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Systematic Medical Parasites

Mohieddin Abdul Fattah

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Trematodes (flukes)
worm Man Reservoir Habitat Exit stage Fasciola Final host Sheep and cattle Biliary passages Egg: Immature, operculate, thin-shelled, yellowish brown, 140 X70 m

Intermediate 1st : Lymnaea snail in fresh water host 2nd : vegetable (watercress)

Infective stage
Mode of infection Disease

Encysted meatcercaria on vegetable

Ingestion of encysted metacercaria in vegetable 1. Acute stage: fever 2. chronic stage: jaundice, anemia 3. Halzoon

diagnosis
Treatment Control
2

1. Detection of eggs in stool & in DA, 2. Detection of specific abs & ags in serum
Triclabendazol orally. 1. Thorough wash of vegetable 2. snail control 3. cooking of liver
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Trematodes (flukes)
worm Man Reservoir Habitat Exit stage Veins draining large intestines mature, ovoid egg with lateral spine 150X70m Schistosoma mansoni Schistosoma hematobium Final host none Veins draining urinary tracts Mature, ovoid, egg with terminal spine,150X70m Bulinus snail Free swimming cercaria Free cercaria penetrate skin immediately after bathing in water 1.Cercarial dermatitis, 2.Katayama fever 3.Bloody diarrhea, 4.Anemia 5.Periportal fibrosis: a)Portal hypertension, b)Splenomegaly c)Esophageal varices., d)Ascites Detection of egg in stool, detection of specific abs & ags in serum 1.Cystitis, ureteritis 2.Dysuria and hematuria. 3.Anemia 4.Carcinoma of U. bladder Detection of egg in urine, detection of specific abs & ags in serum

Intermediate host Biomphalaria snail Infective stage Mode of infection Disease

diagnosis Treatment Control 3

Oral Praziquantel 1.Mass treatment of human cases. 2.Snail control3.Sanitary disposal of sewage 5/2/2012

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Trematodes (flukes)
worm Man Reservoir Habitat Exit stage Heterophyes Final host Cats, dogs and brds In between villi of small intestine Egg: mature, operculate, thick-shelled, ovoid, golden yellow, 30X15 m

Intermediate 1st : Pirenella snail in brackish water host 2nd : fish (Bolty & Boury)

Infective satge
Mode of infection Disease diagnosis Treatment Control
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Encysted meatcercaria fish muscles underneath scales

Ingestion of encysted metacercaria in under-salted or under-cooked fish 1. Enetritis 2. Myocarditis due to embolised eggs 1. Detection of eggs in stool. Praziquantel 1. Thorough cooking of fish 2. sanitary disposal of fishermen excreta.
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Intestinal Cestodes (Tapeworms): Pseudophyllidea

worm Dipyllobothrium latum

Man
Reservoir Habitat Exit stage Intermediate host Infective stage Mode of infection Disease diagnosis Treatment Control
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Final host
Fish eating animals: cats, dog, birds Small intestine Egg: Immature, operculate, abopercular knob, yellowish brown, 75 X50 m. Segments with rosette shaped uterus passed in chains. 1st : cyclops in fresh water 2nd : Salmon fish Plerocercoid in fish Ingestion of plerocercoid in salmon fish 1. Enteritis & abdominal colic 2. megaloblastic anemia due to vitmin B12 consumption 1. Detection of eggs or segments passed in chains in stool Oral Praziquantel 1. Thorough freezing or cooking of fish
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Intestinal Cestodes (Tapeworms): Cyclophyllidea

worm worm Man Taenia saginata Dipyllobothrium latum Tenia solium Final host None

Man Reservoir Reservoir Habitat Habitat Exit stage Exit stage

Intermediate host Intermediate host Infective stage Mode of stage Infective infection Disease infection Mode of Disease diagnosis diagnosis Treatment Treatment Control Control
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Final host

