SUPER PARASITOLOGY TABLE

Description Morphology & Infective & Transmission, Diagnosis & Treatment Pathogenesis Remarks
Parasite Epidemiology Diagnostic stage
; Host
1. Intestinal Amoeba
Cysts have 4 nuclei that locomotion: pseudopodia Infective: Cyst , Transmission: fecal-oral, via enema majority is Asx ; most invasive among the
characteristically have centrally- Diagnostic: equipment Entamoeba family and the only
located karyosomes and fine, lacks mitochondria, no RER Trophozoite ; Amebic dysenstery: bloody diarrhea, fish odor member to cause colitis and liver
uniformly distributed and GA Intermediate : Diagnosis: trophozoite and cyst in the stool, (+) Charcot-Leyden crystals ; abscess, the cyst is resistant to
peripheral chromatin. None ; stool, saline and methylene blue stain, gastric acidity and dessication and
prevalent in the tropics, Definitive: PCR and ELISA (for differentiation amoebic colitis: abdominal pain and diarrhea +/- can survive in a moist environment
Cytoplasm containing RBC placing second to malaria in human from other Entamoeba sp., serum blood and mucus for several weeks ; lasts for weeks
(pathognomonic) terms of mortality caused antibodies (DxOC for ALA), UTZ (round and may return after remission,
by protozoans, equal or oval hypoechoic area with wall Amoebic liver abscess (ALA) is the most infection persist for years
Trophozoites: single nucleus prvalence among men and echoes, usually in the R lobe), CT Scan, common extra-intestinal form of amebiasis
and tending to be more women but ALA is 3-10x MRI (fever, RUQ pain, "Anchovy paste") ; Factors that determine invasion
elongated in diarrheal stool. more commmon in men -number of amoeba ingested
Treatment: DOC is Metronidazole Amoeboma: inflammatory or granulomatous -pathogenic capacity of the strain
for invasive amebiasis, Diloxanide tumor-like mass that may obstruct the lumen -host factors: gut motility &
furoate for asymptomatic cyst immune competence
carriers, Percutaneous drainage of 3 virulence factors: Lectin (for adherence to -+/- of suitable enteric bacteria that
liver abscess if not responding to cells) , Amebapore (form pores on host cell enhances amoebic growth
metronidazole or for prompt relief of memb) and Cysteine proteinases (cytopathic for
pain or for left lobe abscess that may host cell) ;
a. Entamoeba rupture into the pericardium
Histolytica mechanism of immunity: cell-mediated
2. The Commensal Amoeba: are non-invasive and do not cause disease ; reproduce by binary fission ; cysts pass through the acidic stomach unscathed, protected by their cyst wall, excystation occur in the SI
a. Entamoeba dispar: morpholigacally similar to E. histolytica but their DNA and ribosomal RNA are different
b. Entamoeba hartmanni: similar to E. histolytica but is much smaller and does not ingest RBC, sluggish
c. Entamoeba coli: cosmopolitan in distribution, harmless inhabitant of colon, has a larger cyst and greater number of nuclei than E. histolytica
d. Entamoeba polecki: parasite of pigs and monkey, cyst is uninucleated
e. Entamoeba gingivalis: has no cyst stage and does not inhabit the intestines, found in the mouth, moves quickly and has numerous blunt pseudopodia, transmission is via kissing or droplet spray
f. Endolimax nana: small size, sluggish movement
g. Iodamoeba butschlii: no peripheral chromatin granules on the nuclear membrane
3. Free-living Pathogenic amoeba
Cysts: wrinkled fibrous outer has acanthopodia for active route of invasion of CNS is via blood ; Granulomatous Amoebic Encephalitis (GAE): feeds on G(-) bacteria, blue-green
wall (exocyst) and an inner wall locomotion, sluggish and trophozoite trophozoite or cyst in tissues and CSF ; - poorly chlorinated pools algae or yeasts ; reproduce by
(endocyst) that may be polydirectional movement, stage and 5-Fluorocytosine, Ketoconazole, - immunocompromised patients binary fission , most affeacted
hexagonal, spherical, star- ubiquitous ; high incidence dormant cyst Itraconazole, Pentamidine, - manifests as destructive encephalopathy and areas of the brain are posterior
shaped or polygonal. Cysts among AIDS Px and contact stage Amphotericin B, surgical excision of meningeal irritation (confusion, somnolence, fossa, diencephalon, thalamus and
contain only one nucleus with a lens wearers infected cornea with corneal hallucinations, seizures, cranial nerve palsies, brainstem
large karyosome transplantation ; Avoid use of topical visual disturbances, increased ICP)
corticosteroids ; Boiling water is the - Amoebic keratitis: contact lens infection
Trophozoites: pleomorphic, best possible way of killing corneal ulceration, infiltration and clouding,
often produce many spine-like trophozoites and cysts iritis, slceritis, loss of vision; found in nasal
processes called acanthapodia. cavity, throat and intestines
Large nucleus with a large,
centrally-located karyosome
but no peripheral chromatin.
There is no flagellated
trophozoite stage in
a. Acanthamoeba Acanthamoeba spp.
 Cysts in the environment and Naegleria trophozoites I: Cyst Transmission: oral and intranasal Primary amebic meningoencephalitis (PAM): a free-iving amebo-flagellate
culture are spherical, and have readily forms a pair of D: trophozoite routes while swimming in - manifested as fever, headache, signs of because it can exist as an amoeba
a smooth, single-layered wall. flagella originating from the contaminated pools, lakes and rivers, meningeal irritation, vomiting and encephalitis (trophozoite from) and as a
Cysts have a single nucleus tip of a pear-shaped cell N. fowleri is only inhalataion of the dust-borne cyst with progression to coma and death, has flagellate (swimming form) ; is able
body (transforms from an pathogenic to could lead to infection, most often degenerative or cytopathic effects in to survive in elevated temp up to
Trophozoites: cytoplasm is ameba into a biflagellated humans, others isolated from thermal effluents, hot mammalian cell cultures 46C and in hyperchlorinated water
granular and contains many organism) ; soil is the are opportunistic springs and water with elevated temp ; N fowleri does not tolerate temp
vacuoles. The single nucleus is preferred habitat, run-off pathogens. ; higher than 100C and lower than
large and has a large, dense from heavy rains result in 65C, its growth is inhibited by 0.2%
karyosome and lacks peripheral introduction of ameba from trophozoites in the brain and CSF, NaCl and KCl, dehydration is lethal
chromatin. soil into lakes and ponds PCR, ELISA ; to trophozoites but cysts remain
viable if rehydrated within 23
DOC is Amphotericin B, months.
Clotrimazole, Azithromycin, Iodine,
b. Naegleria : N. Chlorine
gruberi (non-
pathogenic), N. fowleri
(pathogenic)
4. Ciliates and Flagellates
Cysts are seen less frequently has a cytosome through I: Cyst, D: both Transmission: ingestion of food/water capable of attacking the intestinal epithelium the largest protozoan parasite
which it acquires food and a cyst and contaminated with fecal material resulting in ulcer with a rounded base and and is the only ciliate known to
Trophozoites: characterized by cytopyge through which it trophozoite ; containing cysts wide neck which in turn causes bloody cause human disease ; unlike
their large size, the presence of excretes waste, has a primarily diarrhea, ulceration is caused by hyaluronidase ; ameba, encystation does not result
cilia on the cell surface, a macro and micronucleus associated with Diagnosis: Trophozoites and cysts in bloody and mucoid stoool around 6-15x a day, in an increase in number of nuclei ;
cytostome, and a bean shaped and two contractile pigs ; feces ; complications include intestinal perforation and reproduce by binary fission ; easily
macronucleus which is often vacuoles ; common in pigs acute appendicitis ; ingested cysts excyst in the inactivated by heat and 1% bleach,
visible and a smaller, less throughout the tropics Treatment: Tetracycline, SI and become trophozoites. Trophozoites ordinary chlorination of water may
conspicuous micronucleus. Metronidazole, Iodoquinol inhabit the lumen, mucosa and submucosa of not be as effective
the large intestines primarily the cecal region,
also blood vessels and lymphatics

