Name Entamoeba hystolitica Entamoeba dispar Entamoeba moshkovshii Entamoeba hart mani Entamoeba polecki Entamoeba coli Entamoeba

gingivalis Endolimax nana Iodamo eba butschlii Naegleria fowleri Naegleria australiniensis Naegleria philippinien sis Naegleria gruberi Acanthamoeba castellanii Acanthamoeba culbertsoni Chilomas tix mesnili Giardia lamblia Amoeba Amoeba Amoeba Amoeba Amoeba Amoeba Amoeba Amo eba Amoeba Amoeba Amoeba Amoeba Amoeba Amoeba Amoeba Flagellate Flagellate Pathogenicity (P,NP,FL) P NP NP NP NP NP NP NP NP P; FL P; FL P; FL NP; FL P; FL P; FL NP P Habitat Mode of Transmission oral-fecal route cecum & colon lumen oral mucosa *most common endocommensal *2nd most common endocommensal pig oral/ intranasal r outes *pigs warm water; tropics Lower respiratory tract fecal-oral route Duo-Jejunum, Ileum mucosal crypt of LI (cecum & upper colon) ur ogenitals fecal-oral route Dientamoeba fragilis Trichomonas vaginalis Flagellate Flagellate P P fecal-oral route STD

Trichomonas tenax Trichomonas hominis Enteromonas hominis Leishmania donovani Le ishmania major Leishmania tropica Leishmania mexicana Trypanosoma brucei gambien se Trypanosoma brucei rhodisiense Flagellate Flagellate Flagellate Flagellate Flagellate Flagellate Flagellate Fla gellate Flagellate NP NP NP P P P P P P oral mucosa cecum kissing Sand fly Sand fly Sand fly Sand fly Glossina (Tse-tse) fly; break blood (hemofla gellate), in skin, bite of blood sucking CSF and lymph invertebrate Trypanosoma cruzi Flagellate P blood (hemoflagellate), CSF and lymph Reduviid/ kissing / triatome bug; ingestion of food contaminated with reduviid f eces (eww!) Plasmodium falciparum Flagellate P Blood and Lymph Bite Anopheles mosquito

Plasmodium malariae Plasmodium vivax Plasmodium ovale Balantidium coli Flagellate Flagellate Flagellate Ciliate P P P P Blood and Lymph Blood and Lymph Blood and Lymph cecum large cecum (and may also be in appendix & lower ileum) cecum, nighttime migration to peranal folds pigs; ingestion of meat with cysts ingestion of egg in food and drinks Trichuris trichiura (whipworm) Nemate P Enterobius vermicularis (pinworm/kigwa) Nemate P human to human; inhaling or swallowing, through finger contamination Capillaria philippinensis Nemate P fish-bird-fish cycle; infect small intestine; jejunum man via ingestion of raw o r undercooked fish Trichenella spiralis (subspecies: nativa, spiralis & Nemate nelsoni) P small intestine then circulation & striated muscles improperly cooked pork/ pork products

Ascaris lumbricoides - largest Nemate intestinal worm P small intestine; heart; lung; gut soil; ingestion of fully embryonated egg Necator americanus (hookworm) - blood-sucking Nemate P skin penetration (ground small intestine, attached itch) > blood-sucking; to muc osa blood> heart> lungs> gut Ancylostoma duodenale (hookworm) - blood-sucking Strongyloides stercoralis (thre adworm) Nemate P skin penetration (ground small intestine, attached itch) > blood-sucking; to muc osa blood> heart> lungs> gut small intestine, swimming in mucosa free-living & p arasitic forms contaminate soil; feces passed out Nemate P Anisakis spp. (herring disease) Nemate P small & large intestine + 3rd stage larval nematode in stomach, attached to crus taceans, fish & sea mucosa mammals > human cyclops > freshH20 fish/ frog > human -- intestine, internal organs, CNS or eyes Gnathostoma spinigerum Nemate P intestine, transitory

angiotrongylus cantonensis Nemate p brain, rarely in lungs pulmonary A. of rats > snails or slugs (humans incidental host) dracunculus medinensis Nemate P local lesions: metatarsal bones on soles of the ingestion of unfiltered water fe et or on the ankle

loa loa Nemate p cutaneous / subcutaneous day biting flies onchocera volvulus Nemate P subcutaneous black fly Wuchereria bancrofti Nemate P Mosquitos(Culex, Anopheles, Lymphatic duct, afferent Aedes, Mansonia, lymph chan nels, lower Coquillettidia) adults half body, rarely in veins produce Microfilar iae, man=def host