Fish eating animals: cats, dog, birds Small intestine Small intestine Egg: mature, round, striated shell, yellow brown, 30-40 m Egg: Immature, operculate, abopercular singly in saginata,in chains (solium) Gravid Segments with branched uterus knob, yellowish brown, 75 X50 m. Segments with rosette shaped uterus passed in chains. Cattle Pigs st : cyclops in fresh water 1 Cysticercus bovis in beef Cysticercus cellulosae in pork 2nd : Salmon fish Ingestion of in fish PlerocercoidC. bovis in beef Ingestion of C. cellulosae in pork 1.Enteritis 1. Enteritis 2. obstruction in salmon fish 2. obstruction Ingestion of plerocercoid Cysticercosis: induced by antipaeristalsis 1. Enteritis & abdominal colic 2. megaloblastic anemia due to vitmin B12 or by external autoinfection consumption 1. Detection of eggs or segments passed iin stool 1. Detection of eggs or segments passed in chains in stool Oral Praziquantel or by Albendazole Oral Praziquantel 1. Thorough freezing or cooking of pork and beef. 1. Thorough freezing or cooking of fish 2. Sanitary disposal of human sewage 5/2/2012

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Intestinal Cestodes (Tapeworms): Cyclophyllidea

worm worm Man Hymenolepis nana Dipyllobothrium latum Final host H. diminuta Occasional final host Dipylidium Occasional final host

Man Reservoir Reservoir Habitat Habitat Exit stage Exit stage

None rodents dogs Fish eating animals: cats, dog, birds Small intestine Small intestine Mature, Spheroid egg, thin Mature ovoid 70egg capsules with Egg: Immature, operculate, 80m with polar shelled, 30-45 m withabopercular knob, yellowish brown,eggs each cluster of 75 X50 m. Segments with polar filaments rosette shaped uterus passed in chains. knobs 20-30 m Intermediate host 1st : cyclops in Intermediate host None or fleas fresh water Beetles or fleas Fleas, dog lice nd : Salmon fish 2 Infective stage Egg or cysticercoid in fleas Cysticercoid in insects Cysticercoid Infective stage Plerocercoid in fish Imgestion of Ingestion of Mode of infection Ingestion of egg in food or Mode of infection cysticercoid in insect Ingestion of plerocercoid in salmon fish in fleas cysticercoid cysticercoid in flea 1. Enteritis 2.Insomnia megaloblastic anemia enteritis due to vitmin B12 Disease Disease 1. Enteritis & abdominal colic 2. Enteritis consumption Detection of egg in Detection of eggs or diagnosis Detection of egg in stool diagnosis 1. Detection of eggs or segments passed in chains in stool stool segments in stool Treatment Oral Praziquantel Treatment Oral niclosamide or Praziquantel Control Control
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Final host

1. Thorough freezing or cooking of fish Health education. Flea control Personal hygiene Rat control

Avoid playing with & 5/2/2012 treta pet animals

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Tissue (Larval) Cestodes (Tapeworms): Pseudophyllidea

Adult worm Larva Man Reservoir Habitat Exit stage final host Infective stage Mode of infection Disease Diagnosis Treatment Control
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Diphyllobothrium mansonoides Sparganum Paratenic Blind end Intermediate host Frogs, snakes, birds (paratenic hosts) Skin, muscles, eye, brain None Cats Procercoid in cyclops and sparganum in frogs 1. Ingestion of infected cyclops 2. ingestion of infected frogs. 3. The use of meat of infected frogs as poultice on skin lesions 1. Skin and muscle nodes 2. Eye: conjuctivitis 3.Brain: fits Identify larva in excision biopsy Surgical removal or ethanol injection Adequately cook meat of paratenic hosts Do not use this raw meat as poultice
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Tissue (larval) Cestodes (Tapeworms): Cyclophyllidea

Adult worm Larva Man Reservoir Habitat Exit stage final host Pigs Eye, brain, skin, muscles None Man Taenia solium Cysticercus cellulosae T. multiceps Coenurus Sheep, rabbits Eye, brain None Dog, foxes Echinococcus granulosus Hydatid cyst Sheep, camels Liver, lung, brain None dogs E. multilocularis Alveolar hydatid rodents Liver, lung, brain None Wolves, foxes, cats

Blind end intermediate host

Infective stage Taenia solium egg egg Mode of 1.ingestion of egg in foods Ingestion of egg infection 2.Internal auto infection in foods 3.external auto-infection Disease Blindness, fits, skin nodes Blindness, fits
Diagnosis Treatment Control
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egg egg Ingestion of egg in Ingestion of egg in foods foods