a. Balantidium coli
Cysts binucleated flagellated I: Cyst Transmission: ingestion of food/water lives in the duodenum, jejunum and upper also known as G. intestinalis, G.
- oval to ellipsoid and measure trophozoite and D: trophozoite contaminated with fecal material ileum of humans, excyst in the duodenum and duodenalis, Lamblia duodenalis or
8-19 µm (average 10-14 µm). quadrinucleated cyst, and cyst ; containing cysts develops into trophozoites which rapidly L. intestinalis, discovered by
- Mature cysts have 4 nuclei, pyriform or tear-drop host: Human multiply and attach to the intestinal villi causing Antoine Van Leeuwenhoek in his
while immature cysts have two. shaped, pointed Diagnosis: trophozoites and cysts in pathologic changes (villous flattening & crypt own stool but was described by
- Nuclei and fibrils are visible posteriorly with a pair of feces, aspiration biopsy, Enterotest, hypertrophy) that leads to a decrease in Lambl ; attachment to villi was
ovoidal nuclei, dorsal side antigen detection tests eletrolyte, glucose and fluid absorption, causes observed to be maximal at body
Trophozoites: of the organism is convex - immunofluorescence test, direct mechanical irritation in the affected tissues, temp and stable at a pH of 7.8 to
- pear-/heart-shaped and while ventral side is fluorescent antibody is considered secretes 8.2 ; floating leaf-like motility ;
measure 10-20 micrometers in concave with a large to be the Gold standard in diagnosis "Old Man's glasses" ; minimal
length. adhesive disc used for ; Lectin which enables attachment to intestinal infective dose of 1-10 cysts
- 2 large nuclei are usually attachment, bilaterally epithelium, causes rearrangement of suggests that it could easily be
visible. symmetrical with distinct Treatment: Metronidazole, Tinidazole, cytoskeleton in human colonic and duodenal transmitted by fecally
- large concave sucking disks medial line called axostyle ; Furazolidone, Alternatives: monolayers --> structural disintegration --> contaminated food ; Important
on ventral surface (used for with erratic tumbling Paromomycin & Quinacrine enterocyte apoptosis ; also causes increased Risk Factors include
attaching to the host's mucosal motion by four pairs of epithelial permeability leading to loss of overcrowding, immunodeficiency
epithelium), flagella ; high prevalence epithelial barrier function ; 50% of cases may be and homosexual practices ;
b. Giardia lamblia shown to be related to the "gay
- median bodies, and 4 pairs of among homosexuals due to asymptomatic, abdominal pain described as
5. Coccidians: characterized by an alternation of generations - 1 sexual & 1 asexual - occuring in the same host. Asexual reproduction is schizogony while the Sexual cycle is sporogony
 Oocysts of I. belli are large (25
to 30 µm) and have a typical
ellipsoidal.
a. Isospora belli
Oocysts are rounded and
measure 4.2 to 5.4 µm in
diameter. Sporozoites are
sometimes visible inside the
oocysts, indicating that
sporulation has occurred.
b. Cryptosporidium
parvum, C. hominis
Oocysts are spherical, 7.5-10
µm in diameter. Sporulation in body, oocysts are
the environment is
temperature-dependent and
may take one to several weeks would appear as blue or
for an infective oocyst to
contain two sporocysts, each
c. Cyclospora containing two sporozoites.
cayatensis
Cysts of Toxoplasma gondii
usually range in size from 5-50 shaped with a pointed
µm in diameter. Cysts are
usually spherical in the brain posterior
but more elongated in cardiac
and skeletal muscles. ;
Tachyzoites (trophozoites) of
Toxoplasma gondii are
approximately 4-8 µm long by 2-
3 µm wide, with a tapered
anterior end, a blunt posterior
end and a large nucleus.
d. Toxoplasma gondii
oocyst has two sporocysts I: oocyt, D: ingestion of food/water contaminated
with each containing four oocyst with fecal material containing cysts ;
sporozoites ; more common oocysts in feces by direct microscopy
in children and male or after formalin-ethyl acetate
homosexuals esp those concentration, Acid-fast stain, Iodine
with AIDS staining, Entero-test, duodenal
aspirate ; bed rest and bland diet for
asymptomatic patients, Co-
trimoxazole or Pyrimethamine-
oocyst will appear as a red- I: oocyst, oocyst; Transmission:
Sulfadiazine forIngestion
symptomatic
of food/water
Px
pink doughnut-shaped C. parvum is now contaminated with fecal material
circular organisms in a blue- considered a containing oocysts ;
background in Kinyoun acid parasite of
fast stain bovines which Diagnosis: Sheather's sugar flotation
can infect or formalin-ethyl-acetate
humans while C. concentration technique or acid fast
hominis will staining (cheapest and quickest),
infect only Indirect fluorescent antibody, enzyme
humans immunoassay and DNA probes ;
Treatment: Presently no acceptable
treatment for Cryptosporidiosis,
Nitazoxanide however has been
reported effective, Bovine colostrum,
paromomycin, claritromycin and
has cyanobacteria-like I: oocyst, D: azithromycin
ingestion have(leafy
of food shown promise as
vegetables)
oocyst ; host: /water contaminated with fecal
autofluorescent and under human only material containing oocysts ; Direct
fluorescent microscopy, microscopic examination of fecal
smears under high magnification
green circles (400x), acid fast staining, safranin
staining, microwave heating, PCR ;
disease is self-limiting and treament is
not necessary, if pharmacologic
trophozoite is crescent- I: tachyzoite, treatmentofis food/water
ingestion warranted, contaminated
Co-
bradyzoite and with cat fecal material containing
anterior and a rounded oocyst, D: oocysts, eating of meat of infected
tachyzoite / animals, blood transfusion, placental
bradyzoite ; I: transfer (1st trimester), organ
human and other transplantation esp bone marrow ;
animals (rodents, examination of tissue imprints stained
pigs), D: cat with Giemsa, hematoxylin or eosin,
serum antibodies, Sabin-Feldman
methylene blue dye test, indirect
hemmaglutination, indirect
fluorescent antibody test, ELISA, latex
agglutination, PCR ; pyrimethamine-
sulfadiazine (rescue agent for
pyrimethamine: Leucovorin), if with
sulfa allergy, use Clindamycin,
alternative drugs: spiramycin,
azithromycin, clarithromycin,
Often Asymptomatic, diarrhea occurs dissemination of parasite into other
intermittently for months, fever, flatulence, organs happen in AIDS Px,
malabsorption syndome ; mucosal lesions of prognosis is good but infections
shortened villi, hypertrophied crypts and may last for months ; cases of
infiltration of the lamina propria with acalculous cholecystitis has been
polymorphonuclear leukocytes esp eosinophils noted after I. belli infection
sporozoites which attach to the surface of Varying degrees of malabsorption
epithelial cells of the GIT --> sporozoites develop and excessive fluid loss
into trophozoites and become intracellular but
extracytoplasmic and attach to the brush Most epidemics are associated
borders ; with water contaminated with calf
feces ; chlorination does not affect
Immunocompetent: manifest as self-limiting the parasite, multiple disinfectants
diarrhea of 2-3weeks and combined water treatment
Immunocompromised: diarrhea becomes more processes may reduce C. hominis
severe, progressively worse and life-threatening oocyst in drinking water
Gangrenous cholecystitis due to heavy infection
of bile duct and gallbladder
Respiratory infections lead to chronic coughing,
dyspnea, bronchiolitis and pneumonia ;
chronic and intermittent watery diarrhea (6-7 D-xylose malabsorption has been
weeks) with >6 stools per day, infections are found to develop in some patients ;
usually self-limiting and immunity may result There is no alternate treatment if
with repeated infections patients are unable to tolerate
sulfamethoxazole, boiling of water
seems to be the best method since
chlorination is not effective
an intracellular parasite which infects different The complete life cycle only occurs
kinds of nucleated cells including macrophages ; in the members of the cat family ;
usually asymptomatic as long as the immune Asexual multiplication is by a
system of the Px is well functioning ; once variation of binary fission called
stimulated the immune system quickly responds endodyogeny (characterized by
to the parasites which, in turn, adapt by formation of plasma membrane by
transforming into bradyzoites that are the two new daughter parasites,
proctected by a cyst wall ; Clinical even before the division of the
manifestations become apparent when immune nucleus) ; follows a typical
system is suppressed (old age, drug-induced, coccidian life cycle consisting of
AIDS etc): encephalitis, myocarditis, focal schizogony, gametogony and
pneumonia, retinochorioditis, lymphoreticular sporogony in the intestinal
hyperplasia with enlargement of the posterior epithelium , the extraintestinal
cervical lymph node, hepatitis, splenomegaly, stages are the asexual stages:
failure to gain weight ; In pediatric Px it may be tachyzoites and bradyzoites ; only
manifested as stillbirth, abortion, chorioretinitis, the tachyzoite and bradyzoite
epileptic seizure, jaundice, hydrocephalus, stages are present in humans ;
microcephaly, anemia, pneumonia ; Food should be protected from
 Oocysts of Sarcocystis in human
feces measure 15-20 µm long
by 15-20 µm wide. Oocysts
sporulate in the intestinal
epithelium and contain two
sporocysts, each of which
contains four sporozoites and a
refractile residual body.
e. Sarcocystis
hominis, S. suihominis
6. Other Intestinal Protozoans
Blastocystis hominis appear as
spherical to oval cyst-like
structures. They vary widely in
size (5 to 30 µm; usual range 8
to 10 µm), and typically consist
of a central body, or "vacuole,"
surrounded by a thin rim of
a. Blastocystic cytoplasm containing up to six
hominis nuclei.
Dientamoeba fragilis has no
cyst stage, and its trophozoites
measure 5 to 15 µm. The
flagella is not usually evident
and the pseudopodia are
angular to broad-lobed and
transparent. While most
b. Dientamoeba trophozoites are typically
fragilis binucleate, some have only one
7. Plasmodium
Plasmodium
falciparum,
Plasmodium vivax,
Plasmodium ovale,
Plasmodium malariae
Pre-patent period
simplest form is called a
zoite, which is banana-
shaped, sporocysts are
composed of 4zoites
lacks cell wall but has a
mitochondrion with
protozoan morphology,
capable of pseudopodial
extension and retraction ;
has 4 morphological forms -
vacuolated, amoeba-like,
granular and mutliple
fission ; more common in
rossette-shaped nuclei ;
resembles Trichomonas
except for the absence of
flagellum ; together with
Enterobius, has high
prevalence among pre-
school children and mental
institutions
pigment producers,
amoeboid in shape,
gametocyte is banana
shaped, microgamete
cytoplasm is light blue in
color while macrogamete is
darker blue, trophozoite is
ring-shaped with a red
chromatin dot and a small
blue cytoplams in Giemsa
or Wright stain, ; 1.5 to
2.7M deaths annually, 2.3B
are at risk of being infected,
falciparum and vivax are
responsible for 90% of
cases of human malaria ;
most important parasitic
disease affecting man,
considered to be one of the
three major infectious
disease threats along with
HIV and TB, it kills more
people than any other
communicable disease
except TB, kills 1.5-2.7M
people each year ; In the
Philippines, 65 out of 78
P. falciparum
11-14 days
I: oocyst D: Transmission: ingestion of uncooked 2 types: Macrocysts (seen by naked eye), causes Sarcosporidiosis or
oocyst ; I: cattle, or undercooked meat of an Microcysts (seen under the microscope), Sarcosystosis, infectivity is
pig D: Human & intermediate host ; penetrate intestinal epithelial tissue and spead prolonged during the cooler
other primates, hematogenously to various areas of the body, months of the year
dogs, cats Diagnosis: Western Blot, IFA, ELISA including the brain
Treatment: NO EFFECTIVE SSx include diarrhea, eosinophilic enteritis,
TREATMENT IS KNOWN, myalgia, weakness and mild increase of creatine
Corticosteroids for muscular kinase
inflammation, Co-Trimoxazole for
I: cyst D: cyst Transmission: fecal-oral route abdominal cramps, IBS, bloating, flatulence, inhabitant of the lower GIT of
(vacuolated diarrhea without fecal leukocytes or blood, humans and other animals ;
form) ; D: Diagnosis: direct fecal smear, nausea, vomiting, low grade fever, malaise reproduction is asexual by binary
human, dogs, hematoxylin, trichrome stain, Boeck fission or sporulation under strict
chicken, ostrich, and Drbohlay's media, Nelson and Blastocystis is hard to eradicate because it hides anaerobic conditions, optimal
macaques Jones media in the intestinal mucus, sticks and holds on to growth is at 37 celsius in the
intestinal membranes presence of bacteria does not grow
Treatment: DOC is metronidazole, on fungal medium ; the vacuolar
iodoquinol, if metronidazole-resistant, form is the main type that causes
I: trophozoites D: Trasmission: fecal-oral route, lives in the mucosal crypts of the cecum and flagellate with only the
trophozoites ; D: transmission of helminth eggs upper colon, does not invade tissues but trophozoite stage known ; no cyst
human, pigs particularly Enterobius vermicularis produces irritation of the mucosa with secretion stage has been identified ; is not
of excess mucus and hypermotility detected by stool concetration
Diagnosis: fecal smear methods, prompt fixation with
Infections are usually asymptomatic, if polyvinyl alcohol, Schaudinn's
Treatment: Iodoquinol, tetracycline, symptomatic: colicky abdominal pain, loss of fixative is helpful
metronidazole appetite, diarrhea with excess mucus,
abdominal tenderness, bloating and flatulence,
I: sporozoites Transmission: bite of a female Symptoms include paroxysms of fever with Asexual life cycle: human and other
from mosquito Anopheles mosquito asymptomatic intervals, weakness, desire to vertebrate
D: trophozoites ; stretch and yawn, aching bones and limbs, loss Sexual life cycle: mosquito
I: human D: Diagnosis: Giemsa or Wright stain of appetite, nausea, vomiting, chills ; Symptoms
mosquito remains to be the Gold Standard composed of cold stage (shivering, peripheral total duration of a typical attack is 8-
(obtain smears evry 6-8hrs) vasoconstriction) and hot stage (fever, 12hrs ; has GPI
- Thick smear +/- of organism headache, palpitations, tachypnea, epigastric (Glycosylphosphatidyl Inositol) act
- Thin smear: species identification discomfort, thirst, nausea vomiting) like endotoxin of gram-negative
bacteria Lipopolysaccharide, they
Quantitative Buffy Coat, Malaria rapid Cerebral malaria is manifested at symmetrical stimulate the monocytes to release
diagnostic tests such as Histidine-rich encephalopathy, retina hemorrhages , bruxism, TNF or cachexin which is implicated
Drug Plasmodium
protein, Prophylactic
LDH (can use neck stiffness; (+) Durck granuloma; and (+) as the cause of Malarial fever ;
distinguish between falciparum and pout reflex, the ff SSx happen to severe malaria: history of cough and convulsions
Chloroquine Areas
non-falciparum) ; P. falciparum
without resistantAcute renal failure, ARDS, hyperkalemia, are very common ; Chloroquine has
hyperuricemia the best safety profile among all
Malarone Areas with chloroquine-resistant P. falciparum antimalarials, it is commonly
Mefloquine Areas with chloroquine-resistant P. falciparum combined with
Sulfadoxine+Pyrimethamine to
Doxycycline Areas with multidrug-resistant P. falciparum reduce resistance, Tetracycline and
Doxycycline are effective but
Primaquine Terminal prophylaxis of P. vivax and P. ovale infections;
cannot be used alone because the
alternative for primary prevention kill parasites slowly ; Anopheles is
night biter, breeding in slow
flowing partly shaded streams ;
prevention include wearing of light-
colored clothing which cover most
of the body, use of insect repellants
P. vivax P. malariae P.ovale
11-15 days 3-4 weeks 14-26 days
 P. falciparum P. vivax P. malariae P.ovale may induce uterine contractions in
pregnant Px
Pre-patent period 11-14 days 11-15 days 3-4 weeks 14-26 days

