INTRODUCTION TO CLINICAL PARASITOLOGY

 Parasitology – study of parasites

 Parasite – organism that lives on and obtains its nutrients from another organism

I. Stages of Parasite
1. Diagnostic stage – stage in the parasitic life cycle that can be identified by examining
appropriate specimens from the host; may or may not be the infective stage
2. Infective stage – stage in the parasitic life cycle that is capable of invading a host

II. According to Habitat

1. Endoparasite – thriving within the body; infection
2. Ectoparasite – peripheral layer of the skin; infestation
Ex. Ticks, mites, fleas (Ctenocephalides spp.), lice (Pediculus spp.), “crabs”/crab
louse/genital louse (Pthirus pubis)

III. According to Pathogenicity

1. Pathogenic – disease-causing parasite; medically important
2. Non-pathogenic – commensal; do not cause any disease; harmless

IV. Host-Parasite Relationship

 Symbiosis – relationship between two different organisms
1. Mutualism – both benefits
Ex: flagellate and termite; facilitate digestion of wood; cellulase enzyme
2. Commensalism – one benefits, other is unharmed
Ex: man and Entamoeba coli
3. Parasitism – one benefits, other is harmed
A. Obligate: could never survive without a host; most parasites studied
B. Facultative: could survive with or without a host
Ex: Strongyloides stercoralis
Note: According to Apollon, Ascaris lumbricoides and Trichuris trichiura may also
be considered as facultative parasites but they are obligate parasites most of the
time.
C. Intermittent: vectors (insects); only visits the host during feeding time
C1. Mechanical or Phoretic vectors: acting as transfer vectors; aid in transferring of
the parasite; no development of the parasite
Ex: house fly, cockroaches (Periplaneta americana): Ascaris lumbricoides ova
or eggs
C2. Biological: required in the life cycle; necessary in the life of the parasite
a. Mosquitoes
 Female Anopheles minimus flavirostris mosquito: principal vector
for malaria; for Plasmodium spp.
 Wuchereria bancrofti (Bancroft’s filarial worm): Anopheles spp.,
Culex spp., Aedes spp.

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  Brugia malayi (Malayan filarial worm): Mansonia spp., Anopheles
spp.
b. Fly
 Tse-tse fly (Glossina spp.): Trypanosoma brucei complex (T. brucei
brucei, T. brucei gambiense, T. brucei rhodiense)
 Sandfly (Phlebotomus spp.): Leishmania spp.
 Deer fly/Tabanid fly/Mango fly (Chrysops spp.): Loa loa
 Blackfly (Simulium spp.): Onchocerca volvulus
c. Gnats/Biting midges
 Culicoides spp.: Mansonella ozzardi, Mansonella
perstans/Dipetalonema perstans
d. Bug
 Reduviid bug/Assassin bug/Kissing bug/Conenose bug (Triatoma
spp.): Trypanosoma cruzi

V. Mode of Transmission (MOT)

 Mode of Transmission – manner in which the parasite is transferred from one host
to another
1. Soil-transmitted (HATS) – needs soil to develop
 Hookworms (Ancylostoma duodenale/Old World Hookworm, Necator
americanus/New World Hookworm): skin penetration
 Ascaris lumbricoides (Giant intestinal roundworm): ingestion of embryonated ova
 Trichuris trichiura (Whipworm): ingestion of embryonated ova
 Strongyloides stercoralis (Threadworm): skin penetration
*Note: “UNHOLY THREE” (HAT): Hookworm, A. lumbricoides, T. trichiura –
due to multiple infections
2. Snail-transmitted – needs snail to be infective
 Flukes/Trematodes: 1st intermediate host
3. Vector-borne – bitten by an infected vector
 Malarial parasites: mosquitoes
 Filarial worms and trypanosomes: arthropods
 Leishmania spp.: sandfly
4. Food-borne – ingestion
 Raw pork: Taenia solium (Pork tapeworm)
 Raw beef: Taenia saginata (Beef tapeworm)
 Crabs/crayfish (Sundathelphusa philippina/Parathelphusa grapsoides): Paragonimus
westermani (Oriental lung fluke)
 Snail (Pila luzonica/”kuhol”, Vivipara angularis/”susong pampang”): Echinostoma
ilocanum (Garrison’s fluke)
 Raw fishes:
o Capillaria philippinensis (Pudoc worm): glass fishes (“bagsit”, “bagsang”,
“birot”, “ipon”)
o Heterophyes heterophyes (Von Siebold’s fluke): mullet fish (Mugil cephalus)
o Opistorchis felineus (Cat liver fluke): freshwater fish (Tinca tinca, Barbus
barbus)