Jaundice, hemoptysis, fits Jaundice, hemoptysis

1. Imaging 2. biopsy 3. serology (Immunoblot) Albendazole, cortisone, surgery Albendazole, Early surgery surgery surgery 1 Treat intestinal taeniasis 1. Avoid playing with dogs 1. Avoid cats 2 sanitary disposal of 2. Treat pet dogs 2. Early 5/2/2012 diagnosis sewage 3 avoid emetics

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Intestinal nematodes with larval lung migratory phase

Adult worm Man Reservoir Habitat Exit stage Immature egg with mammilated shell Ascaris Ankylostoma Necator Final host None Small intestines Immature egg with 8 cell stage none Rhabditiform larva filariform larva Strongyloides Free living & parasitic cycles

IH Egg with 2nd stage larva in Infective Filariform larva in soil soil stage nd Mode of Ingestion of egg with 2 Larva penetrate skin in soil infection larva in food & drinks

Filariform larva in soil, in intestine, or on buttocks Larva penetrate skin in soil, or intestinal mucosa, perianal skin (Internal, external autoinfection) Disease Loffler's pneomonitis Ground itch, pneumonitis, Larva currens, Pneumonitis Enteritis Enteritis Enteritis, Intestinal obstruction Microcytic anemia due to chronic diarrhea, hyperinfection in Biliary stasis blood loss immune compromised Diagnosis Detect & count eggs in stool Detect & count eggs in stool Detect larvae in stool (Baermanns) Oral Mebendazole Oral Albendazole, Thiabendazole Treatment Oral Mebendazole Adequately wash vegetables 1. Do not walk bare footed Control Sanitary disposal of sewage 2. Dont play with soil, 3. Sanitary disposal of man excreta 5/2/2012 10 Fly control, Food sanitation

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Intestinal nematodes without larval lung migratory phase

Adult worm Man Reservoir Habitat Exit stage None Enterobius (oxyuris) Capillaria Final host Fish and birds None Large intestines Immature, Barrel shaped eggs with bipolar plugs Mature egg containing 2nd stage larva Ingestion of infective egg with foods & drinks Colitis & dysentery Rectal prolapse Anemia: microcytic and macrocytic Trichuris

Small intestine D-shaped mature egg Immature egg with bipolar plugs, larvae, adults None IH D-shaped mature egg Infective Filariform larva in fish containing infective larva stage Mode of Ingestion of egg containing Ingestion of fish containing infection infective larva in food. infective larva By autoinfection Disease Appendicitis Enteritis Perianal itching Chronic diarrhea Insomnia Weight loss Nocturnal enuresis Treatment Oral Mebendazole Control Personal hygiene
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Diagnosis Detect eggs in perianal swab Detect eggs & larva in stool Detect eggs in stool. Oral Mebendazole Fish inspection Sanitary disposal system Oral mebendazole Health education. Sanitary sewage disposal
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Larval tissue nematodes : larval trichinosis and larva migrans

Adult Man Reservoir Habitat Exit stage IH Infective stage Mode of infection Disease Diagnosis Treatment Control
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Trichinella Final host & IH Pigs

Toxocara of dogs and cats Old cats , dogs, birds Viscera, eye, CNS

Ankylostoma of dogs and cats None

Paratenic blind end IH

none none Almost none, Paratenic IH (birds) may play role. pigs Encysted larva in pork Mature egg containing 2nd Filariform larva in soil stage larva Ingestion of Ascaris Ingestion of encysted larva in containing 2nd stage like egg larva in Larva penetrate skin pork. foods, drinks Fever Acute diarrhea (adult) Hepatospleno-megaly. Red itchy papules in the feet, arm Fever periorbital edema and face for months Ocular & CNS Myocarditis manifestations Myositis Muscle biopsy Biopsy, Serology Biopsy, Serology Serology, eosinophilia Eosinophilia Eosinophilia Bachman Intradermal test Oral albendazole, Oral albendazole, Oral Mebendazole Oral thiabendazol Oral thiabendazol Dont play in soil Pork sanitation Dont play with dogs ,cats 5/2/2012