Incubation period 8-15days 12-20 days 18-40 days 11-16 days

Asexual cycle 48hrs 48hrs 72hrs 48hrs

Periodicity Malignant tertian Benign tertian Benign quartan Benign tertian

RBC preference All ages Young RBC Old RBC Young RBC

Parasitemia Highest Low Lowest Low

Merozoites 0 12-24 6-12 8

Ring trophozoite Thin; 2 chromatin dots Thick; 1 chromatin dot Thicker than falciparum; Compact with little
1 chromatin dot vacuolation
Gametocytes Banana-shaped Large round Compact Small round

Peripheral blood Rings and crescents All forms All forms All forms
(gametocytes)
Cerebral Malaria Yes No No No

P. falciparum Recrudescence Yes No Yes No

pre-patent period: 11-15 days ; Incubation
Relapse No Yes No period: 12-20 days ; infect young
Yes RBC ; has
relapse
Drug resistance Many Few Few Few

Dots Maurer dots Schuffner dots Ziemann dots Schuffner dots

P. vivax
Clinical setting Drug Therapy Alternative drug
Chloroquine-sensitive uncomplicated P. Chloroquine
falciparum
P. vivax and P. ovale infections Chloroquine + Primaquine
Uncomplicated chloroquine-resistant P. Quinine+Doxycycline/Clindamycin Quinine + Sulfadoxine-Pyrimethamine or
falciparum Or Quinine + Tetracycline or Clindamycin OR
Sulfadoxine-Pyrimethamine Malarone (Atovaquone-Proguanil) OR
Mefloquine OR
Ca-artemether+Lumefantrine
Pregnancy Quinine
P. ovale Severe or complicated P. falciparum infections Artesunate+Doxycycline/Clindamycin or Artemether+Doxycycline/Clindamycin
Mefloquine/Malarone OR
OR Mefloquine/Malarone
Quinidine gluconate OR
Artemotil
MDR malaria Mefloquine, sulfadoxine-pyrimethamine, halofantrine,
artemisinin and family can be given

Mefloquine + Artesunate is the DOC for SE Asian

countries

P. malariae
8. Babesia cause malaria like infection most are asymptomatic
a. B. divergens cattle parasite
 Babesia parasites resemble
Plasmodium falciparum,
however Babesia has several
distinguishing features: the
parasites are pleomorphic (vary
in shape and size), can be
vacuolated, and do not produce
b. B. microti pigment.
9. Blood and Tissue Flagellates
A typical trypomastigote has a
large, subterminal or terminal
kinetoplast, a centrally located
nucleus, an undulating
membrane, and a flagellum
running along the undulating
membrane, leaving the body at
the anterior end.
Trypanosomes measure from
12 to 30 µm in length.
single or paired, amoeboid,
oval/spherical/bizaare-
shaped bodies ;
intraerythrocytic parasites
look "teardrop-shaped"
trophozoites in tetrads:
"Maltese Cross"
trypomastigotes are
characteristically C or U-
shaped ; 16-18M are
infected, chronic disease is
more common than acute
disease, highest incidence
occurs in the fifth decade of
life, Male>Female
I: sporozoite D: Transmission: bite from and infected
trophozoite ; I: black-legged tick, Ixodes scapularis
tick D:dogs, (also known to carry Borrelia
cattles, horses, burgdoferi), vertical transmission from
rats an infected mother to fetus, blood
transfusion
Diagnosis: Immunofluorescent assay
(IFA), PCR is the DxOC ;
I: metacyclic enters human host through scratched
trypomastigote skin or through mucous membranes
D: trypanosomes that are rubbed with fingers
; I: rodents and contaminated with the bug's feces
burrowing (Triatoma/Rhodnius/Panstrongylus
animals D: better known as reduviid, kissing or
humans assasin bug), may also enter through
the conjunctiva of the eye and cause
edema of the eyelids and conjunctiva
(Romaña's sign) ;
Diagnsis: Trypanosomes in blood, CSF,
fixed tissue or lymph via thick blood
smears (only in the first 2months),
blood culture, Xenodiagnosis,
Immunofluorescent antibody test,
complement fixation test, indirect
hemagglutination assay, ELISA, Dot-
immunobinding assay, PCR ;
The larval form of the tick attaches to the white-
footed mouse for a blood meal and picks up the
parasite from the host. After feeding, the larva
molts to an infective nymphal stage which
attaches to grass leaves and other vegetation,
waiting to bite a bigger vertebrate host (usually
deer or human). The infected nymph takes a
blood meal in the new vertebrate host then
emerges as an infective adult which will need
trypomastigotes are engulfed by macrophages
and multiply through binary fission as
amastigotes ; cells frequently invaded are the
reticuloendothelial cells of the spleen, liver,
cardiac, smooth and skeletal muscles ; at the
site of inoculation, a local inflammation is
produced which is called a Chagoma (small
painful reddish nodule), other SSx include fever,
generalized lymphadenopathy ; chronic
infection may manifest as cardiomyopathy,
megaesophagus, megacolon
Most human infection occur in
summer of spring (May to July)
because of abundance of grass and
bushes ; prevention include
wearing of light-colored pants,
avoidance of places where ticks are
found, use of insect repellants
Chaga's disease / American
Trypanosomiasis ; only exists in the
American continent ; exhibits all
four stages of development:
amastigote, promastigote,
epimastigote and trypomastigote ;
is a zoonosis transmitted from
rodents and burrowing animals

