobothriasis
Characteristics:

Transmission:

Fish tapeworm
Human ingest undercooked fish containing larvae
attaches to gut wall adults proglottids
eggs passed in feces fresh water eggs hatch
eated by copepods eated by fresh water fish
larvae form in fish muscle
Eating raw or undercooked freshwater fish

Lab. Diagnosis: Eggs visible in stools


Treatment: Praziquantel
Prevention: Adequate cooking of fish. Proper
disposal of human waste

Echinococcus granulosus

Hydatid cyst disease


Characteristics:

Transmission:

Ingestion of eggs in food contaminated with dogs feces

Pathogenesis:

Dog tapeworm
Dogs are infected when they ingest the entrails of sheep
containing hydatid cyst
Develop in the gut eggs passed in the feces
ingested by sheep (and humans) hatch in the gut
migrate in the blood to other organs (liver and brain)
forms large cyst containing daughter cyst

Hydatid cyst in a space occupying lesion ruptures


antigens can cause anaphylaxis

Lab. Diagnosis: Examination of excised cyst


Treatment: Albendazole or surgical removal of cyst
Prevention: Sheep entrails should not be fed to dogs

TREMATODES
(Flukes)

Clonorchis sinensis

Disease: Clonorchiasis
Characteristics:

Transmission:

Liver flukes
Humans ingest undercooked fish containing larvae
duodenum enters biliary duct adults
release eggs passed in feces eggs eaten by
snails eggs hatch multiply free swimming
cercariae encyst under scales of fish eaten by
humans
Eating raw or undercooked freshwater fish.

Pathogenesis: Inflammation of biliary tract


Lab. Diagnosis: Eggs visible in feces
Treatment: Praziquantel
Prevention: Adequate cooking of fish. Proper
disposal of human waste.

Paragonimus westermani

Disease: Paragonimiasis
Characteristics:

Lung fluke
Humans ingest undercooked freshwater crab meat
containing larvae peritoneal cavity burrow
through diaphragm lung parenchyma become
adults eggs enter bronchioles Coughed up or
swallowed freshwater enter snails multiply
infects and encyst in crabs

Transmission: Eating raw or undercooked


crab meat
Pathogenesis: Inflammation and secondary
bacterial infection of lungs
Lab. Diagnosis: Eggs visible in sputum or
feces
Treatment: Praziquantel
Prevention: Adequate cooking of crabs.
Proper disposal of human waste.

Schistosoma (mansoni,
japonicum, haematobium)

Disease: Schistosomiasis
Characteristics:

Blood fluke
Humans are infected by penetrating the
skin blood vessels liver adults
portal vein mesenteric venules
(mansoni, japonicum) or urinary bladder
(haematobium) excreted hatch in
fresh water penetrate the snails
multiply free swimming cercariae

Transmission: Penetration of skin

Pathogenesis:

Eggs induce inflammation, granulomas, fibrosis


and obstruction (liver and spleen)
S. mansoni damages the colon (inferior
mesenteric venules)
S. japonicum damages small intestines (superior
mesenteric venules)
S. haematobium damages the urinary bladder;
can lead to carcinoma

Lab. Diagnosis: Eggs visible in feces or


urine. Eosinophilia
Treatment: Praziquantel
Prevention: Proper disposal of waste.
Swimming in endemic areas should be
avoided.

NEMATODES
(Roundworms)

Ancylostoma duodenale and


Necator americanus
Disease: Hookworm
Characteristics:
Penetrates skin blood lungs
alveoli trachea swallowed
Adults in SI attach to walls via teeth
(ancylostoma) or cutting plates (necator)
Eggs passed in feces

Transmission:
Penetrate skin of feet

Pathogenesis:
Anemia

Lab. Diagnosis:
Eggs visible in stool exam

Treatment:
Mebendazole or pyrantel pamoate

Prevention:
Use of footwear. Proper disposal of
human waste

Ascaris lumbricoides
Disease: Ascariasis
Characteristics:
Humans ingest eggs larvae in gut
blood lungs alveoli trachea
swallowed adults lay eggs
passed in the feces
Become infective in soil