Brugia Malayi Nemate P Lymphatics Intermediate host Mosquito(Mansonia, Aedes, Culex) Def host: humans Trichostrongylus Nemate p Small Intestine def host: herbivorous mammal, Incidental host: humans Ancylostoma Caninum Ancylostoma Ceylanicum Smallest of A. Liver by juvenile, but no organ exempt dogs Cats, Wild Relative Toxacara Canis Dog

Disease details Clinical Management (1st is drug of choice) Metronidazole 650mg TID 14d Diagnostic Tests (gold standard) Infective Stage / Diagnostic stage (PAM) Primary Amebic Meninggoencephalitis - N. fowleri (GAE) Granulomatous Amoeb ic Encephalitis Keratitis Traveller's diarrhea associated with E. vermicularis i nfection Trichomoniasis - common STD in women Temp above 46 C Chlorinated H20 0.05mg/L Amphotericin B.; Miconazole Metronidazole serological technique (DOT/PCR)

Pentostam / Stibogluconate West African Sleeping Sickness Pentamidine trypanosomes in buffy coat trypomastigote in blood metacyclic trypomastigote fro m fly to man East African Sleping Sickness Melarsoprol for CNS involvement Chagas Disease; American trichomoniasis Cardiomegaly, Hepatomegaly and megacolon Nifurtimox and Premaquine Xenodiagnosis metacyclic trypomastigote from bug to man Quinine, Premaquine, Chloroquine

Quinine, Premaquine, Chloroquine Balantidial dysentery rectal prolapse, bloodstreaked diarrheal stools, ab Mebend azole, Albendazole pain, vomiting, weight-loss, anemia Pyrvinium pamoate; mebend azole or albendazole DFS, Kato, Acid ether/formalin coc'n method embryonated egg (japanese lantern, bipolar plugs) embryonated eggs ingested (D-shaped eggs) pruritus ani scotch tape method ab pain, boborygmus, diarrhea, weight loss, Mebendazole, Albendazole malaise, an orexia, vomiting, edema 1st wk- (invasion)larva into intestine causes ab pain, n ausea, vomiting, and diarrhea; 2nd (migration) Mebendazole, oral prednizole; or circulation to muscles, thiabendazole (may expel adult) edema on face, high eos; 3rd (encystment) recovery or death esophagus w/ stichocytes; eggs (21x36um peanut-shaped eggs) ingested larva in st ool; eggs w/ bipolar plugs encysted larva during striated infected / encysted muscle (deltoid) biopsy; ELIS A or larva in striated Bentonite Flocc Test; NO Eggs = muscle NO stool exam

Loaffler's syndrome (bronchospasm), Bolus, Ectopic migration to appendix; heartlung migration Levamisole Hydrochloride; Mebendazole, Albendazole DFS, recovery of egg or adult worm fully embryonated egg ground itch, pneumonitis, bronchitis, anemia (microcytic, hypochromic) Mebendazole & pyrantel pamoate; iron & folic acid therapy DFS, egg in stool (74-36um egg w/ thin hyaline shell; 4-8 cellfilariform (3rd st age) stage eggs; single-shell; larvae unembryonated egg) ground itch, pneumonitis, bronchitis, anemia (microcytic, hypochromic) skin rxns (rash, pruritus), pneumonitis Mebendazole & pyrantel pamoate; iron & folic acid therapy Abendazole or thiabend azole DFS, egg in stool (74-36um egg filariform (3rd stage) w/ thin hyaline shell; 4-8 celllarvae stage eggs) rhabditoidal larvae in stool transparent, thinexam; doud enal content check, shelled eggs Harada Mori culture gastroscopy, xray, sero tes ts, px history 2-24 hrs after, gastric surgical removal of larvae; symptoms due to ulceration, prevention is by cooking/ hematemesis may be freezing @ -20C for 60 hrs present epigastric pain, nausea, local, transitory & inflammatory swellings, CNS / eye i nvolvement surgical removal of worm; prevention - soak meat in vinegar for 5 hou rs, avoid uncooked meat clinical pic / px history, eos, immunologic tests