S. Intestine mucosa (adult) Sk. muscles (encysted larva) None

Cutaneous tissue

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Adult tissue nematodes :

Adult worm Man Reservoir Wucheraria Brugia Lymphatic filariasis Final host none Cats, monkey Loa loa Calabar swelling Final host Onchocerca River blindness Final host

none None Subcutaneous, subcutaneous Habitat Lymph vessels and nodes subconjunctival Exit stage Sheathed mf Sheathed mf in Sheathed microfilaria in Non sheathed mf in skin with tail in blood with blood with 2 blood with tail full of nuclei free of nuclei anucleate tail nuclei in tail Simulium (black fly) IH Mosquitoes: culex, anopheles Chrysops rd stage larva in labium of rd stage larva in labium of rd stage larva in labium of 3 3 3 Infective Culex, Anopheles, Aedes Chrysops Simulium stage rd rd rd Mode of 3 larva enter mosquito bite 3 larva enter Chrysops bite 3 larva enter Simulium bite wound during blood meal wound during blood meal infection wound during blood meal Disease T.P E., Lymphangitis,fever Calabar swelling . Epidydmo-orchitis conjunctivitis Hydrocele, eosinophilia Elephantiasis Detect microfilaria in blood Detect microfilaria in blood DEC, Ivermectin Mosquitos control Mass treatment DEC, Albendazole Chrysops control Dermatitis Sowda Keratitis Iridocyclitis, retinitis Detect microfilaria in skin Ivermectin Aerial insecticides over waterfalls
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Diagnosis Treatment Control

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protozoa: Luminal amoebo-flagellates

organism Disease Man Reservoir Entamoeba histolytica Amoebiasis Final host None Giardia intestinalis Giardiasis Final host None Trichomonas vaginalis trichomoniasis Final host None

Vagina, Urethra Small intestine Habitat Large intestine Trophozoites, Trophozoites Exit stage Trophozoite, binucleate cysts, quadrinucleate cysts quadrinucleate cysts None IH None None Quadrinucleate cyst in food Quadrinucleate cyst in food Trophozoites Infective and drinks and drinks (No cyst stage) stage Mode of Ingestion of 4 nucleate cysts Ingestion of 4 nucleate cysts Direct transmission by Sexual infection in food and drinks in food and drinks intercourse Vaginitis Never invade mucosa. Disease Invade the mucosa Vaginal discharge Acute colitis intestinal colic Urethritis Diarrhea, Dysentery Villous atrophy, watery dysuria Amebic liver & brain abscess Diarrhea, steatorrhea Detect cyst, trophozoite Diagnosis in stool Detect cyst, trophozoites in Detect trophozoites in vaginal or detect specific coproantigen stool & duodenal aspirate urethral discharge to exclude E. dispar Treatment Metronidazole for trophozoit Metronidazole Metronidazole Dilaxonide furuate for cyst Food Sanitation. Food Sanitation. Control Sanitary disposal system Sanitary disposal system Condom limits transmission 5/2/2012 14 Fly control Fly control

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Protozoa: Tissue flagellates; Leishmania

Type organism Man Reservoir none Cutaneous leishmaniasis L tropica L major Final host rodents None Visceral leishmaniasis L donovani L infantum Final host dogs Mucocutaneous L. braziliensis Final host

Arboreal animals REC in skin, these Habitat Reticulo-endothelial cells in skin REC in spleen liver, bone marrow metastasize to mucosa of (BM), lymph nodes (LN) nose & mouth Amastigotes in ulcer Amastigotes in REC in blood Amastigotes in ulcer Exit stage

IH Infective stage Mode of infection Disease

Phlebotomus (sandfly)

Phlebotomus (sandfly)

Lutzomiya (sandfly)

Metacyclic promastigote in sandfly regurgitates

Sandfly regurgitates promastigote into the bite wound during feeding Dry ulcer Wet ulcer Kala azar Infantile fever Multiple sores Espundia Black fever HepatoSplenomegaly splenomegaly Tapir nose Anemia, no skin pigmented skin darkening Detect amastigote in BM, LN, and Detect amastigotes in Diagnosis - Detect amstigotes in skin ulcer. spleen aspirates skin ulcer - Positive leishmanin Negative Leishmanin Pentostam IM or IV Pentamidin IM Treatment Control -Protective clothing -Insect repellants Insecticides -Reservoir control
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Type African trypanosomes organism T gambiense T rhodesiense Man Final host Reservoir Domestic Game animals Habitat Blood, lymph nodes, Brain Trypomastigote Exit stage IH Glossina Infective Metacyclic stage Trypomastigote (MTM) in saliva of glossina Mode of infection Glossina injects the MTM into skin