Transmission:
Food contaminated with soil containing
eggs

Pathogenesis:
Larvae in lung can cause pneumonia
Heavy worm burden can cause intestinal
obstruction or malnutrition

Lab. Diagnosis:
Eggs visible in feces. Eosinophilia

Treatment:
Mebendazole or pyrantel pamoate

Prevention:
Proper disposal of human waste

Enterobius vermicularis
Disease: Pinworm infection
Characteristics:
Humans ingest eggs adults in gut
at night, females migrate from the anus
lay many eggs on skin and in
environment
Reinfection is common

Transmission: Ingestion of eggs


Pathogenesis: Perianal pruritus
Lab. Diagnosis: Scotch tape
technique

Treatment: Mebendazole or pyrantel


pamoate

Strongyloides stercoralis
Disease: Strongyloidiasis
Characteristics:
Penetrate the skin blood lungs alveoli
trachea swallowed adults females produce
eggs hatch in colon passed in feces

Transmission: Penetration of skin


Pathogenesis: Massive superinfection in
immunocompromised persons
Lab. Diagnosis: Visible in feces. Eosinophilia
Treatment: Thiabendazole
Prevention: Proper disposal of human waste

Trichinella spiralis
Disease: Trichinosis
Characteristics:
Humans ingest undercooked meat containing
larvae adults in SI female worms release
larvae blood skeletal muscle or brain
encyst

Transmission: Ingestion of raw or


undercooked meat, usually pork
Pathogenesis: Inflammation of muscle
Lab. Diagnosis: Visible in muscle biopsy.
Eosinophilia.
Treatment: Thiabendazole
Prevention: Adequate cooking of pork

Trichuris trichiura
Disease: Whip worm infection
Characteristics:
Human ingest eggs adults in gut eggs
passed in feces soil

Transmission: Food or water


contaminated with soil containing eggs
Pathogenesis: Causes little damage
Lab. Diagnosis: Eggs visible in feces
Treatment: Mebendazole
Prevention: Proper disposal of human
waste

Toxocara canis
Disease: Visceral larva migrans
Characteristics:
Eggs passed in dogs feces ingested by
humans hatch in SI blood liver,
brain, eyes trapped and die

Transmission: Ingestion
Pathogenesis: Granulomas form around
dead larvae. Can cause blindness
Lab. Diagnosis: Larvae visible in tissue
Treatment: Diethycarbamazine
Prevention: Dogs should be dewormed

Wuchereria bancrofti
Disease: Filariasis
Characteristics:
Bite of female mosquito deposit larvae
adults blood (night) ingested by
mosquitoes

Transmission: Female mosquitoes


(anopheles and culex)
Pathogenesis: Causes inflammation
blocks lymphatic vessels (elephantiasis)
Lab. Diagnosis: Visible in blood smear
Treatment: Diethylcarbamazine
Prevention: Mosquito control

PROTOZOA

INTESTINAL PROTOZOA

Entamoeba histolytica
Disease: Amebic dysentery and liver
abscess
Important Properties:
Life cycle has 2 stages:
Motile ameba trophozoite
Found in diarrheal stools

Nonmotile ameba cyst


Found in non-diarrheal stools
Highly resistant, readily killed by boiling or
freezing but not chlorination
Removed by filtration
4 nuclei

Transmission:
Ingestion of cyst fecal-oral route from
contaminated food and water
Anal-oral transmission

Pathogenesis:
Ingested cyst ileum trophozoites
cecum colon secrete enzymes
localized necrosis muscularis layer
tear drop ulcer submucosa portal
circulation liver abscess