Treatment: NO ENTIRELY SUITABLE

a. Trypanosoma
cruzi
A typical trypomastigote has a
small kinetoplast located at the
posterior end, a centrally
located nucleus, an undulating
membrane, and a flagellum
running along the undulating
membrane, leaving the body at
the anterior end.
Trypomastigotes are the only
stage found in patients.
b. Trypanosomoa
Trypanosomes range in length
brucei gambiense
from 14 to 33 micrometer.
flattened and fusiform,
body tapes anteriorly and is
blunt posteriorly, pale blue
cytoplasm is granular and
may be vacuolated, red-
staining flagellum runs
along the edge of the
undulating membrane and
becomes free anteriorly ;
Affects over a third of
Africa, 20,000 new cases
are reported each year,
prominent in areas near
river banks and streams
DRUG - Nifurtimox and Benznidazole
are only partially effective in acute
disease
I: metacyclic Transmission: a bite of the vector
trypomastigote Glossina sp (tsetse fly) where the
D: trypanosomes parasite trypomastigote form develop
; I: rodents and into epimastigotes (in the salivary
burrowing gland), multiply and transform into
animals D: the infective stage, Congenital
humans transmission is possible
Diagnosis: Giemsa stain, buffy coat
concentration method, indirect
hemagglutination, ELISA,
Immunofluorescence
TreatmentPentamidine, Suramin (both
does not reach CSF), Melarsoprol or
Tryparsamide (if with CNS
involvement), Eflornithine has been
found to be effective in late stages of
Gambian Trypanosomiasis
In humans, the parasite live in the blood, in the West African Sleeping Sickness
reticular tissues of the lymph and spleen and the (West and Central Africa) which is
CSF, multiply by longitudinal binary fission, the chronic form
invade the CNS in chronic infection ; earliest SSx
is a chancre (local, hard, painful lesion at the site
of inoculation)
Acute stage: irregular fever, headache, joint and
muscle pains, dizziness, debility, rash, posterior
cervical lymphadenopathy with a consistency of
ripe plums (Winterbottom's sign)
CNS invasion: headcahes become more and
more severe with increasing mental dullness
and apathy, Tremors, hyperesthesia (Kerandel's
sign) and inversion of sleep cycle may be
observed
Trypanosomes are able to evade the immuse
response of the host through a process called
antigenic variation. This refers to the ability of
the Trypomastigote to change its surface coat,
 Affects over a third of
Africa, 20,000 new cases
are reported each year,
prominent in areas near
river banks and streams
c. Trypanosoma
brucei rhodesiense
Amastigotes of Leishmania are Promastigotes have a single I: Promastigotes transmitted via bite of sandfly
spherical to ovoid and measure free flagellum arising from D: Amastigotes ; (Phlebotomus spp), congenitally, by
1-5 µm long by 1-2 µm wide. the Kinetoplast at the D: humans
They possess a large nucleus, a anterior end ; 12M cases
prominent kinetoplast, and a are affected worldwide
short axoneme, the last of
which is rarely visible by light
microscopy.
d. Leishmania
tropica, L. braziliensis,
L. donovani
10. Microsporidia important parasites of fishes, birds, insects
coiled within the spore is a usual hosts: birds
unique structure called the esp. parrots
polar filament which
functions to insert in the
host cell the spore's
nucleus and cytoplam
(sporoplasm) in order to
initiate infection
a. Encephalitozoon
concentration method, indirect cervical lymphadenopathy with a consistency of
hemagglutination, ELISA, ripe plums (Winterbottom's sign)
Immunofluorescence
East African Sleeping Sickness (East
CNS invasion: headcahes become more and
and South Africa) which is the
TreatmentPentamidine, Suramin (both more severe with increasing mental dullness
acute form ; Rhodesian is more
does not reach CSF), Melarsoprol or and apathy, Tremors, hyperesthesia (Kerandel's
rapid and fatal than Gambian.
Tryparsamide (if with CNS sign) and inversion of sleep cycle may be
involvement), Eflornithine has been observed
found to be effective in late stages of
Gambian Trypanosomiasis Trypanosomes are able to evade the immuse
response of the host through a process called
antigenic variation. This refers to the ability of
the Trypomastigote to change its surface coat,
which is a variant surface glycoprotein, so that
the antobodies previously produced by the host
cannot act on it, resulting in recurrent waves of
Amastigotes live intracellularly in monocytes, L. tropica invade the lymphoid
PMNs or endothelial cells, multiply by binary tissue of the skin (cutaneous
blood transfusion, by contamination fission ; L. tropica is manifested as skin ulcer Leishmaniasis), L. donovani the
of bite wounds and by contact ; with elevated and indurated margins, painless visceral organs (Kala-Azar or
demonstration of Leishmania in tissue and do not result in lymphadenopathy, systemic Visceral Leishmaniasis) while L.
biopsies (skin for cutaneous SSx are absent , diffuse cutaneous Leishmaniasis braziliensis the skin and mucous
Leishmaniasis, bone marrow spleen or causes widespread thickening of the skin with membranes (Mucocutaneous
lymph nodes for Kala-Azar), aldehyde lesions resembling that of lepromatous leprosy ; Leishmaniasis) ; Post Kala-Azar
& complement-fixation tests, In mucocutaneous Leishmaniasis, lesions Dermal Leishmaniasis (PKDL) begin
immunofluorescent antibody test, resemble that of cutaneous Leishmaniasis , as small macule or hypopigmented
counter-current electrophoresis however, there is metastatic spread to the areas around the mouth which
technique ; Sodium stibogluconate, oronasal and pharyngeal mucosa (Espundia), spread to the face, arms and trunk ;
N-methyl-glucamine antimonite, 2nd which is highly-disfiguring (leprosy-like tissue Delayed Hypersensitivity reaction
line agents include amphotericin B, destruction and swelling - Tapir Nose), also with to Leishmania develop in the late
pentamidine, metronidazole and chiclero ulcer (erosion of the pinna) ; In visceral stages of the infection
nifurtimox (Pentamidine and Leishmaniasis, there is twice-daily fever,
Amphotericin B in resistant cases), splenomegaly, cachexia, hepatomegaly,
Miltefosine is the first line drug for lymphadenopathy and anemia. parasites are
Kala-azar in India numerous in the reticuloendothelial cells of the
spleen, liver, lymph nodes, bone marrow,
intestinal mucosa and other organs
Diagnosis: fecal samples or biopsy Microsporidia family is obligatory, intracellular, has three common species: E.
specimens under the light microscope, multiply via binary fission or multiple fission ; intestinalis formerly called Septata
hematoxylin stain, eosin stain, considered to be among the most primitive of intestinalis (causes chronic
Warthin-Starry stain, Giemsa stain, eukaryotic cells as they posses characteristics diarrhea, nephritis conjunctivitis,
Chromotope 2R (stains spore and similar to prokaryotic organisms - lack bronchitis, bronchiolitis,
spore wall), mitochondria, has 70s ribosomes, all have disseminated infection, biliary tract
resistant spores and multiply within the host cell infection, E. cuniculi (causes
Gold standard: Electron microscope ; keratoconjunctivitis, disseminated
infection, bronchiolitis, hepatitis,
Immunofluroescence is used to adrenalitis, peritonitis, UTI and
distinguish between species, PCR Respiratory infections) and E.
hellem (causes Interstitial nephritis,
Treatment: Albendazole and other keratoconjunctivitis, disseminated
Benzmidazole derivatives, 5-FU, and infection ; all species mostly affect
sparfloxacin immunocompromised px
 E. bineusi causes chronic diarrhea
(in immunocompromised px CD4
<50 cells/L), wasting syndrome,
b. Enterocytozoon gallbladder and biliary tract
c. Pleistophora infection
causes myositis
such as cholecystitis ; has
d. Nosema keratoconjunctivitis
e. Brachiola B. vesicularum causes myositis
V. cornea (formerly known as
Nosema corneum) causes
f. Vittaforma keratoconjunctivitis
T. hominis causes myositis
g. Trachipleistophora
causes keratoconjunctivitis, corneal
h. Microsporidium stroma infection

NEMATODE INFECTION
1. Intestinal Nematodes
Fertilized eggs: rounded and have a thick has polymyarian type of somatic I: fully embryonated Transmission is by ingestion of food or while When eggs are ingested, the larvae hatch in the lumen of the most common intestinal nematode of man,
shell with an external mammillated layer muscle arrangement, has a terminal eggs D: playing with soil contaminated with small intestines and the penetrate the intestinal wall. They "Giant round worm", Soil-transmitted
that is often stained brown by bile. mouth with 3 lips and sensory unembryonated or embryonated eggs ; enter the venules to go to the liver through the portal vein, on helminth (disease of poverty), reinfection is
papillae ; affects around 1Billion fertilized egg; D: to the heart then to pulmonary vessels where they break out of usually observed 4months post-treatment and
Decorticated eggs: absent outer layer. people, 70% of whom are from Asia, humans Diagnosis: Direct Fecal smear, Kato technique or capillaries to enter air sacs. In the lungs they undergo motling full reinfection appears at 6-7months after
at least 20,000 die annually, mostly cellophane thick smear method, Kato-Katz before migrating to the larynx and oropharynx o be swallowed treatment. This situation may be remedied by
Unfertilized eggs: elongated and larger young children, has a cosmopolitan technique into the GIT. Adult worms reside in but do not attach to the giving treatment at least 2x a year at an
than fertile eggs. Thinner shells and their distrubution mucosa of the small intestines interval of 4-6months among school children ;
mammillated layer is more variable, either Treatment: Albendazole is the DOC, Mebendazole, Loeffler's syndrome (hypersensitivity
with large protuberances or practically Pyrantel pamoate, Ivermectin May have allergic manifestations such as asthmatic attacks and pneumonitis, malabsorpton syndrome)
none. Contain mainly a mass of refractile edema of the lips, most frequent compaint is abdominal pain,
granules may be regurgitated and vomited or escape through the nostrils,
may enter the liver or gallbladder and be lodged in the appendix
Adults of Ascaris lumbricoides are large or pancreas, may cause intestinal obstruction
roundworms. Females measure 20-35 cm
long with a straightened tail; males are
smaller at 15-31 cm and tend to have a
curved tail. Adults of both sexes possess
three 'lips' at the anterior end of the
body.

a. Ascaris lumbricoides
Eggs:cannot be differentiated cylindrical, fusiform, grayish-white, I: filariform larva D: Transmission: Infection is by penetration through blood-sucking nematodes: attach to the mucosa of the small Itch is known as "ground itch" or "dew itch" ;
microscopically. the head is curved opposite to the eggs ; D: human exposed skin, for Ancylostoma, it can also be intestine and copulate; female worms deposit eggs which are patients may suffer from IDA due to
- thin-shelled, colorless curvature of the body, which is like a transmitted via oral route (eating raw vegetables then passed out with human feces continuous blood loss ; here in the Philippines,
hook at the anterior end contaminated with larvae or by ingestion of raw 97% of hookworm infection is Necator while
Infective, third-stage (L3), filariform larvae infected meat, transmammary transmission Eggs hatch in soil--> into a rhabtidiform larva which is then Ancylostoma would account for 1%. The
have a pointed tail and a striated sheath Ancylostoma is slightly larger than transformed into filariform larva, penetrates the skin, enter remaining 2% is composed of mixed infections
Necator, eggs have bluntly rounded Diagnosis: Direct Fecal Smear, Kato technique or venules and migrate to the heart and into the alveoli of the ; Ancylostoma ca also affect other species:
Adult hookworms reside in the small ends and a single thin transparent Kato-Katz, Concentration methods like ZnSO4 lungs, larva then ascends to the trachea where it is swallowed Ancylostoma braziliense (cat hookworm),
intestine of their hosts. hyaline shell centrifugal flotation and formalin-ether passing down to the small intestine ; penetration through the Ancylostoma caninum (dog hookworm)
- Males are bursate, with two spicules that concentration method, culture methods lie Harada- skin produces maculopapular lesions and localized erythema,
do not fuse at their distal ends. usually in tropical or subtropical Mori ; Itching is often severe, there may be pneumonitis, bronchitis,
- Females measure approximately 10-15 countries abdominal pain, steatorrhea, bloody diarrhea,
mm long. Treatment: Mebendazole, Albendazole (DOC)
- Adults of both sexes have a buccal
capsule containing sharp teeth.

