PARASITOLOGY

Parasitology - area of biology concerned with the phenomenon of dependence of one living organism on another. Medical Parasitology - concerned with animal parasites of humans and their medical significance as well as importance in human communities

Biological Relationships
Commensalism - symbiotic relationship in which 2 species live together one is benefited; the other is not affected ex. Entamoeba coli supplied with nourishment host not benefited nor harmed ( no tissue damage in the host) Mutualism - both are benefited by the association

Parasitism - one is benefited; the other is harmed

1. Parasites as to habitat or mode of development: a. endoparasite infection presence of parasite in a host b. ectoparasite infestation presence of ectoparasite on a host c. erratic parasite - parasite found in an organ which is not its usual habitat d. obligate parasite - parasites that cant live without a host

e. Facultative parasite
- survive with or without a host - exist in free-living or may become parasitic when the need arises f. Accidental or incidental parasite - a parasite which establishes itself into a host where does not ordinarily live

it

g. Permanent parasite - parasite that remains in or on the body of the host for its entire life h. Spurious parasite - parasite of animals that parasitizes human but there is no development in the parasite

 Oviparous- lays unembryonated eggs

Ovoviviparous- lays embryonated eggs Viviparous/larviparous- lays larvae

Host a. intermediate host - harbors the asexual or larval stage of the parasite
b. definitive or final host - one in which the parasite attains sexual maturity.

Vectors

- responsible in transmitting the parasite from one host to another ex. Flies, cockroaches feed on fecal material and transfer enteric organism to food

Mode of Transmission
1.Oral

- ingestion thru contaminated water, food containing infective stage of parasite ex. Taenia saginata (beef tapeworm) Taenia solium (pork tapeworm)

2. Skin penetration ex. A. braziliense and A. caninum - exposure of skin to the soil

Schistosoma - enters skin via water

3. Transplacental - mother to the fetus 4. Transmammary infection - infection transmitted through the mothers milk
5. Sexual intercourse ex. Trichomonas vaginalis

PHYLUM NEMATODA: roundworms

2 subclasses: a. Phasmidia- with caudal chemoreceptors; chemoreceptors function in modulation of chemorepulsion behavior - cause diseases in man b. Aphasmidia- without caudal chmoreceptors eg. Trichiuris Trichinella Capillaria Amphids- with cephalic receptors; do not cause diseases in man

Characteristics
Cylindrical Non- segmented Dioecious Pseudocoele Cuticle Male smaller Male has coiled posterior ends; female has tapering posterior ends
Ascaris female , cross-section

Intestinal Nematodes

Ascaris lumbricoides
Common name: Giant intestinal roundworm Habitat: lumen of small intestine

3 non-human ascaris: Toxocara cati- cat Toxocara canis- dog Ascaris suum- pig Morphology:
ADULT Whitish or pinkish triradiate lips

Female: larger; straight blunt tail Male: smaller; curved posterior end with 2 spicules

OVA
1. fertilized ova
- oval or spherical, thick- walled - consists of the ff. layers: 1. inner lipoidal vitelline membrane (absent in unfertilized egg) 2. middle glycogen layer 3. outer mammillated albuminous layer (absent in decorticated egg)

fertilized, corticated

fertilized, decorticated

2. unfertilized ova - long, narrow, thin walled - no lipoidal vitelline layer - irregular mammillated albuminous outer layer

embryonated egg
- infective stage - embryonation occurs in the soil

Pathogenesis and clinical manifestation Ascariasis

Larval migration:
pneumonitis, Loefflers syndrome:

Adults in the intestine: intestinal obstruction, appendicitis, intestinal perforation, biliary ascariasis, cholecystitis, pancreatitis, etc

Diagnosis:
1.Direct fecal smear -eggs are easily found due to a large number of the female oviposition, approximately 240,000 eggs per female per day Therefore, eggs passed in feces is diagnostic 2. Kato-Katz Technique
Quantitative Intensity of infection Per gram of feces

Epidemiology
World wide distribution More than 1 billion individuals are affected 70% from Asia Mode of transmission: Ingestion of food/ water contaminated with embryonated oocysts or from contaminated fingers

Factors favoring the spread of the transmission: 1. Simple life cycle. 2. Enormous egg production ( 240,000 eggs/ day/ female ). 3. These eggs are highly resistant to ordinary disinfectants (due to the ascroside). The eggs may remain viable for several years. 4. Social customs and living habits. 5. Disposal of feces is unsuitable

Prevention 1.Sanitary disposal of feces. 2.Hygienic habits such as cleaning of hands before meals. 3.Health education.

