PARASITOLOGY LABORATORY

SMCM EMT2017

Trichinella spiralis
-

Common name: Trichina worm

Disease caused: Trichinosis, Trichiniasis
Smallest nematode parasitic to humans
Female viviparous/larviparous are capable
producing 1500 larvae.

of these carnivorous animals (or eating food contaminated

with such meat).

of

LARVAE
Has spear-like burrowing anterior
80-100 m
900-1300 m x 35-40 m
LIFE CYCLE
Encysted larvae in pig muscle
Mode of transmission (MOT): ingestion of
improperly cooked pork
Infected flesh is digested by gastric juice
Adults in the duodenum
Larviparous female burrows into mucosa and
deposit larvae.
Encyst in striated muscle
Dead end cycle

PATHOLOGY
Incubation and intestinal invasion:
Diarrhea
Constipation
Vomiting
Abdominal cramps
Nausea
Larval migration and muscle invasion:
Fever
Pain and swelling
Weakness
Splenomegaly
Gastric and intestinal hemorrhages
Encystment and encapsulation:
Fever
Weakness
Pain
DIAGNOSIS
Muscle biopsy
Serological ELISA
TREATMENT
Thiabendazole: 1st week of infection
Mebendazole: larvicidal
PREVENTION AND CONTROL
Focus on the infected pigs
Cook meat 77C or 177F
Freezing: -15C for 20 days/ -30C for 6 days
Smoking (steaming), salting (preserving) or drying
is not effective.

Capillaria philippinensis
-

Trichinellosis is acquired by ingesting meat containing cysts

(encysted larvae)

of Trichinella. After exposure to gastric

acid and pepsin, the larvae are released

from the cysts
and invade the small bowel mucosa where they develop into
adult worms
(female 2.2 mm in length, males 1.2 mm; life
span in the small bowel: 4 weeks). After 1 week, the females
release larvae

that migrate to the striated muscles where

they encyst
. Trichinella pseudospiralis, however, does not
encyst. Encystment is completed in 4 to 5 weeks and the
encysted larvae may remain viable for several years.
Ingestion of the encysted larvae perpetuates the cycle. Rats
and rodents are primarily responsible for maintaining the
endemicity of this infection. Carnivorous/omnivorous animals,
such as pigs or bears, feed on infected rodents or meat from
other animals. Different animal hosts are implicated in the
life cycle of the different species of Trichinella. Humans are
accidentally infected when eating improperly processed meat

Severe diarrheal syndromes in humans

Pathogenic to humans
Intestinal capillariasis

EPIDEMIOLOGY
In 1962, a healthy young man from Luzon PH
(Tagudin) fell ill.
Post-mortem examination revealed capillariasis
infection
He was the first documented casualty of human
intestinal capillariasis.
Epidemic
during
1967-1968
where
1200
individuals were infected
Common in children having a history of pica
Capillaria spp. parasitize many classes of
organisms although 4 species have been found in
humans:
C. philippinensis (intestinal capillariasis)
C. plica (urinary capillariasis)
C. aerophila (pulmonary capillariasis)
C. hepatica (hepatic capillariasis)
MORPHOLOGY
Adult: small, slender nematode
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embryonated in the intestine, and release larvae that can

cause autoinfection. This leads to hyperinfection (a massive

Female is larger than male:

Male: 2-6 mm
Female: 3-6 mm

Unique feature
EGGS: ovoid/peanut-shaped, operculated with
flattened bipolar plugs, broad shoulders and a
striated shell
LIFE CYCLE
Host: humans
Intermediate host: freshwater and brackish
water fish
Role of intermediate host: site where the parasite
only develops before becoming infectious to the
primary host
Embryonation occurs in water only.
Unembryonated egg cannot be infectious.
Only embryonated egg is capable of infecting
humans because of its capacity to form larvae.
Prevalent in coastal areas
After embryonation, C. philippinensis egg is
ingested by the fish.
The infective intermediate host (fish) is ingested
by humans, goes to the systemic circulation, and
the cycle repeats.
OR, accidental host (birds) will ingest the fish.

number
of
adult
worms)
.Capillaria
philippinesis is
currently considered a parasite of fish eating birds, which
seem to be the natural definitive host

CLINICAL FEATURES
Associated malaise (due to lack of protein),
anorexia, nausea and vomiting
Advanced disease shows:
Cachexia (loss of weight)
Diminished reflexes
Dehydration
DIAGNOSIS
C. philippinensis can be fatal in severely infected
individuals which may result in severe diseases
with a high mortality when untreated.
Early diagnosis is very important.
LABORATORY DIAGNOSIS
1. Stool analysis
Stools are bulky with elevated fecal fat content
and an average daily stool weight of 1200 g
(versus controls of 170 g).
Protein loss in the stools may be 15 times that
seen in controls.
Not a routine test in the lab, but can be done.
2. Egg
Still under stool analysis
Diagnostic characteristic
Length: 40 m x 20 m
Trichuris trichiura egg

Capillaria
philippinensis egg

Difference: shape of bipolar plugs

TREATMENT
Hospitalization
Intake of fluids and electrolytes (especially, K
replacement)
High-protein diet
Antidiarrheal agents

Typically, unembryonated eggs are passed in the human

stool

and

environment

become

embryonated

in

the

external

; after ingestion by freshwater fish, larvae

hatch, penetrate the intestine, and migrate to the tissues

.
Ingestion of raw or undercooked fish results in infection of the
human host
. The adults of Capillaria philippinensis (males:
2.3 to 3.2 mm; females: 2.5 to 4.3 mm) reside in the human
small intestine, where they burrow in the mucosa
. The
females deposit unembryonated eggs. Some of these become

SPECIFIC TREATMENT
Drug of choice: Albendazole
Treatment of choice: 200 mg
Effective against eggs, larvae,
worms
Alternative drug: Mebendazole
Dosage: 200 mg
Pediatric dose is the same

and

adult

PREVENTION
Prevention of ingestion of raw fish
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(Add. Info) To prevent infections by parasites with

vectors, eliminate the vector first.