eosinophilic meningitis, ocular involvement - failing vision, intraocular hemorr hage, retinal detachment, severe headache headache relieved by lumbar puncture removal of 10 ml of CSF; disease is self li miting (46wks); antihilmentic kills worms in CNS & greatly inflam rxn; surgical re moval - anterior or vitreous chamber endemic area consider pts. w/ acute severe headache, ssx of meningitis or mening oencephalitis, low-grade fever; peripheral eosinophilia; larva and adult worm in CSF via lumbar puncture 3rd stage larva mammalian host ; humans ingestion of infective snail, juvenile female migrate into the skin - cutaneous blisters (hands, arms, buttocks, scrotu m); secondary infxn- tetanus; sequelae - arthritis epinephrine - allergic rxn relieve evidence of infection ssx od dracontiasis - n iridazole, cutaneous lesions; x-ray - dead thiabendazole, metronidazole; calcifi ed worms surgical removal larva

calabar swelling surgical removal; diethylcarbamazine fugitive swelling, microfilaria @ 3rd stage larva peripheral blood @ day time subcutaneous nodule: africa - below the waist, central excision of nodules; iver mectin america - above the waist microfilariae in bloodless skim snip 3rd stage larva Asymptomatic Phase: Inflammatory (Acute) Phase: lymphedema, orchitis, hydrocele, epididymitis Obstructive Phase: Chyluria, Elephantiasis Diethylcarbamazine(DEC) 6mg/kg 7-12days, Ivermectine w/DEC, Albendazole w/DEC, E dematous limbs pressure bandage. Microfilariae in blood, PCR, Ultrasonography, Xray Filariform (3rd stage) larvae injected by Mosquito

same as above, Elephantiasis (not beyond knees or elbows) 1 lesion: traumatic da mage to mucosa of Si, Heavy infection is clinical manifestation: emaciation, ane mia, ab pain, blood in stool and diarrhea Creeping Eruptions, Human Muscle No Cr eeping Eruption( Cutaneous Larva Migrans) same as above same as above Thiabendazole, Pyrantel pamoate Stool exam (egg) Culturing junveniles in powdered charcoal for differentiation f or similar Filariform stages of hookworm, and Strongyloides same as above same as above Only for severe patient, ELISA: antibody, distinguis from Visceral Larva Migrans , liver, Mebendazole, Photocoagulation A.lumbricoides, T. Canis, Liver eyes(blin d) death if brain for eye Biopsy

TROPHOZOITE / morphology length w/ RBC inside morph similar to E. histolytica mo rph similar to E. histolytica no RBC; 1 nucleus has ingested bacteria feeds on b acteria numerous food vacoules large karyosome; absent chromatin large glycogen vacuole prominent single nucleus large karyosome 5-12um motility fast swimming CYST length 4 nucleus chromatin bars 5-10um 15-25um short & blunt pseudopodia numerous pseudopodia 6-15um lobose pseudopodia flagellate form (exposed to H20) NO CYST FORM oval or round single-walled Uni-n ucleate 5-14um 7-10 um spiral groove 3-20um 3 pairs of blepharoplasts; total of 6 flagella anterior hyaline knob/nipple ellipsoid, double contour, thickwalled NO CYST FORM NO CYST FORM 4-5 - 10um pear-shaped, bilaterally 7-12 um 4 pairs of flagella symmetrical, w/ sucking dis c 2 rosette-shaped nuclei w/ large central karyosome short undulating membrane ( half of body) 5-12um undulating membrane w/ flagella 3-30um 4 anterior flagella + 1 posterior flagella

costa, thin similar to T. tenax similar to E. nana 3-15um 4 anterior flagella + 1 posterior flagella runs w/ undulating membrane NO CYST FORM NO CYST FORM

M30Adult - whip-like anterior 3/5; 45mm; robust posterior 2/5 F3550mm 3K to 10K eggs/day Adult - with cephalic alae 5-15mm M1.53.9mm; F2.35.3mm Adult Female- viviparous, produce 1.5K larva in 1.4-1.6 lifetime; Male- horn-lik e mm pappilae near cloaca, has no spicule coils into spiralshaped body w/c encysts