Treatment
Albendazole
Drug of choice 400 mg single dose 200 mg for children under 2 year old

Mebendazole
500 mg single dose

Pyrantel Pamoate
10 mg/kg body weight (max. of 1 g)

Trichuris trichiura

Common name: Whipworm Habitat: wall of the caecum

MORPHOLOGY Adult
thick posterior portion and long thin anterior portion
Male 30-45 mm Coiled posterior end Single spicule Retractile sheath Female 35-50 mm Bluntly rounded posterior end Can produce over 60 million eggs in an average life span of 2 years

OVA - barrel shaped, football shaped, Japanese lantern shaped - with protuberant bipolar mucus plugs

Disease: Trichuriasis leading to rectal prolapse during heavy infection Infective stage: embryonated egg

Epidemiology
Distributed in warm, moist areas of the world 20% 30% prevalence in temperate countries 60% - 85% in tropical countries Children 5 to 15 years of age are frequently infected
Mode of transmission Ingestion of embryonated egg (Anus to mouth; finger to mouth; airborne retroinfection)
Occurs quite frequently with Ascaris lumbricoides due to similarities in transmission and mode of distribution

Treatment
Mebendazole
Drug of choice 500 mg single dose in light infections 2 3 days of consecutive treatment for moderate and heavy infections Contraindicated during early pregnancy and in hypersensitivity

Albendazole
400 mg single dose Contraindicated during pregnancy

harder to expel because attaches to the mucosa of the caecum by burying its anterior portion in a pin-fashion manner

HOOKWORMS
Soil transmitted Blood-sucking

Adults in intestinal mucosa

Bleeding of intestinal wall

2 non-human hookworms causing cutaneus larva

migrans or creeping eruptions or ground itch

1. Ancylostoma braziliense Common Name: cat hookworm Habitat: Small intestine (jejenum) Disease: human are incidental hosts 2. Ancylostoma caninum Common Name: dog hookworm Habitat: intestine Disease: human are incidental hosts

HOOKWORMS
Necator americanus
Synonym: Uncinaria americana Common name: New World Hookworm Habitat: small intestine (jejunum)

Ancylostoma duodenale
Uncinaria duodenalis

Old World Hookworm

Small intestine (duodenum)

Points of differentiation 1. Size 2. Body curvature

A. duodenale
Bigger C shaped

N. americanus
Smaller S shaped

Points of differentiation 3. Dental pattern/ buccal cavity

N. americanus A. duodenale Semilunar cutting plates 1 pair of true teeth

Points of differentiation
4. Copulatory

N. americanus A. duodenale
Oval (top view) bipartite/bidigitate With fused spicules Circle (top view) tripartite/tridigitate with unfused spicules

bursa of the male

Hookworm ova

-resemble each other -thin shelled -Ovoid -in the early stage of segmentation, 2 to 8 cell stage

HOOKWORM LARVAE
Rhabditiform larva (1st stage) Short and tout Filariform larva (3rd stage) Long and slender

Feeding stage larva Non-feeding stage open mouth closed mouth Flask shaped esophagus With pointed tail and sheath With long narrow buccal With pointed tail and chamber and flask sheath shaped esophagus

Hookworm Filariform Iarva (infective stage)

Pointed tail
Cuticle (sheath)

Buccal cavity Infective filariform larva (third stage) showing its protective envelope

Hookworms can remain in an arrested state of development in the muscle. Adult hookworms migrate, and mature as blood sucking parasites of the small intestine where they reproduce.

Differences Between the Life Cycle of Ascaris and Hookworm

Ascaris Hookworm

Infective stage embryonated egg filariform larvae _____________________________________________________________________ route of infection by mouth by skin _____________________________________________________________________ mode of infection passively actively _____________________________________________________________________ blood-lung pass through the liver dont pass through the liver migration in lungs of host, larvae the larvae dont molt and molt twice and stay stay in the lungs for10 days _____________________________________________________________________ food of the adults intestinal content blood _____________________________________________________________________ life span 1 year several years _____________________________________________________________________

Pathogenesis and Clinical Manifestations

1. Larval migration (1) Dermatitis, known as "ground itch" or "stool poison".The larvae penetrating the skin cause allergic reaction, petechiae or papule with itching and burning sensation. Scratching leads to secondary infection. (2) pneumonitis (allergic reaction), Loeffier's syndrome: cough, asthma, low fever, bloodtinged sputum or hemoptysis, chest-pain, inflammation shadows in lungs under X-ray. These manifestations go on about 2 weeks.