b. Hookworms: Necator
americanus, Ancylostoma
duodenale
 Trichuris trichiura eggs are 50-55
micrometers by 20-25 micrometers. They
are barrel-shaped, thick-shelled and
possess a pair of polar “plugs” at each
end. ; Adult males of Trichuris trichiura
are 30-45 millimeters long, with a coiled
posterior end. Adult females are 35-50
millimeters with a straight posterior end.
Both sexes have a long, whip-like anterior
end.
have an attenuated anterior 3/5 I: embryonated eggs D:
traversed by a narrow esophagus unembryonated egg ;
resembling a string of beads, egg is D: human
lemon-shaped with plug-like
translucent polar prominences,
"barrel-shaped" eggs with bipolar
plugs ; occur in both temperate (20-
30%) and tropical countries (60-85%)
Fecal-Oral route ; Direct Fecal Smear, Kato thick
smear, Kato-Katz technique (for egg counting and
egg reduction rate), concentrations methods such
as acid-ether and formalin-ether ; Mebendazole
(DOC), Albendazole, Ivermectin +/- Albendazole
Inhabit the large intestines, deeply embedded in the cecum, the
infective eggs go to the small intestine and undergo four larval
stages to become adult worms ; cause petechial hemorrhages
which may predispose to amebic dysentery because ulcers
provide a site for E. histolytica invasion, there may be rectal
prolapse, severe diarrhea in heavy infection that may be blood-
streaked, abdominal pain, nausea, vomiting, anemia, weight loss
Whipworm, frequently observed to occur
together with Ascaris, distribution and
prevalence are co-extensive with that of A.
lumbricoides, unlike ascaris, there is NO heart-
lung-migration ; mass treatment may be
indicated if infection rates is higher than 50%,
periodic mass treatment may be necessary due
to reinfection

c. Trichuris trichiura
Eggs: measure 50-60 micrometer by 20-30 meromyarian, adult worms hasve I: egg D:adult worm or Transmission: route of infection is through the males are rarely seen because they usually die after copulation, Human Pinworm / Enterobiasis / Oxyuriasis
micrometer , are elongate-oval and cuticular alar expansions at the egg in perianal folds ; mouth, the respiratory system (inhalation of dust adult worms found in the lower ileum and cecum, gravid female ; characterized by perianal itching ; termed
slightly flattened on one side. ; anterior end and a prominent D: human containing Enterobius eggs) and through the anus worms migrate down the intestinal tract and exit through the familial diasease because it easily spreads
posterior esophageal bulb, eggs are (retroinfection when they go back to the large anus to deposit eggs on the perianal skin, after deposition, the within the family ; second dose may be may be
Adult males of Enterobius vermicularis asymmetrical with one side flattened intestines ; female dies ; mild catarrhal inflammation of the intestinal necessary due to high reinfection rates ; the
measure up to 2.5 mm long by 0.1-0.2 and the other side convex ; 208.8M mucosa, mechanical irritation and secondary bacterial invasion, only intestinal nematode that cannot be
mm wide; adult females measure 8-13 infected, female>male Diagnosis: adult worm or egg on microscopic intense itching, insomnia due to pruritus ; complications include controlled through sanitary disposal of human
mm long by 0.3-0.5 mm wide. examinations, may be seen in the feces or perianal appendicitis, vaginitis, endometritis, salpingitis and peritonitis ; feces because eggs are deposited in the
regions, Graham's scotch adhesive tape swab eggs can be collected from the fingertips and under the perianal region
Adult males have a blunt posterior end (greatest number of eggs seen) ; fingernails of schoolchildren, female worms migrate to the
with a single spicule; females possess a perianal area even during daytime but more migration occurs in
long pointed tail. In both sexes, there are Treatment: Pyrantel Pamoate (DOC), the evening hours
cephalic expansions. Albenadazole, Mebendazole, cure may be
considered only after seven perineal smears are
negative

d. Enterobius vermicularis
First-stage rhabditiform larvae (L1): short short buccal cavity has four indistinct I: filariform larva D: Transmission: penetration of skin ; free-living forms are found in the soil ; from the skin, it enters the only species naturally pathogenic to
buccal canal, a rhabditoid esophagus and lips Rhabtidiform larvae ; the circulation, pass through the lungs and migrate to the larynx humans, more of a fecally transmitted worm
a prominent genital primordium D: human Diagnosis: repeated concentration techniques such where they are subsequently swallowed ; greatest numbers are rather than soil-transmitted helminth ;
as Harada-Mori culture and Baermann funnel, found in the duodenal and jejunal regions ; autoinfection occurs disseminated infection occurs among patients
Infective, third-stage filariform larvae (L3): Beale's string test, duodenal aspiration, small when rhabditiform larva pass down the large intestine and with immunocompromised patients ; serology
notched tail and the esophagus to bowel biopsy, larvae in sputum or urine develop into filariform larva ; erythema and pruritic elevated may not be useful in filaria endemic areas since
intestine ratio is 1:1. hemorrhagic papules, lobar pneumonia with hemorrhage, there are cross-reactions between
Treatment: Albendazole (egg reduction rate cannot intractable painless intermittent diarrhea (Cochin China Strongyloides and filarial worm
be determined because eggs are not passed out in diarrhea)
the feces but are ovideposited in the intestine and
other tissue of the host)

e. Strongyloides stercoralis
 Eggs: have two inconspicuous polar
prominences and a striated shell.
Adult males are shorter than adult
females in length.
Females may contain embryonated or
unembryonated eggs in utero.
the esophagus has rows of secretory
cells called stichocytes and the entire
esophageal stucture is called a
stichosome
Eggs: peanut-shaped with striated
shells and flattened bipolar plugs
I: larvae D: adult worm Transmission: ingestion of uncooked small
or unembryonated egg freshwater/brackish water fish "Bagsit" ;
; I: migratory fish-
eating birds D: human Diagnosis: Direct Fecal Smear, stool concentrations
methods, duodenal aspiration
Treatment: Mebendazole, Albendazole (DOC)
because it can destroy larval stage more than
mebendazole, electrolyte replacement and high-
protein diet
characterized with abdominal pain, chronic diarrhea, gurgling
stomach (borborygmus), weight loss, anorexia, severe protein-
losing enteropathy, malabsorption of fats and sugars, decreased
excretion of xylose, Hypokalemia and high levels of IgE ;
flattened and denuded villi and dilated muscoal glands, lamina
propria is infiltrated with plama cells, lymphocytes,
macrophages and neutrophils
parasites do not invade intestinal tissue but
they are responsible for micro-ulcers in the
epithelium and the compressive degeneration
and mechanical compression of cells, the
ulcerative and degenerative lesions in the
intestinal mucosa may account for
malabsorption of fluid, protein and electrolytes

f. Capillaria philippinensis
2. Blood and Tissue Nematodes
The microfilaria of Wuchereria bancrofti
are sheathed. They have a gently curved
body, and a tail that is tapered to a point.
The nuclear column (the cells that
constitute the body of the microfilaria) is
loosely packed
Adults of Wuchereria bancrofti are long
and threadlike.
creamy, white, long, filiform in shape
, microfilariae appear as minute
snake-like organisms constanty
moving around the RBCs, when
stained, the central axis shows dark
staining nuclei which serves as an
important identifying feature ;
affects 120M worldwide, adult >
children, male > female
I: microfilariae D: Transmission: bite of mosquito (Aedes, Culex,
microfilariae; D: Anopheles sp. for Wuchereria ; Mansonia sp. for
human, cat is a Brugia ; all are night biters) infected with
reservoir host microfilariae ;
Diagnosis: wet smears, thick blood smears taken
between 8pm-4am (due to nocturnal periodicity),
DEC provocative test to allow blood smear
collection even in daytime, antigen detection
techniques (circulating filarial antigens) such as
simpel card test, PCR, UTZ may demonstrate live
worms in the lymphatics, contrast
lymphangiography, lymphscintigraphy using
radiolabeled albumin or dextran ;
worms are found tightly coiled in nodular dilatations in lymph
vessels and in sinuses of lymph glands (usually in the lower
extremities, inguinal lymph nodes, epididymis of the males,
labial glands of females), female worms produce microfilariae
which gain entrance to the blood where they are picked up by a
mosquito during a blood meal ; selectively induce CD4+
lymphocyte apoptosis, which may contribute to immune
unresponsiveness to filariasis ; SSx include fever, lymphadenitis,
funiculitis, swelling of arms and legs, edema ; there is also a
chronic proliferative overgrowth of fibrous tissue around the
dead worms, ADL / adenolymphangitis or DLA /
dermatolymphangioadenitis (sensitization to the products of
living or dead worms)
lymphatic filariasis is one of the most
debilitating diseases (lymphedema,
elephantiasis or hydrocoele) plaguing most of
the tropical countries today, causes "Tropical
pulmonary eosinophilia" (characterized with
paroxysmal nocturnal cough,
hyoereosinophilia, high IgE titers, elevated
ESR) , may also present as "Expatriate
Syndrome" which is hyperresponsiveness to
the mature or maturing worms ; affected
extremities should be elevated at night and
exercised regularly, and washed twice daily to
prevent secondary infection