Adult - head has 3 anterior lips w/ denticles; Male = slender, ventrally-curved posterior w/ 2 spicules; Female = strictly oviparous M1231cm; F2035cm 200K - 250K eggs a day; strictly unembryonated head bent opposite direction to body; buccal capsule w/ paired cutting plates; A dult male - broad membranous copulatory bursa w/ rib-like projections @ posterio r end M59mm; F911mm head bent on same direction larger as body; buccal capsule w/ 2 than pairs ventr al teeth necator Adult - female only (parthenogenesis) F2.7x30u m 10-20 eggs in 2 uteri at a time 1-3cm

adult= narrowed both ends, cuticula smooth, thickend @ both ex. Cepahlic tip w/ 3 lips, no buccal capsule; male, male= bursa copulatrix 16ventrad, 2 broad lobes that 19mm coalese medially, flashy female, bursal rays; female= post 21end shap ed bluntly, 25mm subterminal anal pole, vulvar opening to the anus, barber pole (twisted uterus & intestine) mouth - small triangular w/ quadrangular sclerotized plates, lips absent,cephali c papillae = outer circ -4doub papillae, inner circ. 2 doub papillae; male = pos t end coiled on itself 1or more x, copulatory spicule subequal, 10 pairs caudal papillae; female- gravid uterus ant. & post branch, intestine squashed nonfxnl male 40mm female 1240mm

whitish, long slender, blunt tail, simple head no lips, 8 cephalic papillae, cut icula w/ bosse except head and tail; male - copulatory spicule unequal in length , 3 pairs (preanal) 5 pairs (postanal) papillae - assymetrical; female- vulva 2. 5mm frm ant. end, wolbachia not reported male 2034mm female 2070mm slender and blunt @ both ends, absent lips& buccal capsule,2 circle & 4 papillae each surround the mouth, esophagus not conspicously divided; male - post end cu rl ventrallya nd lacks alae 4 pair (adanal) & 6-8 pairs (postanal) papillae; fem ale vulva just behind the posterior end of esophagus male 1942cm female 33.550cm

PRE-CYST length Others -

West African = Winterbottom's sign East African = Lymphadenopathies Stage 1 = Chancre --> Recover --> Parasites in Blood stream --> Parasitemia Stage 2 = daytime somnolence, nighttime wakefulness --> stupor / coma --> death

4 moults stages 3 moults

2 moults 2 moults then 3rd stage larva 2 moults then 3rd stage larva

Winterbottom's sign Romana's sign Kerandel's sign boborygmus hematemesis

 enlarged, non-tender, mobile posterior cervical lymph node unilateral edema affect ing both upper and lower eyelids and conjunctiva pain along the course of a nerv e manifested if there is CNS involvement gurgling stomach vomiting of blood

Classifications Trichuris Geohelminths Triumvirate Moulting Aphasmids esophageal stichocytes INFECTIVE STAGE embryonated egg ingestion skin penetration bite of arthropod vector 1 1 3x 1 1 1 1 1 1 1 Capilllaria Trichenella W. bancrofti, B. Malayi, Loa loa, Onchocerca volvulu + Trichostrongylus orientalis, Angiostrongylus cantonensis & Dracunculus medinen sis infective larva (3rd stage or filariform) ingestion encysted larva ingestion hea rt-lung migration 1 1 + Angiostrongylus cantonensis

Ascaris 1 1 2x Hookworms 1 1 2x Strongyloides Toxocara spp Enterobius vermicularis Anisakis Gnathostoma 1 1 1 1 1 1 1 , Onchocerca volvulus 1 (skin lang) 1 1 1 1 1

nathostoma

Phylum Nematoda Aphasmid Nematodes Species found in the large intestine Trichuri s trichiura Species found in the small intestine Capillaria philippinensis Trich enella spiralis Phasmid Nematodes Species found in the large intestine Enterobiu s vermicularis Species found in the small intestine Ascaris lumbricoides Necator Americanus - hookworm Ancylostoma duodenale - hookworm Strongyloides stercorali s Anisakis simplex Gnathostoma spinigerum Trichostrongylus spp. Species causing larval migrants (microfilaria) Ancylostoma braziliense, Ancylostoma caninum, Anc ylostoma ceylanicum Toxocara cati and Toxocara canis Species found in lymph node s, blood and tissues Wuchereria bancrofti Brugia malayi Loa-loa Onchocerca volvu lus Species found in the CNS Angiostrongylus cantonensis Species found in the su bcutaneous tissue Dracunculus medinensis

ma ceylanicum