2. Adults in small intestine (1) Epigastric pain as that of a duodenal ulcer. (2) A large worm burden results in microcytic hypochromatic anemia. The symptoms are lassitude, edema, palpitation of the heart. In severe case, death may result from cardiac failure or physical exhaustion. (3) Allotriophagy (or pica ) is due to the lack of trace element iron . (4) Amenorrhea, sterility, abortion may take place in women. (5) Gastrointestinal bleeding (6) Infantile hookworm disease

Diagnosis
Direct fecal smear
only for heavy infections

Kato Technique
Increases detection rate

Kato Katz Method

Quantitative diagnosis

Zinc Sulfate Centrifugation Formalin Ether Concentration Harada-Mori

Allow hatching of larvae from eggs on strips of filter paper with one end immersed in water

Epidemiology
Over 900 million people infected Associated anemia causes 50,000 deaths annually

Ancylostoma duodenale

Necator americanus

Mode of transmission: skin penetration Direct skin contact with free-living soil larvae (e.g. walking barefoot)

Prevention and Control

Sanitary disposal of human feces Wearing of footwear Health education Treatment of infected individuals Mass chemotherapy when prevalence is greater than 50% Protection of susceptible individuals through
Improved househod income Improved diet to prevent malnutrition

- Deworming of pets

Treatment
Albendazole Drug of choice Ovicidal and larvicidal 400 mg single dse in adults and children over 2 years old Available in chewable tablets or suspension Not recommended for pregnant women Mebendazole 500 mg single dose in adults and children Not recommended for children below 2 years old

Enterobius vermicularis
Synonym: Oxyuris vermicularis Common Name: pinworm or seatworm General Characteristics:

look like a pin

anterior end tapers and is flanked on each side by cuticular extensions called cephalic alae with a prominent posterior esophageal bulb the cephalic alae and esophageal bulb are important in identification of the species
Habitat: caecum, appendix, ileum, colon

Adult Male - smaller - about 2-5 mm in length - has a curved, relatively blunt posterior end

- dies right after mating, thus males are

rarely seen

Female
longer long pointed tail gravid female lays 4, 672 to 16,888 eggs/day (11,105 eggs on average/day) dies after deposition

Ova
- colorless and transparent - thin shell and one of the sides is flattened (D shaped) - content is a larva

Pathogenesis and Clinical Manifestations

Enterobiasis or oxyuriasis Major symptom is anal pruritus, which associates with the nocturnal migration of the gravid females from the anus and deposition of eggs in the perianal folds of the skin In young girls, migration of the worms may produce vaginitis and salpingitis or granuloma of the peritoneal cavity
Adult Pinworms on the perianal skin

 Diagnosis
eggs and the female adults removed from the folds of the skin in the perianal regions by the use of the scotch tape swabs made in the morning, before the patient has washed or defecated

Epidemiology
more common in white than colored people more prevalent in children than adults most common where people live under crowded conditions such as orphanages, kindergartens, and large families

Mode of transmission:
Ingestion of eggs from fingers contaminated by scratching Contact with contaminated linens or clothing

Infective Stage:
Embryonated egg

Treatment

Pyrantel pamoate Albendazole

Drug of choice 10 mg/kg with a second dose 2 to 4 weeks late

Mebendazole

Alternative drug 400 mg single dose Chewable tablets

500 mg single dose Chewable tablets

Prevention: 1. treat the patients and carriers 2. individual health 3. public health 4. health education and hygienic habits

Trichinella spiralis
Common Name: Muscle worm Viviparous parasite Habitat: small intestine: adult worms larvae encysted in muscles of the pigs

 Female
3.5 mm by 0.06 mm possesses a characteristic clubshaped uterus

Male
1.5 mm by 0.04 mm Possesses a pair of papillae used to hold the female during copulation

Encysted Larva
- Spear-like burrowing

anterior tip - infective stage

Pathogenesis and Clinical Manifestation

Trichinosis
Incubation and intestinal invasion
Diarrhea or constipation Vomiting, malaise, nausea, abdominal cramps, similar to acute food poisoning

Larval migration and muscle invasion

Myalgia, periorbital edema, eosinophilia -complications: splenomegaly, meningitis, cerebral lesions

Encystment and encapsulation

 Needs 2 hosts for the completion of life cycle

Serve both as final and intermediate hosts each host harbors both the adult and larval stages Hosts Humans Rats Dogs Cats Pigs Bears Foxes Carnivores/omnivores

 Epidemiology
Occurs whenever meat is part of the diet Human infection: dead end infection

Mode of Transmission - ingestion of undercooked meat (pork) containing encysted larvae