Treatment: Diethylcarbamazine (DOC),

Ivermectin, DEC +/- Ivermectin or Albendazole, for
acute attacks, the initial step is to relieve the pain
(clean cloth soaked in cools water, elevate and rest
legs), surgical drainage of hydrocoele
a. Wuchereria bancrofti,
Brugia malayi
third stage (L3), infective larva: terminal pale and filiform, well-developed I: third larval stage D: transmitted via ingestion (eating mollusks, leafy causes eosinic meningoencephalitis in man ; adult worms live in rat lungworm ; infection is self-limiting ;
projection on the tip of the tail which is caudal bursa which is kidney-shaped larvae ; I: slugs and vegetables contaminated with mucus secretion of two main branches of the pulmonary arteries of the rat, lay eggs Charcot-Leyden crystals have been found in
characteristic of A. cantonensis. and single-lobed, uterine tubules of snails D: human the mollusk, freshwater crabs or prawns, in the smaller vessels of the lungs, hatch larvae and then enter the meninges ; snail species include the ff:
female worms wound spirally around contaminated water) or active penetration, when the respiratory tract and migrate up to the trachea where they Achatina fulica (giant African snail), Hemiplecta
the intestine "Barber's pole" pattern rats or humans ingest infected mollusks ; are swallowed and eventually expelled in the feces of the rat ; sagittifera, Helicostyla macrostoma, Vaginilus
larvae pass through the stomach into the intestine and then plebeius, Veronicella altae ; anthelmintics not
Diagnosed by CSF eosinophilia of greater than 10%, enter the circulatory system and migrate to the brain or spinal usually neccessary because infection is self-
CSF protein mildly elevated but CSF glucose is cord, they may also migrate to the eye ; SSx include severe limiting and killing worms in the brain can
normal, CT Scan (to exclude neurocysticercosis) ; intermittent occipital or bitemporal headaches, stiffness of the cause greater inflammatory reaction ; A.
neck, weakness of the extremities, abdominal pain, facial cantonensis infections are predominantly
NO ANTHELMINTIC TREATMENT IS paralysis, low-grade fever ; may cause intraocular hemorrhage, cerebral, being one of the most common
RECOMMENDED AT PRESENT but Mebendazole, retinal detachment causes of eosinophilic meningitis, although
Albendazole, Thiabendazole and Ivermectin were developing but immature adult worms can on
successful in animal studies, analgesics for pain, occasion migrate to the lungs. No A.
removal of 10ml CSF at frequent intervals to cantonensis eggs or larvae have been
relieve headache, Prednisone 30mg daily, surgical recognized in human tissues.
removal of the worm when it is lodged in the
b. Angiostrongylus anterior chamber of the eye
cantonensis
 larvae can be found encapsulated in
muscle tissue. Diagnosis is usually made
serologically or based on observation of
the larvae in muscle tissue following
biopsies or autopsies.
c. Trichinella spiralis
whitish in color ; occurs wherever
meat is a part of the diet
I: larvae D: larvae ; I: & Transmission: ingestion of undercooked meat ; infective larvae are usually encysted in the muscle fibers of the full recovery is expected since trichinosis is a
D: human, rats, dogs, host ; larvae upon ingestion excyst in the stomach or small self-limiting disease ; is primarily a zoonosis,
cats, pigs, bears, foxes, Diagnosis: larva in muscle biopsy (usually in intestine, then they burrow into the subepithelium of the villi human is the dead end infection for the
other acarnivores and pectoral, gluteus, deltoid, biceps and where they mature, adult worms mate and after fertilization, parasite, usually maintained in a pig-to-pig or
omnivores gastrocnemius) , elevated creatine phosphokinase, will produce eggs that grow into larvae, larvae penetrate the pig-to-rat-to-pig cycle ; meat should be cooked
lactate dehydrogenase and myokinase levels, mucosa through the lymphatics into the circulation and finally at 77C temperature, or frozen to -15C to -30C
blood eosinophilia, antibody titers, Bentonite into striated muscles ; SSx include diarrhea/constipation, to kill the larvae, smoking, salting or drying
flocculation test (BFT), Latex flocculation test (LFT), vomiting, abdominal cramps, malaise, high remittent fever ; may meat is not effective
IFAT, ELISA, Beck's xenodiagnosis ; cause splenomegaly, pericardial effusion, CHF, meningitis and
cerebral lesions
Treatment: SUPPORTIVE TREATMENT (analgesics,
antipyretics, bed rest), prednisone for severe
cases, Thiabendazole during the 1st week of
infection expels adult worm (but no effect on
larvae), Mebendazole is larvicidal

CESTODE INFECTION
1. Intestinal Cestodes
Eggs: radially striated, internal oncosphere mature proglottids are square in
has six refractile hooks;
The scolex of T. saginata has four large
suckers but lacks the rostellum and
rostellar hooks.
The scolex of T. asiatica possesses
rudimentary hooklets in a wart-like
formation. ;
Adults can reach a length of 2-8 meters,
but the scolex is only 1-2 millimeters in
diameter.
shape and contain mature male and (larvae) D: eggs in the
female reproductive organs ;
Cysticercus is ovoid and milky white
I: Cysticercus bovis
stool ; D: human
Transmission: ingestion of encysted larva from raw inhabits the upper jejunum, gravid proglottids undergo apolysis Beef tapeworm, cosmopolitan in distribution,
or improperly cooked beef ; and are either passed out with the feces or actively crawl out of adult worm seems to be irritated by alcohol
the bowel to the external environment, eggs are released and and passage of proglottids sometimes happen
Diagnosis: proglottids / eggs in feces, India Ink, remain viable in the soil for weeks, when cattles ingest Taenia after a drinking bout
formalin-ether technique, perianal swab ; eggs, the oncosphere is released, oncosphere actively
penetrates the intestinal mucosa and enter venule to get to
Treatment: Praziquantel (DOC) , criteria for cure: systmeic circulation, it then enters a muscle fiber and develops
recovery of scolex or a (-) stool exam 3months into Cysticercus bovis ; most common CC is passage of
after treatment proglottids or segments in the stool, SSx include weight loss,
epigastric pain, pruritus ani, loss of appetite , proglottids are
actively motile and they may cause obstruction in the bile,
pancreatic ducts and appendix

a. Taenia saginata
The scolex of T. solium contains four large
suckers and a rostellum containing two
rows of large and small hooks. There are
usually 13 hooks of each size. ;
Gravid proglottids are longer than wide
and the two species, T. solium and T.
saginata, differ in the number of primary
lateral uterine branches: T. solium
contains 7-13 lateral branches and T.
saginata 12-30 lateral branches.
Proglottids of T. asiatica are similar to T.
saginata and possess more than 12
primary uterine branches.
shorter than, has less proglottids
than and has smaller and more
spherical acetabula than T. saginata,
has 4 acetabula , scolex carries a
cushin-like rostellum with a double
crown and large & small hooks which
are absent in T. saginata , eggs are
indistinguishable from T. saginata ,
mature cysticercus has scolex with 4
suckers and a circlet of hooks,
I: Cysticercus bovis Transmission: ngestion of improperly cooked eggs are ingested by hogs and oncospheres are released, Pork tapeworm, cosmopolitan in distribution,
(larvae) D: eggs in the infected meat, the larva is ingested and the scolex inhabits upper small intestines, proglottids are less active than infected meat is called "measly pork" ; Taenia
stool ; I & D: human, attached to the intestinal mucosa ; T saginata , the oncosphere penetrates the intestinal mucosa to eggs are very resistant ; autoinfection is
pig, cattle, goat, wild typically encyst in muscles as Cysticercus cellulosae , commonly common ; neurocysticercosis is one of the
boar & moonkeys,is Diagnosis: identifying proglottids eggs or scolex in infected are the muscles, tongue, heart, diaphragm, liver, most serious zoonotic diseases worldwide ; In
intermediate host the feces, CT scan, ophthalmoscopy, ELISA, Electro- spleen, mesentery ; SSx include non-specific abdominal pain but the Philippines, T. saginata is more common
immuno transfer blot, western blot for antibodies, obstruction is not likely (because proglottids are not that active) than T. solium ; freezing at -20oC for 10days
DOT ELISA ; ; Cysticerci are multiple and can develop in any organ or tissue, kills the cysticercus
usually in the striated muscles , brain, eye heart, lungs and
Treatment: Praziquantel (DOC), Niclosamide, peritoneum, cysts may survive up to 5yrs, most serious
Albendazole, Predinosolone, mannitol (for manifestation is neurocysticercosis (focal neurologic deficits,
increaed intracranial pressure due to "tumor") , generalized seizures, obstructive hydrocephalus, nausea,
surgical removal vomiting) , (+) increased opening pressure, elevated protein,
decreased glucose and increase in mononuclear cells ;
ophthalmic SSx include intraorbital pain, photopsia, loss of
vision, may float freely in the vitreous and aqueos humor

b. Taenia solium
Eggs: oval and smaller than those of H.
diminuta,
- Inner membrane have two poles, from
which 4-8 polar filaments spread out
between the two membranes.
-The oncosphere has six hooks.
the oncosphere has a thin outer
membrane and a thic inner
membrane with conspicuous bipoar
thickenings, from each of which arise
4-8 hair-like polar filaments
embedded in the inner membrane ;
about 20M is infected
I: Cysticercoid larvae direct or indirect tranmission ; wet smears,
D: eggs in the stool ; I : concentration methods, proglottids are not
rice and flour beetles, recovered because they undergo degeneration
D: human prior to passage with stools ;
TreatmentPraziquantel (dose is higher because
cysticercoids are more resistant)
has a dual pathway, direct (host ingests eggs which hatch in the
duodenum) and indirect development (accidental ingestion of
infected arthopod intermediate hosts like the rice and flour
beetles) ; light worm burden is usually asymptomatic , SSx
include headcahe, dizziness, anorexia, pruritus of nose and and
anus, diarrhea, abdominal pain, pallor , heavy infections may
cause enteritis due to necrosis and desquamation of the
intestinal epitheliam cells , in time, immunity may limit or
eventually clear the H. nana population spontaneously
dwarf tapeworm, the only human tapeworm
which can complete its entire life cycle in a
single host (no need for an obligatory
intermediate host) ; a familial and institutional
infection common in orphanages, day care
centers and mental institutions

c. Hymenolepsis nana
 These eggs are round or slightly oval, size eggs are bile-stained, NO BIPOLAR I: Cysticercoid larvae accidental ingestion of grain beetles infesting dried eggs when ingested by a wide range of adult and larval insects rat tapeworm, cosmopolitan in distribution ; in
70 - 85 µm X 60 - 80 µm, with a striated FILAMENTS, with hooklets with fan- D: eggs in the stool ; I : grians, dried fruits flour and cereals ; wet smear ; like fleas, beetles, cockroaches, mealworms and earwigs the Philippines, prevalence is only about 8%
outer membrane and a thin inner like arrangement insects, D: human Praziquantel develop into cysticercoid larvae
membrane. The space between the
membranes is smooth or faintly granular.
The oncosphere has six hooks. There are
no polar filaments extending into the
space between the oncosphere and the
outer shell. ; Proglottids of Hymenolepis
spp. Proglottids of Hymenolepis spp. are
craspedote; i.e. they overlap.

d. Hymenolepsis diminuta
Dipylidium caninum eggs are round to pale reddish adult worm with I: Cysticercoid D: Transmission: ingestion of infected insects ; larval fleas ingest the ova as they feed on epidermal debris ; common intestinal parasite of dogs and cats ;
oval and contain an oncosphere that has 6 proglottids are narrow with two sets proglottids in the stool when the insect is ingested by mammalian host (dog, cat, stool examination for the presence of egg
hooklets. of male and female reproductie ; I : flea D: dog & cats Diagnosis: wet smear of stool ; human), the cystocercoid is liberated and becomes an adult ; capsules is not recommended since the gravid
organs and bilatera genital pores very minimal SSx (slight intestinal discomfort, epigastric pain, proglottids do not disintegrate in the intestines
Proglottids: contains egg packets that are "Double-pored worm", egg is Treatment: Praziquantel diarrhea, anal pruritus and allergic reactions) but in the environment ; 5.19-36% of dogs in
round to ovoid and contain 5 to 15 or spherical, thin-shaped with a Manila is infected but the dissection of fleas
more eggs each. hexacanth embryo ; human infection only showed 2.4% prevalence ; intermediate
is rare hosts: Ctenocephalides canis (dog flea),
scolex: conical-shaped and has four Ctenophalides felis (cat flea), Pulex irritans
suckers. Retractable rostellum armed with (human flea), Trichodectes canis (dog louse)
several rings of small spines, used for
anchoring into the host's tissue.