Clinical Findings:
Dysentery acute intestinal amebiasis (bloody,
mucous containing diarrhea)
Lower abdominal discomfort, flatulence and
tenesmus (difficulty in defecation)
Chronic amebiasis occasional diarrhea, weight
loss and fatigue
90% are asymptomatic carriers
Feces containing cyst
Amebic abscess right upper quadrant pain,
weight loss, fever and tender, enlarged liver

Can penetrate lungs


Aspiration of liver abscess yields brownishyellow pus with the consistency of anchovy
paste

Laboratory Diagnosis:
Stool exam or fecalysis
(+) Trophozoites in diarrheal stools
(+) Cyst in formed stools
Treatment:
Metronidazole (Flagyl)
Drain hepatic abscess
Prevention:
Avoid fecal contamination of food and water
Good personal hygiene
Purification of water
Use of night soil for fertilization of crops should
be prohibited
Vegetables should be cooked

Giardia lamblia
Disease: Giardiasis
Important Properties:
2 Stages:
Trophozoite pear shaped with 2 nuclei, 4
pairs of flagella and suction disk
Cyst oval, thick walled with 4 nuclei and
several internal fibers
Pathogenesis:
Fecally contaminated food and water ingestion
of cyst encystation in duodenum
trophozoite attaches to the gut but does not
invade inflammation protein and fat
malabsorption

Clinical Findings:
Non-bloody, foul smelling diarrhea
Steatorrhea
Nausea and vomiting, anorexia, flatulence and
abdominal cramps persisting for weeks or months
No fever
Laboratory Diagnosis:
Stool exam
(+) Trophozoites in diarrheal stool
(+) Cyst in formed stools
String test

Treatment: Metronidazole (Flagyl)


Prevention: Drink boiled, filtered or iodine
treated water

UROGENITAL PROTOZOA

Trichomonas vaginalis
Disease: Trichomoniasis
Important Properties:
Pear shaped with a central nucleus and
4 anterior flagella
(+) Undulating membrane
Exists only as a trophozoite; no cyst
form

Pathogenesis:
Transmitted by sexual contact
Primary location are the vagina and the
prostate

Clinical Findings:
Watery, foul smelling,
greenish vaginal discharge
accompanied by itching and
burning
Strawberry cervix
Usually asymptomatic in men;
10% with urethritis
Laboratory Diagnosis:
Vaginal or prostatic secretions
Treatment and Prevention:
Metronidazole for both partners
Maintenance of low pH of the vagina
Condoms

BLOOD AND TISSUE


PROTOZOA

Plasmodium
Disease: Malaria
**P.vivax, P.ovale, P.malariae,
**P. falciparum

Important Properties:
Vector and definitive host: Female
anopheles mosquito
2 Phase in lifecycle:
Sexual cycle: Mosquitoes
Sporogony sporozoites

Asexual cycle: Humans (intermediate host)


Schizogony Schizonts

Lifecycle in Humans:
Sporozoites from mosquito saliva
human blood hepatocytes within 30
mins cell multiplication merozoites
(male) released from liver infect
RBC
Periodic release of merozoites
recurrent chills, fever, and sweat
P.vivax and P. Ovale produce a latent
form (hypnozoite) in the liver Relapse

Lifecycle in Mosquitoes
Human RBC merozoites (males) and
female (gametocytes) Anopheles
mosquito bite ingest gametocyte (egg
cells) gut fertilization burrows in
gut wallsporozoites are released
migrate to salivary gland next blood
meal human blood

Pathogenesis:
Pathologic findings result from destruction of RBC; 2
reasons
Release of merozoites
Action of spleen to sequester the infected RBC and
lyse them
(+) Enlarge spleen (splenomegaly) due to congestion
with erythrocytes
P.falciparum is more severe
Infection of more RBC of all ages
P.vivax reticulocytes;

P.malariae mature RBC

Occlusion of capillaries with parasitized RBC


Leads to life threatening hemorrhage and necrosis,
particularly the brain (cerebral malaria)
Extensive hemolysis and kidney damage
hemoglobinuria dark color urine black water
fever