Prevention and Control

Health education adequate cooking of pork meat Smoking, salting, drying meat are not effective Meat inspection Keep pigs in rat-free pens

 Treatment
Thiabendazole 25 mg/kg body weight twice a day for 7 days during the first week of infection expels the adult worm from the GI tract No effect on migrating larvae and infections detected 2 weeks after exposure Mebendazole Larvicidal Given at 20 mg/kg body weight 6-hourly for 10 to 14 days

Strongyloides stercoralis
Common Name: threadworm a facultativ parasite (a.) free-living: in the soil (b.) parasitic: in the human body no parasitic males because females are parthenogenic Habitat: small intestine

rhabditiform larva - diagnostic stage - smaller, stouter, spindle shaped - short buccal cavity and a muscular esophagus
filariform larva -infective stage -long esophagus -a forked or a notched tail without a sheath

Pathogenesis and Clinical Manifestations

Strongyloidiasis producing cochin china diarrhea 3 phases of infection Invasion of the skin by filariform larvae Erythema Pruritic hemorrhagic papules Migration of larvae inside the body Lobar pneumonia (lungs) Penetration of intestinal mucosa by female worms

Diagnosis
Eosinophilia Duodenal aspiration Small bowel biopsy Concentration techniques
Harada Mori Culture Baer mann funnel

 Epidemiology
50 to 100 million people are infected Frequently found among male children (7 14 years old) Mode of transmission: skin penetration (e.g. walking barefoot) infective stage: filariform larva Larvae penetrate the skin and migrate to the lungs

Treatment
Albendazole
Drug of choice 400 mg for 3 consecutive days for adults and children over 2 yeas of age Eradicate up to 80% of infection

Thiabendazole
50mg/kg (max. of 3 g/day) in 2 divided doses daily for 2 consecutive days after meals

Contraindicated in pregnant women and those with hypersensitivity to the drugs

Capillaria philippinensis
Common Name: Pudoc worm Habitat: small intestine (jejenum) Disease: Capillariasis or Pudocs disease or mystery disease (malabsorption syndrome)

Morphology: Adult Female - have eggs in utero arranged in single or multiple rows Male - characterized by chitinized spicule and a long sheath extending beyond the length of the worm

eggs

Ova
Peanut-shaped Striated shell With flattened bipolar mucus plugs

Pathogenesis and Clinical Manifestations

Capillariasis Or pudocs disease or mystery disease ma characterized by gurgling stomach (borborygmus), abdominal pain, and diarrhea

Epidemiology
First recorded in Northern Luzon, Philippines 2,000 cases documented in the Philippines Thailand, Iran, Japan, Egypt, Korea, Taiwan, India

Mode of Transmission
eating raw freshwater fish fish harboring the 2nd stage larva

Intermediate Hosts
Brackish water fish: bagsit Fresh water fishes: ipon, birot, bagsing or bagtu

Prevention and Control

Discouraging people in endemic areas to eat raw fish Good sanitary practices Avoid washing fecally contaminated bedsheets in lagoons Educational programs

Treatment
Electrolyte replacement High protein diet Antidiarrheal drugs Antihelminthic drugs
Albendazole
400 mg once a day for 10 days Drug of choice Destroys larval stages

Mebendazole
200 mg 2x a day for 20 days

Blood Nematodes

Wuchereria bancrofti

Wuchereria malayi

Habitat: lymph vessels and lymph glands

Points of Differences Wuchereria bancrofti synonym Filaria bancrofti microfilaria Vectors (mosquitoes) urban: rural: No terminal nuclei Aedes poecilus Anopheles minimus flavirotris

Wuchereria malayi Brugia malayi 2 terminal nuclei Mansonia bonneae Mansonia uniformis

pathology

Elephantiasis of the lower extremities

Elephantiasis of the upper extremities

Edema in the legs and genitalia Elephantiasis occurs in patients who have been repeatedly infected

Diagnosis: Giemsa-stained
microfilaria in thick blood smear diagnostic stage: demonstration in the peripheral blood of the microfilaria obtained during the night (8 am to 4 pm) because of nocturnal periodicity; microfilaria are minute snake-like organisms moving about the red cells in fresh blood specimen infective stage: filariform larva (3rd stage larva)

Epidemiology
More than 1 billion people in over 80 countries are at risk Over 120 million peole are affected 43 million are seriously affected In the Philippines: Camarines Norte Camarines Sur Albay Sorsogon Mindoro Palawan Romblon Mountain Province All provincrs of Mindanao

Prevention and Control

WHO has targeted elimination of filariasis by 202 DEC medicated table or cooking salt