e. Dipylidium caninum
for self study
f. Raillietina garrisoni
Diphyllobothrium spp. eggs are oval or
ellipsoidal and range in size from 55 to 75
µm by 40 to 50 µm. There is an
operculum at one end that can be
inconspicuous, and at the opposite
(abopercular) end is a small knob that can
be barely discernible ; Close-up of a few of
the proglottids showing the rosette-
shaped uterus at the center of each
proglottid.
segments are motile, white, appears I: Cysticercoid larvae accidental ingestion of flour beetles ; wet smear of cysticeroid larva attaches to the intestinal villi to develop into a common tapeworm of rats ; a common
like grain of rice ; D: ova or proglottids in stool ; sometimes, the worm may be expelled by adults ; Direct infection does not occur if eggs are ingested by intestinal cestode of rodents in the Philippines
the stool ; I : Tribolium child sponatenously without treatment ; the mammalian host, therefore these is no autoinfection in H.
confusum (flour Praziquantel may be given to expel the worm diminuta infection ; Px are usually asymptomatic
beetle), D: human
has two sucking grooves or bothria I: procercoid larvae D: ingestion of fish infected with plerocercoid larvae The ova complete their development in water and release the one of the 13 species that infect human; "Fish
located dorsally and ventrally ; Ova eggs in the stool ; I : by man, dog, cat or other mammals ; direct fecal free-swimming coracidium, a ciliated embryo, which is ingested tapeworm" or the "Broad tapeworm" ;
are yellowish-brown with an fish (perch, trout, smears suffice, Kato technique for demonstrating by freshwater copepods, the copepod is in turn ingested by fish, compete with VitB12 in the diet which may
inconspicuous operculum, opposite salmon, pike) D: eggs ; Praziquantel (DOC) the procercoid larva migrates through fish tissue and develop lead to megaloblastic anemia (vitamiin B12
the operculum is a small knob-like human into a plerocercoid larva or "sparaganum" in themuscle and content is approximately 50times that of T.
thickening viscera ; Infected Px may show no signs of disease, SSx include saginata ; although other mammalian host exist
nervous disturbances, digestive disorders, abdominal as reservoir hosts, human is responsible for the
discomfort, weight loss, weakness, anemia propagation of the infection in endemic areas

g. Diphyllobothrium latum
2. Extraintestinal Cestodes
 Eggs: radially-striated. The internal
oncosphere contains 6 refractile hooks
Higher magnification of the cyst showing
daughter cyst (brood capsule). Note the
hooklets (purple arrow) inside one of the
protoscoleces and the calcareous
corpuscles (light blue arrows) along the
germinal layer.
a. Echinococcus sp - E.
granulosus, E. multilocularis
for self study
b. Sparganosis - Spirometra
mansoni, S. erinacei, S.
ranarum
TREMATODE INFECTION
1. Blood Flukes
Schistosoma japonicum:
- eggs: large and more rounded
- spine: smaller and less conspicuous
Schistosoma mansoni:
- eggs:characteristic shape, with a
prominent lateral spine near the posterior sucker and a gonophore (suckers aid
end. The anterior end is tapered and
slightly curved
Schistosoma haematobium:
- large and bear a conspicuous terminal
spine.
a. Schistosoma japonicum ,
S. Mansoni, S. haematobium
adut worm posseses a pyriform
scolex, short neck and three
proglottids, For E. multilocularis,
foxes are the natural definitive host
and small rodenst are the
intermediate hosts, humans may be
infected by eating raw plants
contaminated with feces of infected
dogs or rats
larvae are opaque, glistening white
eggs can be ovoidal, rounded or pear- I: cercariae D: eggs in
shaped, are pale yellow with a
curved hook or spine near one of the Oncomelania snails,
polar ends ; unlike other trematodes, man D: dog, pig, cat,
schistosomes have separate sexes,
with large sucker anteriorly, a ventral rodents, monkey
in movement and help flukes
maintain their position inside the
veins ; has incomplete digestive
system ad excretory system made up
of flame cells ; In the Philippines, the
total exposed population is
approximately 6.8M, highest
prevalence is among 5-15y.o., mean
prevalence is 4.4%
I: egg D: eggs in the accidental ingestion of eggs, eggs may come from
stool, hydatid cyst ; I : soil or fur of dogs ; UTZ and history is highly
goat, horse camel, suggestive, serologic tests such as indirect
sheep, man D: dog hemagglutination (IHA), indirect fluorescent assay
(IFA), enzyme immunoassay (EIA), Echinococcus
antigens, ELISA ; surgical resection is still the Tx
of choice for echinococcosis, instilling scolicidal
agent such as hibitane, 95% ethanol or 30%
hypertonic saline solution, endoscopic
sphincteretomy is Tx of choice for hydatid cysts
that have ruptured into the biliary tract and causes
obstructive jaundice ; For inoperable cases and
post surgery, Albendazole, PAIR technique
(Puncture, Aspirate, Injection, Reaspiration),
Cyclosporin A
I: Plerocercoid larvae drinking water containing Cyclops or copepods
D: eggs in the stool ; I : infected with procercoid larvae, eating infected
frogs, toads, snakes, D: intermediate hosts such as frogs, toads or snakes
dogs, cats and other containing plerocercoid larvae, applying
carnivores plerocercoid infected flesh of frogs and snakes as
poultices in sores of the eyes, vagina or skin
leading to penetration of cutaneous tissue,
consumption of infected flesh of paratenic hosts
like wild pigs ; Dx is by finding white larvae in the
lesion ; Tx of choice is surgica removal of
plerocercoid
Transmission: skin penetration by free-swimming
the stool ; I : cercariae ;
Diagnosis: rectal or liver biopsy, Merthiolate-iodine- lumen and subsequently exported with feces, once
carabaos, cows, formalin concentration technique, Kato-Katz
technique, ELISA, intradermal test for immediate
hypersensitivity using worm extracts, indirect
hemagglutination using worm antigens, circumoval and develop into sporocysts which will later develop into
precipitin test (COPT) - method of choice in the
Philippines ;
Treatment: Praziquantel
adult worms inhabit the small intestines of dogs, eggs are E. granulosus (unilocular cystic echinococcus),
swallowed by intermediate host and hatch in the duodenum, E. multilocularis (alveolar echinococcus) , E,
oncosphere penetrate the intestinal wall and migrate into multilocularis is less common ; Hydatid sand
mesenteric venules which lead them to lodge in various organs refers to protoscolices and brood capsules in
and tissues, the larval stage is called Hydatid cyst, once inside the cyst ;
the definitive host the protoscolices evaginate, attach to the
intestinal wall and develop into adults which reside in the small
intestines of the host (where they release eggs) ; organs most
commonly involved are the liver, lungs, brain and orbit ; causes
down regulation of the inflammatory cytokine leading to local
immunosuppression ; hepatic cyst are mostly found in the
Inferior right lobe and may cause obstructive jaundice, cyst may
rupture from coughing, muscle strain etc and may metastasize
and reach other tissues to develop into secondary cysts ; SSx
include intermittent jaundice, fever, eosinophilia, inc ICP and
Jacksonian epilepsy, hematuria, kidney dysfunction ; may lead
to pyogenic abscess formation, intrabiliary rupture of the cyst is
the most common complication
most are found in the eyes, subcutaneous and muscular tissues Infection is prevented by drinking boiled or
of the thorax, abdomen, thigh, inguinal region and in the viscera filtered water and by cooking meat thoroughly
; SSx may be painful edema due to migrating larvae
adult worms are primarily parasites of the portal vein and its Oriental lung fluke, endemic in China,
branches, Eggs deposited in mucosal or sub-mucosal terminal Philippines and Indonesia, has a wide range of
veins or capillaries escape through ulcerations into the intestinal definitive host ; there is evidence that
schistosomule escape from the lungs into the
embryonated, egg comes in contact with freshwater, hatches pleural cavity and pass through the diaphragm
and liberates a free-swimming ciliated larva called a miracidium, into the liver to reach the portal vein ;
the miracidium infect the snail Oncomelania hupensis quadrasi cercariea are most abundant in the field during
the early part of the night ; organs usually
cercariae, the cercariae leave the snail host and become free- affected are the liver, lungs and intestines ;
swimming in the water, cercariae are transformed into eggs are not demonstrable in the feces
schistosomula after skin penetration and find entry into
superficial lymphatic vessels or subcutaneous veins to reach the
lungs, from the lungs the schistosomule migrates intravascularly
to reach the portal vein where they mature ; worms ingest RBCs
and possess a protease (hemoglobinase) that breaks down
globulin and hemoglobin ; SSx include dermatitis, superficial
lung petechiae, fulminating meningoencephalitis with fever,
headache, coma, confusion ; may cause pneumonitis,
hepatosplenic disease, cor pulmonale
 Paragonimus westermani eggs range from
80-120 µm long by 45-70 µm wide. They
are yellow-brown, ovoid or elongate, with
a thick shell, and often asymmetrical with
one end slightly flattened. At the large
end, the operculum is clearly visible. The
opposite (abopercular) end is thickened. ;
Adults of Paragonimus spp. are large,
robust, ovoid flukes. They are
hermaphroditic, with a lobed ovary
located anterior to two branching testes.
Like all members of the Trematoda, they
possess oral and ventral suckers.
b. Paragonimus westermani
2. Intestinal Flukes
Eggs: broadly ellipsoidal, operculated,
unembryonated when passed in feces.
Fasciola hepatica: abopercular end has a
roughened or irregular area.
a. Fascilopsis buski
for self study
b. Echinostoma ilocanum,
Artyfechinostomum
malayanum
Adults of Heterophyes heterophyes are
minute flukes, measuring 1-2 mm in
length. The tests are large and paired, and
are situated near a small ovary. The
surface of the worm is covered with
minute spines.
c. Heterophyid flukes -
Heterophyes heterophyes
2. Liver Flukes
Other species include P.
philippinensis and P. siamensis ;
reddish brown worm which
resembles a coffee bean ; egg is oval,
yellowish-brown, thick-shelled ; adult
worms are found in pairs or in threes
in fibrotic capsules or cysts in the
lungs of the host ; 20.7M are
infected,
endemic in countries in SE asia,
China, Korea and India
E. ilocanum worm is reddish-gray
while its egg is straw-colored, A.
malayanum egg is larger and is
golden brown in color
egg is light-brown in color ;
worldwide distribution may be due
to the fact that heterophyids have
adapted to snails belonging to
various families and are not specific
to their secondary intermediate host
I: metacercariae D: ingestion or raw or insufficiently cooked crabs with SSx include cough, hemoptysis consistent with PTB,
unembryonated eggs metacercariae ; Solitary nodular lesions may mimic bloodstained or rust-colored sputum with foul fish odor, low-
in the sputum or stool; CA and fungal diseases on CXR, (+) ring-shadowed grade fever, fatigue, myalgia ; they escape into the respiratory
I : 1st- snail, 2nd- crab opacity comprising several contiguous cavities that tract where they are moved out by the ciliary epithelium and
D: human give the appearance of a bunch of grapes, move along with exudates, they are either coughed out or
intradermal test with antigen (does not swallowed into the alimentary canal to be passed out with feces
differentiate between present and past infections), ; traverses the intestinal wall into the peritoneal cavity, migrates
serology such as complement fixation, enzyme through the diaphragm to the lungs where it matures, provoke a
immunoassay (EIA), immunoblot (IB) ; granulomatous reaction that gradually proceeds to the
Praziquantel, corticosteroids in Px with cerebral development of fibrotic encapsulation ; cerebral involvement is
involvement, Bithionol, Triclabendazole the most serious complication (Jacksonian epilepsy, cerebral
hemorrhage, meningitis)
I: metacercarie D: eggs Transmission: ingestion of encysted metacercaria adult worm lives in the duodenum attached to the intestinal
in the stool ; I : 1st- on aquatic plants or when the hull or skin of fruits mucosa by its suckers, eggs are released together with feces
snail 2nd-aquatic of these plants is peeled off between the teeth ; into the water, it embryonates in water, gives rise to a
plants D: pigs and miracidium ; inside the snail, the miracidium transforms into a
human Diagnosis: fecal smear sporocyst, which subsequently produces rediae and then to a
cercarie, cercariae emerge from the snails into water the
Treatment: Praziquantel attaches and encyst a metacercarie on the surfaces of seed
pods, bulbs, stems or roots of various aquatic plants ;
inflammation and ulceration occur at the site worm attachment
leading to increased mucus secretion, bleeding, gland abscesses
and intestinal obstruction ; SSx include generalized toxic and
allergic symptoms
I: metacercariae D: ingestion of metacercariae encysted snails ; fecal adult worm lives in the small intestines of the definitive host ;
eggs in the stool ; I : smear ; Praziquantel ; the rat is an important immature eggs are released by the parasite and transported to
1st- 2nd-snails D: dog, reservoir host for echinostomes the environment through the feces, the eggs mature in water
human, rat, cat, pig and a miracidium hatches from the egg to infect the 1st snail
intermediate host,it then develops into a rediae and then into a
cercariae, after escaping the snails, the cercariae swims in water
to infect the second snail intermediate and transforms into a
metacercariae ; causes ulceration and consequently diarrhea
(sometimes bloody) and abdominal pain
I: metacercariea D: Ingestion of metacercariae encysted in fish ; Kato- eggs are produced and passed out into the environment
eggs in the stool ; I : katz technique, Praziquantel together with feces, miracidium hatches when the egg is
1st-snail, 2nd-fish D: ingested by the first snail intermediate host and transforms into
human a sporocyst which the develops into cercariae, cercariae encyst
as metacercariae on or under the scales, fins, tails, or gills of the
fish ; there is inflammation at the site where the worm is
attached or burrowed in the mucosa, excessive mucus
production and sloughing off of the superficial layers may occur,
PUD or APD (upper abdominal discomfort, gurgling abdomen,
colicky abdominal pain, mucoid diarrhea)
lung fluke disease, pulmonary distiomiasis,
endemic hemoptysis or parasitic hemoptysis,
"oriental lung fluke" ; first intermediate snail
(Antemelania asperata, A. dactylus formerly
known as Brotia asperata), second
intermediate host is the mountain crab
(Sundathelphusa philippina formerly known as
Parathelphusa grapsoides) ; worms may persist
for up to 20yrs ; is a zoonotic disease of
carnivorous animals
first intermediate host is the snail belonging to
the genus Segmentina or Hippeutis, second
intermediate host such as Trapa bicornis
(water caltrop), Eliocharis tuberosa (water
chestnut), Ipomea obscura (water morning
glory) and Nymphaea lotus (lotus)
Intermediate hosts for E. ilocanum: first
intermediate host is the snail (Gyraulus
convexiusculus, Hippeutis umbilicalis), second
intermediate host (Pila luzonica or kuhol and
Vivipara angularis or susong pampang) ;
Intermediate hosts for A. malayanum: first
intermediate is unknown while second snail
host is Lymnaea cumingiana or birabid
snail intermediate host of H. taichui and
Procerovum calderoni are the brackish water
snails, Melania juncea and Thiara riquetti,
second intermediate host atre fishes (30
different species)
 Eggs: broadly ellipsoidal, operculated, Fasciola worm has a characteristic I: metacercariae D: Transmission: ingestion of metacercariae encysted the fluke penetrates the intestinal wall to reach the peritoneal F. hepatica is the temparate liver fluke or
unembryonated when passed in feces cephalic cone which has a marked eggs in the stool ; I : in edible aquatic plants or by drinking water with cavity where it wanders until it reaches the liver capsule, the sheep liver fluke while F. gigantica is the
widening at the base of the cone 1st-snail 2nd- aquatic floating metacercarie ; parasite then burrows through the liver parenchyma, and enters tropical liver fluke ; In tropical countries,
Adult: anterior end is cone-shaped, unlike ("shoulder"), F. giganitica is longer plants D: sheep, the bile ducts where it becomes sexually mature, inside the fascioliasis is considered the ost important
the rounded anterior end of Fasciolopsis and its shoulders less developed F. human Diagnosis: fecal smear or demonstration of eggs in snail, the miracidium develops into a sporocyst to produce a helminth infection of cattle with reported
buski. gigantica egg is also bigger affects different samples such as duodenal contents and cercariea, it the escapes the snail and swims freely in water to prevalence of 30-90% ; lives for 9-13years ; first
2.4M individuals bile, PCR-restriction fragment length encyst in surfaces of the aquatic plants forming a metacercariae intermediate host: snail (from the Lymnaedia
polymorphism (RFLP) assay ; ; can be asymptomatic, SSx include RUQ pain, sundden high family such as Lymnaea philippinensis, L.
fever, hepatomegaly ; the acute phase corresponds to the auricularia rubiginosa), second intermediate
Treatment: Bithionol, Triclabendazole migration of the juvenile parasite from intestine to the liver host: aquatic plants (Ipomea obsucra or
while the chronic phase is asymptomatic and corresponds to the kangkong and Nasturtium officinale or water
period when the parasite has already reached the biled ducts, cress
can cause obstruction leading to inflammation and
subsequently fibrosis ; complications include atrophy of the
liver, periductal cirrhosis, abscess formation, hemobilia etc