American T Free living amoeba T cruzi Naegleria Acanthamoeba Final host Final host Final host Armadillo None None Blood, REC Brain , CSF cornea, skin ulcer, brain None Trypomastigote None Triatoma None None Metacyclic Trophozoites in Trypomastigote warm, or heated Cysts and trophozoites (MTM) in feces water in swimming from wet soil of Triatoma pools (MTM) in feces Trophozoites enter Cysts and trophozoites of Triatoma nose then migrate enter man through: enters the bite via olfactory eye, nose and skin ulcer wound epithelia to brain chronic Acute fatal Chagoma , Disease Primary amoebic In Healthy: Keratitis Romana sign Skin chancre meningoIn immuneFever and lymphadeno-pathy Fever , Myocarditis in rhodesian type lymphadeno- encephalitis (PAM) compromised: Granulomatous amebic pathy Encephalitis, Death in healthy persons encephalitis (GAE) Myocarditis Mega colon diagnose early to Detect Trophozoites Detect TM in in blood smears. avoid fatal course; and cystsandbrain Diagnosis Detect TM in blood smears. Detect motile biopsies Xenodiagnosis trophozoites in CSF. In corneal scrapings Sulfadiazine, pomadine Treatment Pre CNS:Suramin -CNS:Melarsoprol Nifurtimox Amphotericin B Control Treat cases -Reduce the vector Improve housingDont bath in under- - Care of skin lesions 5/2/2012 16 Insecticides chlorinated S pools Sterilized saline for lens

Protozoa: Trypanosoma & free living amoeba

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Type organism Man Reservoir

Protozoa: Tissue, Blood and intestinal coccidia

Malaria (plasmodium) P. vivax P. ovale P. malariae P. falciparum IH none None monkey None In Liver cells in exo erythrocytic cycle and RBCs in erythrocytic cycle Ring, merozoite, Schizont Ring and Gametocytes gametocytes In gut and salivary glands of Female anopheles

Toxoplasmosis Toxoplasma BEIH Blood warmed mammals All cells commonly of REC, Habitat muscles, myocardium, brain,eye Exit stage None

FH
Infective stage Mode of infection

Disease Diagnosis Treatment 17 Control

Cats Disporocystic tetrazoic Oocyst in cat's feces in soil, Mature oocysts in Sporozoites in saliva of anopheles. Tachyzoites, in WBCs, human feces or Merozoite in RBCs Bradyzoites in tissue cysts calves feces. from meat of animals Ingestion of oocysts in food. Female Anopheles injects sporozoites into Ingestion of Ingestion of cyst in meat. blood vessel during blood meal. oocysts in food and Tachyzoite trans-placentally Merozoites (in RBCs) enter via blood drinks esp. water & by blood transfusion transfusion to make erythrocytic only Acquired: compromised Fever (F), Hemolytic anemia and jaundice Enteritis with Fever, lymphadenopathy. Splenomegaly watery diarrhea Myocarditis, Encephalitis and abd. Retinochoroiditis (RC) Relapse after 5 ys Nephrotic Cerebral malaria Prolonged cramps diarrhea Black water F Congenital: by hypnozoites syndrome Recrudescence in compromised Abortion, stillbirth, RC Detect acid fast Detect specific IgM or low Detect exit stages in blood smears oocysts in stool avid IgG antibodies by ELISA Chloroquine Quinine + Nitazoxanide Pyrimethamine, spiramycine primaquine-relapse Chloroquine doxycyclin only 5/2/2012 Mosquito control - Chemo-prophylaxis Use water filter cook meat-cat control

Cryptosporidiosis Cryptosporidium IH &FH calves In epithelia of GIT, biliary , respiratory tracts Asporocystic tetrazoic oocyst Man (enterocytes)

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