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 o Clonorchis sinensis (Chinese liver fluke/Oriental liver fluke): freshwater
fish (Ctenopharyngodon idellus)
o Diphyllobothrium latum (Broad/Fish tapeworm): salmon, pike, perch, trout
o Anisakis spp. (Herring’s worm): herring (eg. from sashimi)
 Plants:
o Fasciola hepatica (Sheep liver fluke/Temperate liver fluke), Fasciola
gigantica (Giant liver fluke/Tropical liver fluke): Ipomoea aquatica
(“kangkong”/water morning glory), Nasturtium officinale (water cress)
o Fasciolopsis buski (Giant intestinal fluke): Trapa bicornis (water caltrop),
Eliocharis tuberosa (water chestnut), Ipomoea aquatica (“kangkong”/water
morning glory), Nymphaea lotus (lotus)
5. Contact-transmitted – readily infective
 Trichomonas vaginalis: non-encysting protozoan
-trophozoite – infective stage
-sexually transmitted, communal bathing, public toilet
 Enterobius vermicularis (Pinworm, seatworm, societyworm, “tiwa”): inhalation,
ingestion; “D” shaped ova
-female resides in the large intestine, comes out and deposits eggs in the perianal
area at night
6. Others
A. Transplacental: Toxoplasma gondii
B. Transmammary (SAT): Strongyloides stercoralis, Ancylostoma duodenale,
Trematodes
C. Intranasal (HAN): Hartmannella spp., Acanthamoeba spp., Naegleria fowleri
D. Airborne/Inhalation: Enterobius vermicularis, Ascaris lumbricoides (ingestion is still
the main MOT)

VI. Other Types of Parasites

1. Permanent – stays in the host all throughout; parasite that lives its whole life
(hatching until death) in a single host but eggs or cyst are to be transferred to a new
host before a second generation develops
2. Incidental/Accidental – unusual host infection
3. Periodic – require two different hosts (1st-larva, 2nd-adult); parasite in which larval
stage develops in host different from that of an adult
4. Erratic – infect other organs different from what it usually infects

VII. Types of Hosts

1. Definitive host – final host; harbors adult or sexual stages of the parasite
2. Intermediate host – harbors asexual or larval stages of the parasite
3. Reservoir host – allows parasite life cycle to continue; becomes additional source for
human infection; also a definitive host (harbors adult parasite)
Ex: pigs – Balantidium coli, rats – Paragonimus westermani, cats – Brugia malayi
4. Paratenic host – transfer host; source of infection; carry infective stage but the
parasite does not develop or multiply
Ex: wild boar – Paragonimus westermani

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 USEFUL MNEMONICS FOR CLINICAL PARASITOLOGY

HEART-LUNG MIGRATION (ASH) TRANSMAMMARY PORTAL OF

ENTRY (SAT)
Remember Ash from Pokemon
Theme song: “I will travel across the land, searching  Strongyloides stercoralis
far and wide!”  Ancylostoma duodenale
 Trematodes
 Ascaris lumbricoides
 Strongyloides stercoralis
 Hookworms TRANSPLACENTAL PORTAL OF
ENTRY (TORCH)

“UNHOLY THREE” (HAT)  Toxoplasma gondii

 Rubella (German measles)
 Hookworms
 Cytomegalovirus (CMV)
 Ascaris lumbricoides
 Herpes simplex virus (HSV)
 Trichuris trichiura

PARASITES RECOVERED IN
SOIL-TRANSMITTED PARASITES SPUTUM (ATESPEECH)
(HATS)  Ascaris lumbricoides larva
 Trichomonas tenax: oral cavity
 Hookworms  Entamoeba gingivalis: oral cavity
 Ascaris lumbricoides
 Strongyloides stercoralis larva
 Trichuris trichiura
 Paragonimus westermani ova
 Strongyloides stercoralis
 Entamoeba histolytica
 Echinococcus granulosus: hydatid cyst
MOST FREQUENT NEMATODES  Cryptosporidium parvum: modified AFS
(ATE)  Hookworm larva

 Ascaris lumbricoides
 Trichuris trichiura AUTOINFECTION (TECHS)
 Enterobius vermicularis  Taenia solium
 Enterobius vermicularis: external
 Capillaria philippinensis: internal
 Hymenolepis nana
 Strongyloides stercoralis: internal

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 GRANULOMA FORMATION (ASA) PARASITES CAUSING
INFLAMMATION OF THE BRAIN
 Acanthamoeba spp.
AND MENINGES (ANA)
 Schistosoma spp.
 Anisakis spp.  Angiostrongylus cantonensis: Human
eosinophilic meningoencephalitis
INTRANASAL PORTAL OF ENTRY (HEM)
(HAN)  Naegleria fowleri: Primary Amebic
 Hartmannella spp. Meningoencephalitis (PAM)
 Acanthamoeba spp.  Acanthamoeba spp.: Granulomatous
 Naegleria fowleri Amebic Encephalitis (GAE)

Lecture notes from:

Asst. Prof. Gregorio L. Martin I, RMT, MSMT, MPH

Mr. Alvin Rey F. Flores, RMT, MT(ASCPi), MPH

Ms. Kim Abbegail T. Aldecoa, RMT, IMT(ASCPi)

Other sources and additional readings:

Clinical Parasitology: A Practical Approach (Second Edition) by Elizabeth A. Zeibig

A Concise Review of Clinical Laboratory Science (Second Edition) by Joel D. Hubbard

Mas-Coma, S., Bargues, M.D., & Valero, M.A. (2005). Fascioliasis and other plant-borne trematode
zoonoses. Retrieved from https://www.researchgate.net/publication/7612540_Fascioliasis_and_other_pl
ant-borne_trematode_zoonoses

Gabriel IV, J.H. (2010). Parasitology-Definition of Terms. Retrieved from

https://www.scribd.com/doc/34315288/Parasitology-Definition-of-Terms

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