Protozoa

1) Amoeba: Entamoeba histolytica

- Faecal Oral route
- Faeces, containing cysts are ingested
- Cysts enter GI tract and under go asexual reproduction - many cysts
- Cysts shed in Faeces
- Complication:
- Cysts invade Bowel wall: Dystentry: Stools with bloody mucus
- Cysts invade Liver: Hepatitis
- Cysts invade lungs and brain

2) Hemosporida: Plasmodium Falciparum, P. Vivax, P.Ovale, P.malariae

- Vector transmission
- In mosquito:
- trophozoites undergo asexual reproduction: many cysts produced
- cysts infect other cells, where they mature into trophozoites— > cycle continues
- some cysts infect salivary gland of mosquito —> injected into humans
- In humans:
- cyst enter blood stream of humans
- cysts go to liver where they undergo asexual reproduction
- cysts infect RBC
- in RBC
- cysts mature into trophozoites
- trophozoites under i) asexual reproduction to produce many cysts
- this causes RBC to lyse (hemolytic anemia. metabolic waste released into system.
fever)
- cysts infect other RBC, where they mature into trophozoites
- cycle continues: more RBC are infected
- trophozoites could also undergo ii) sexual reproduction to produce gametocytes
- When patient is bitten by mosquito, gametocytes enter mosquito
- Haploid gametocytes fuse to form trophozoites
- mosquito cycle continues

P.vivax, P.ovale and P.malariae: only infect a subtype of RBC (young or old). synchronized
hemolysis. periodic fever (every 3-4 days)

P.falciparum: infects all types of RBC. hemolysis is not synchronized. Different RBC lyse at
different times. This results in almost perpetual hemolysis. Hence, the fever is almost
continuous.

P.falciparum is the most dangerous species of the plasmodium family. (complication: cerebral
malaria. one of the biggest killers of children in developing countries)

Treatment: anti-malarial: Quinines

Helminth
1) Nematoda: Hookworm
- Eggs in faeces are released into soil
- In the soil: Eggs hatch into larvae
- When someone steps onto infected soil with bare feet, larvae penetrate skin and enter
capillaries
- Larve travel to capillaries in alveolar tissue: affects lung
- Larvae is coughed out, and subsequently swallowed, allowing it to enter Gut
- In Gut: larvae mature into adult hookworm
- Hookworm sucks on blood in the stomach —> Hemolytic Anaemia
- causes fatigue
- affects concentration
- lowers IQ
- common cause of children failing school in developing countries
- Eggs are shed in faeces.

2) Wu Brancrofti, Bruggia Timori, Bruggia Malayi

- Mosquito: L1-L3
- L3 form enters humans during mosquito bite
- L3 enters peripheral Lymph nodes
- L3 matures into adult form in Lymph nodes
- severe inflammation of Lymph nodes ischemia, ulceration?
- obstruction of the lymphatic draining
- inflammation —> scarring —> further obstruction of lymphatic drainage
- vicious cycle
- Lymphatic filiaris: lymphadema of lower limbs, scrotal swelling in men (elephantitis)
- Eggs are shed into blood - L1 form
- Taken up by mosquito when patient is bitten

Treatment:
1) Early stage: surgery to drain excess fluid, remove parasite, allow inflammation to subside
2) Late stage: scarring too extensive. tissue is to fibrotic. Damage is irreversible. Physiotherapy
to aid lower limb movement. Monitor for possible complications: cellulitis-> sepsis-> death

3) Cestoda: Taenia Solium (Pig Tapeworm)

- Cysts is excreted in faeces
- Faeces is ingested by Pigs
- Cysts travel from pig’s GI tract to muscles
- When the pig is killed by farmer, the muscles-containing the cysts- are ingested by humans
- In humans
- best case scenario: cysts mature into adult tapeworm. Asymptomatic. Carrier of Tania
Solium. Eggs shed by mature tapeworm shed into faeces. Cycle continues.
- worst case scenario: cysts migrate into brain and cause neurocysticercosis - manifests as
epilepsy (infection by taenia solium is one of the most common causes of adult onset
epilepsy in developing countries— especially in areas near pig farms, like Indonesia)

Treatment: anti parasitic agents- albendazole. Surgery to remove cysts from brain
4) Trematode: Schistomiasis Japonicum, S.masoni
- Eggs are released through urine and faeces, and enter water supply
- Eggs enter water snails, where they mature into larvae.
- Larvae is released by water snails,
- When someone touches the water, the larvae penetrates skin of the person
- Larvae travel via blood steam to liver
- In the liver: larvae mature into adult worms
- Male and female worms unite, and travel together to their next destination
- S.japonicum: small intestine: bleeding, chronic inflammation, puts patient at higher risk of
colon cancer. Eggs are shed into urine.
- S.masoni: bladder: hematuria, chronic inflammation, puts patient at higher risk for bladder
cancer. Eggs are shed into faeces.
wrong:
Schistomiasis Japonicum and Schistomiasis masoni: intestines- colon cancer
Schistomiasis haematobium: bladder - bladder cancer