Elimination of microfilariae in the blood

Personal protective measure

Treatment
Diethylcarbamazine (DEC)
Drug of choice 6 mg/kg body weight for 12 days Divided doses after meal

Ivermectin
200 to 400 ug/kg body weight in a single oral dose

CHARAC- HABITAT MOT and TERISTIC Infective FEATURES Stage 1.Ascaris -adult w/ SI -ingestion of lumbricoides trilobed (lumen) embryonated anterior or egg thru Giant triradiate lips contaminated Roundworm food &drinks Male smaller, curved post. Non-human ascariscaris end with 2 copulatory Toxocara spicules
cati: cat ascaris Toxocara canis: dog as Ascaris suum: pig ascaris

NEMATODE

Femalebigger blunt post. end

Diagnosis DISEASE TREAT/DIAGNOSTIC MENT STAGE Stool exam Ascariasis MebendaAscaris zole EGG pneumoPyrantel A) Unfertilized nitis Pamoate -Long narrow Loefflers albendazole - no vitilline syndorme membrane B)Fertilized - with 3 layers a. Inner lipoidal vitelline b. Middle glycogen c. Outer albuminous mammillary

2. Trichuris trichiura whipworm

-whip-like - male: single spicule; retractile sheath

LI

-ingestion of embryonated egg

OvaTrichuriasis prominent mucus plugs a) Barrelshaped b) Japanese lantern c) Footballshaped

Mebendazole

3. Hookworms a. Necator americanus New World Hookworm b. A. duodenale Old World Hookworm

N. americanus - S shaped - No true teeth; semilunar cutting plates; bursa is bipartite - smaller A.duodenale - C shaped -2 pairs of teeth; bursa

SI:

jejenum

Direct skin contact with free-living soil larvae (filariform) Rhabditiform larva (feeding stage)- short and stouter Filariform larva (non feeding stage)- long and slender with pointed posterior

Egg occurrence -Ovoid, thin shelled -In the early stages of segmentation (2-8 cell stage)

Ground itch or collie itch Creeping eruptions or cutaneous larva migrans

Mebendazole Albendazole

duo den um

c. A. brazilienze cat hookworm d. A. caninum dog hookworm

Causes creeping eruption s or ground itch

Thiabendazole -can be prevented by deworming pets

4.Enterobius vermicularis
pinworm/ seatworm

- spindle shaped with wing like cephalic alae - female dies after oviposition - male dies after copulation

LI (caecu m, append ix, ileum, colon)

Ingestion of embryonated ova Transmiss ion: Anus to mouth; Finger to mouth; airborne and retroinfect ion

D shaped bilayered ova a. Outer Albumin ous layer b. Inner Lipoidal

Perianal swab/ scotch tape

EnteroBiasis leading to pruritis ani (intense itching of anus)

Thiabendazole Albendazole (Vermox or Pyrantel pamoate)

5. Strongyloides stercoralis threadworm

-Smallest SI: Nematode in duodeman num -Facultative parasite -Females are parthenogen ic

-Skin penetration by filariform larva (with a notched or forked tail) - unsheathed

Rhabditi form larva:smal ler & stouter Eggs not normally seen because hatch to rhabditifor m while in small intestine Peanut shaped ;mucus plugs not protruding

Strongyloidosis or cochinchina diarrhea

Thiabendazole Albendazole

6. Capillaria philippinensis pudoc worm

-Very delicate and tiny - with chitinized spicule - eggs in uterus in single or

SI Jejenum

-Ingestion of fresh water fish harboring the 2nd stage larva IH (ipon, birot, bagsang,

Capillari -sis Pudoc disease or mystery disease

Albendazole Meben -dazole

7. Trichinella spiralis Muscle worm Zoonoticparasite of rat viviparous

-minutethread-like worms Male -with conical papillae Female -with club shaped uterus

Muscle tissue and small intestin e

Eating Encysted inadequately larva cooked pork with encysted larvae Requires 2 hosts to complete life cycle Hosts: rat man,

Trichinosis Thiaben dazole zoonotic and (parasite mebend of rat) azole

8.Blood Nematode a.W. brancrofti Bancrofts filaria b. W. malayi Malayan filaria/ Brugia No terminal Nuclei

Lymph vessels and lymph glands

With 2 terminal nuclei

-Bite of mosquito (Aedes, Anopheles, and Mansoni) with the filariform larva (3rd stage)

Giemsa Filariasis stained microfila ria which is snakelike with 2-3 rows of nuclei ; exhibit nocturna

Diethycarbama -zide (DEC)