a. Fasciola hepatica ;
Fasciola gigantica
Clonorchis sinensis eggs:
- small, oval shaped with a convex
operculum, that rests on visible
"shoulders" at the smaller end of the egg.
At the opposite (larger, abopercular) end,
a small knob or hooklike protrusion is
often visible.
- miracidium is visible inside the egg. ;
Clonorchi sinensis adults:
- flattened, hermaphroditic, with a single
ovary situated anterior to two branches
testes. ;
adult worms are leaf-like in shape
with transparent tegument ; affects
30M people, male > female, adults
more tha children
I: metacercariae D: ingestion of metacercarie in infected undercooked
eggs in the stool ; I : or raw fish and in salted dried or pickled fresh
1st- snail, 2nd-fish D: water fish ; fecal smear, Potassium permanganate
dog, cat, pig smear (will show distinct melon-like ridges in the
surface of O. viverrini eggs), Phosphoglycerate
kinase (PGK), ELISA, Enzyme immunoassay (EIA),
determination of IgM antibodies, PCR ;
Praziquantel, Albendazole
metacercariae excysts in the duodenum and moves through the
ampulla of vater to the common bile duct and then to distal
biliary capillaries where it matures into adult worms, egg
escapes into the environment via the feces ; upon enrty into the
snail host, miracidium transform into a sporocyst which then
produces cercariae which is released in water to infect
freshwater fishes ; causes wall of the ducts to become thickened
and dilate 2-3x its normal diameter, causes periductal fibrosis,
cirrhosis and portal hypertension, SSx include chills, fever
enlargement with tenderness of the liver
First intermediate host is the snail of C.
sinensis belong to the genera Parafossarulus
(P. manchouricus, P. anomaliospiralis, P.
stratulus), Bulimus (B. striatulus),
Semisulcospira, Alocinma (A. longicornis),
Thiara (T, granifera) and Melanoides (M.
tuberculatus) , 1st intermediate host for
Opistotorchis flukes is under the genus
Bithynia snails ; Second intermediate hosts are
Freshwater fishes under Cyprinidae family ;
infection is related to the carcinoma of the
liver and adenoCA of the gallbladder

Eggs of Opisthorchis spp: often

indistinguishable from the eggs of
Clonorchis sinensis.

Adults of Opisthorchis spp:

b. Clonorchis sinensis,
Opistorchis felineus,
Opistorchis viverrini
- similar to, but often smaller than
Clonorchis sinensis
- differ from adults of Clonorchis in the
shape of the testes
- differ in distribution of the vitelline
glands
- ventral sucker (acetabulum) smaller than
the oral sucker.

* GA: Golgi Apparatus ; RER: Rough Endoplasmic Reticulum ; Asx: Asymptomatic ; Troph: Trophozoite ; ADCC: antibody dependent cell cytotoxicity ; DxOC: Diagnostic of choice ; SI: Small intestine
IFA: Indirect Fluorescence antibody test

** In general, almost all parasitic infections are associated with poor sanitation and crowded areas

FOR BETTER RESOLUTION OF PICTURES PLS REFER TO THIS LINK: https://www.cdc.gov/dpdx/az.html