Timing of the Fever Cycle:


P.malariae 72 hrs (Quartan malaria)
Recurs every 4th day
Others 48 hrs (Tertian malaria)
Recurs every 3rd day
Malignant malaria: P.falciparum
Benign malaria: P.vivax and P.ovale
Transmission:
Mosquito bites
Placental transmission, blood transfusion, IV
drug abuse
Occurs in tropical and subtropical areas
especially in Asia, Africa and Central and South
America

Clinical Findings:
IP: 2 weeks; Abrupt onset of fever and chills with
headache, myalgia and arthralgia
Fever spike up to 41C, with n/v and abdominal pain
Fever is followed by drenching sweats
(+) Splenomegaly and hepatomegaly
(+) Anemia
Untreated malaria
Extensive kidney and brain damage
Other plasmodium (malariae, vivax and ovale)
are self-limited

Relapse: P.ovale and P.vivax


Occurs several years after the initial illness
as a result of hypnozoites latent in liver

Laboratory Diagnosis:
Microscopic examination of blood
Thick smear screen for presence of
organisms
Thin smear for species identification

P.falciparum Crescent shaped (banana


shaped)

Others - spherical

Treatment:
Chloroquine
But does not kill hypnozoites of P.vivax and
P.ovale
Primaquine kills hypnozoites
Prevents relapses
Prevention:
Chemoprophylaxis for travellers
2 weeks before arrival until 6 weeks after departure
Followed by Primaquine is exposure is high
Mosquito netting, window screens, protective clothing and
insect repellants
Mosquitoes feed from dusk to dawn
Protection during the night

Drainage of stagnant water in swamps and ditches


No vaccine

Toxoplasma gondii
Disease: Toxoplasmosis
Important Properties:
Definitive host: Domestic cat and other
felines
Humans and other mammals are
intermediate hosts
Transmission:
Ingestion of cyst in undercooked meat or
from contact with cat feces
Cycle in Cats: ingestion of raw meat ex.
Mice
Humans: eating undercooked meat (lamb,
pork)

Pathogenesis:
Transmission: Ingestion or transplacental
Ingestion intestines brain, lungs, liver and
eyes
Cell mediated immunity plays a major role;
antibodies enhances killing
Congenital infection of fetus
Mother is infected during pregnancy
Clinical Findings:
Asymptomatic in immunocompetent adults
Congenital infection- abortion, stillbirth or neonatal
encephalitis, chorioretinitis and
hepatosplenomegaly
Fever, jaundice and intracranial calcifications

Laboratory Diagnosis:
Immunoflourescence
Microscopic examination of trophozoites
and cyst

Treatment:
Congenital toxoplasmosis sulfadiazine
and pyrimethamine

Prevention:
Cook meat thoroughly
Pregnant women should avoid
undercooked meat and contact with cats
Cats should not be fed raw meat

Pneumocystis carinii
Disease: Pneumonia in
immunocompromised patients
Important Properties:
Lifecycle in unclear
DNA analysis in 1988; should be
classified as fungus related to yeast
Medically; protozoan
Does not grow in fungal media
Antifungal drugs are ineffective

Found in domestic animals such as


horses and sheep and in variety of
rodents

Pathogenesis:
Transmission: Inhalation
Cyst in alveoli inflammation frothy exudate
blocks oxygen exchange
Pneumonia occurs when helper T cells are
reduced (AIDS, premature or debilitated infants)
Clinical Findings:
Sudden onset of fever, cough and dyspnea
and tachypnea
Bilateral rales and rhonchi
CXR: Diffuse interstitial pneumonia
Extrapulmonary pneumocystis: liver, spleen,
LN and bone marrow
50-100% mortality

Laboratory Diagnosis:
Microscopic examination of lung tissue

Treatment:
TMP-SMX + Pentamidine + Atovaquone

Prevention:
TMP-SMX or Pentamidine
chemoprophylaxis in
immunosuppressed patients

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