FILIARIASIS (Filarial Worms)

GENERAL LIFE CYCLE
Human infection is acquired when infective larvae
enter the skin at the arthropods feeding site.
Larval migration takes place in tissue.
Adults are in various tissue (according to species)
They mature to produce microfilariae
LYMPHATIC FILARIASIS
Habitats the lymphatic system:
Wuchereria bancrofti
Brugia malayi
Transmitted by mosquito that results to deformity
and disability
Adults seen in the lymphatic vessels
(Add. Info) The reason why parasitic infections are
still prevalent in provinces is that the indigenous
people perceive sickness as a curse and reject
medicine

Nuclei are well-separated yet numerous in the

body.
Body of microfilaria has sweeping curves.
Tail tapers to a point with no nuclei present.
The sheath is typically stains pale pink with
Giemsa.
Sheath extends beyond the tip of the tail, but the
nuclei do not.

LIFE CYCLE
During a blood meal, uninfected mosquito
introduces 3rd stage filarial larvae (L3 larvae) on
the skin of human host, where they penetrate into
the bite wound.

Wuchereria bancrofti
-

Vector can also be infected when it sucked blood

from an infected human.

Bancrofts filariasis
A blood and lymphatic dweller. The infection
results to elephantiasis (severe and disfiguring).
Vectors:
Culex,
Aedes
and
Anopheles
mosquito

DIAGNOSIS
Detection and identification of microfilaria in
stained blood smear (lymphatic vessels).
Best seen at night after 10 PM (nocturnal)
(Add. Info) Mosquito carrying dengue is often seen
during the morning.
MORPHOLOGY
During a blood meal, an infected mosquito introduces thirdstage filarial larvae onto the skin of the human host, where
they penetrate into the bite wound

. They develop in adults

that commonly reside in the lymphatics

. The female
worms measure 80 to 100 mm in length and 0.24 to 0.30 mm
in diameter, while the males measure about 40 mm by .1
mm. Adults produce microfilariae measuring 244 to 296 m
by 7.5 to 10 m, which are sheathed and have nocturnal
periodicity, except the South Pacific microfilariae which have
the absence of marked periodicity. The microfilariae migrate
into lymph and blood channels moving actively through
lymph and blood

. A mosquito ingests the microfilariae

during a blood meal

. After ingestion, the microfilariae lose
their sheaths and some of them work their way through the
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wall of the proventriculus and cardiac portion of the

mosquito's midgut and reach the thoracic muscles
the

microfilariae

develop

into

first-stage

larvae

. There
and

subsequently into third-stage infective larvae

. The thirdstage infective larvae migrate through the hemocoel to the
mosquito's prosbocis

and can infect another human when

the mosquito takes a blood meal

Brugia malayi
-

A blood and lymphatic dweller. The infection can

cause elephantiasis, but it is not disfiguring or
common like W. bancrofti.
Vectors: Mansonia, Anopheles and Aedes
Diagnosis of microfilaria in stained blood smear

1.
2.
-

3.
-

MORPHOLOGY
-

The head space is twice as long as it is broad.

Tail tapers around to 2 nuclei that appear to be
connected by a fine thread.
Nuclei in body appear crowded.
Sheath stains pink-red with Giemsa stain and body
is closely folded in an angular fashion.

MODE OF TRANSMISSION AND INCUBATION

PERIOD
Lymphatic filariasis: transmitted by the bite of the
vector (infected mosquito) which harbors L3 larvae
L1
L2
L3

Thick blood smear

Consists of thick layer of lysed/dehemoglobinized
RBC
Allows more efficient detection of parasite
Cannot have an optimal review of the morphology
Thin blood smear
Can view the morphology
Consists of blood spread in a layer with a
decreasing thickness toward feathery edge
In feathered stage, the cells should be monolayer,
not touching one another.

Immunochomatographic diagnostic test

Kit containing antibodies against the parasite
In vitro immunodiagnostic test used to detect W.
bancrofti antigen in the blood.
During an infection, there are antigens and
antibodies present.
It employs an antibody specific for W. bancrofti.
(Add. Info) Advantage of antigen detection: can
see early infection since antibodies are still not
present.

LYMPHATIC FILARIASIS CLINICAL MANIFESTATION

Elephantiasis hydrocele (accumulation of fluid)
Penis
Legs
Breast
LYMPHATIC FILARIASIS MANAGEMENT BY WHO
The elimination strategy has 2 components:
1. To stop the spread of infection by interrupting
transmission: kill the vectors!
2. To alleviate the suffering of affected population:
control morbidity.
NATIONAL FILARIASIS ELIMINATION PROGRAM
1. Selective treatment
For infected individuals
Drug: diethylcarbamazine citrate
Dosage: 6 mg/Kg body weight in 3 divided doses
for 12 consecutive days casually given after
meals
2. Mass treatment
Drugs are given to all population in endemic area
(2 y.o. and above).
Diethylcarbamazine citrate + albendazole
400 mg
Singe dose given anually
Prophylaxis for immunity

1-3 hours
3-4 days
5-6 days

DIAGNOSTIC METHOD