CLASSIFICATION OF PARASITES identify the Can you

parasites in the pictures?

PARASITES

CLASSIFICAT ION OF PARASITES

PROTOZOA

METAZOAN ( Helminths )

SPOROZOA ( Sporozoans ) SARCODINA ( Ameobas )

CILIATA ( Ciliates ) PLATYHELMINTHES ( Flatworms )

NEMATHELMINTHES ( Round worms )

MASTIGOPHORA ( Flagellates )

Balantidium coli

They are single cell-like microorganisms. Shape: Spherical to oval (elongated). They belong in the Kingdom Protista. Most are unicellular. They are classified based on their mode of locomotion (pseudopodia, flagella, cilia & w/o means of locomotion) Not all are parasitic (some are facultative parasites [Acanthamoeba spp. & Naegleria fowleri]). Habitation: Normally they reside in the soil or water & can invade or gain entrance in our body.

PROTOZOA

 MOT: Intestinal & Luminal protozoa: Direct

contact (person-to-person) & ingestion of contaminated food & water. Blood & Tissue protozoa: direct contact or through vectors (carriers). Stages: CYST (dormant)- the INFECTIVE STAGE the stage of the parasite that enters the host ; TROPHOZOITE (motile) the PATHOGENIC STAGE the stage of the parasite that is responsible for disease production. Diagnosis: Microscopic examination of body fluids, tissue specimens, or feces (small

PROTOZOA

MEDICALL -IMPORTANT Y

KINGDOM Protista SUBKINGDOM Protozoa PHYLUM Sarcodina CLASS Lobosea

CLASSIFICATION PROTOZOA

Entamoeba histolytica Acanthamoeba spp. Naegleria spp. PHYLUM Sarcomastigophora SUBPHYLUM Mastigophora Intestinal flagellates Giardia lamblia Urogenital flagellates Trichomonas vaginalis Blood & Tissue flagellates Leishmania spp. Trypanosoma spp.

OF

M E D I A LLY-I P O R TA N T C M

PHYLUM CLASS

PHYLUM

Apicomplexa Sporozoa Tozoplasma gondii Plasmodium spp. Ciliophora Balantidium coli

C LA SS I I A T I N F C O P R O TO Z O A

OF

IMPORTANT PROPERTIES
It

is an intestinal protozoa. Life cycle; Two stages: (1) The non-motile cysts found in nondiarrheal (hard) stools; (2) The motile trophozoites found w/n the

PHYLUM SARCODINA: Entamoeba histolytica

PATHOGENESIS & EPIDEMIOLOGY

MOT:
7 1

PHYLUM SARCODINA: Entamoeba histolytica

Ingestion of the infective stage-cysts in contaminat ed food & water (by the fecaloral route). There is no

5 4

 Epidemiolo

gy: Found worldwid e but is more common in tropical countries (areas with poor sanitatio

World annual rates of morbiditv and mortality

Infections Disease (millions) (millions) Protozoa malaria amoeba toxoplasma trypanosoma 24 Nematodes intestinal nematodes filaria onchocerca Cestodes tapeworms 2400 250 30 2.5 800 480 150 50 40 1.2 2.6 3 5 20 Deaths (thousands) 1500 100 10 60 80 <1 50 1000

PHYLUM SARCODINA: Entamoeba histolytica

Trematodesschistosoma 200

DISEASE: AMEBIASIS
ACUTE INTESTINAL AMEBIASIS:

PHYLUM SARCODINA: Entamoeba histolytica

Presents as dysentery (bloody, mucus-containing diarrhea). Accompanied by lower abdominal discomfort, flatulence & tenesmus. CHRONIC (may occur): Occasional diarrhea Weight loss Fatigue (In some patient) A granulomatous lesion called an AMEBOMA may form in the cecum/in the rectosigmoid area of the colon (malignant

PHYLUM SARCODINA: Entamoeba histolytica

DISEASE: AMEBIC AMEBIASIS

LIVER ABSCESS (ALA): RUQ pain Weight loss Fever Tender enlarged liver The abscess has a characteristic anchovy-sauce appearance LUNG DISEASE (once the trophozoite penetrate the diaphragm from the

PHYLUM SARCODINA: Entamoeba histolytica

LABORATORY DIAGNOSIS Stool Examination positive TREATMENT

&

detection of trophozoites in diarrheal stools or cysts in formed stools. Serological Testing for invasive amebiasis DOC: Metronidazole & Tinidazole for symptomatic intestinal amebiasis or hepatic abscess; Iodoquinol or Paromomycin for

PREVENTION
Avoiding fecal contamination

PHYLUM SARCODINA: Entamoeba histolytica

of food and water. Observing good personal hygiene such as proper hand washing. Purification of water source. The use of night soil as fertilizer should be avoided. Adequate cooking of vegetables should also be observed.

PHYLUM SARCODINA : Acanthamoeba &

Acanthamoeba castellani & Naegleria They fowleriare minor protozoan pathogens.

They

Naegleria

are free-living amebas that cause meningoencephalitis. Habitation: They are widely found in soil & freshwater lakes; Acanthamoeba can survive in cold water, Naegleria can survive in thermal spring water. Infective stage (for both): cyst & the pathogenic stage is trophozoite. MOE/T: Naegleria: intranasal (swimming in contaminated water) nasal mucosa cribriformplate-brain; Acanthamoeba:

PHYLUM SARCODINA : Acanthamoeba &

Acanthamoeba castellani & Naegleria Targets: Acanthamoebafowleri

immunocompromised individuals; Naegleria healthy individuals, usually children. Other than meningoencephalitis: Acanthamoeba cause keratitis (cornea inflammation) parasites have been recovered from contact lenses, lens cases & contact lens solutions.

Naegleria

PHYLUM SARCODINA : Acanthamoeba &

DIAGNOSIS, TREATMENT & DIAGNOSIS: Finding the parasite in the CSF. PREVENTION
DOC:

Amphotericin B Naegleria infection; Pentamidine, Ketoconazole, or Flucytosine Acanthamoeba infections (Prognosis is poor even w/ treatment). PREVENTION: Infection w/ Acanthamoeba can be prevented by adequate boiling of water. (since dust carries the cysts) masks should be worn while cleaning. Regular disinfection of contact lenses is also advised. There is no known means of prevention & control

Naegleria

PHYLUM MASTIGOPHORA: Giardia lamblia

IMPORTANT PROPERTIES (1) LIFE CYCLE:

Trophozoite pear-shaped w/ 4 pairs of flagella; (2) Cyst oval & thick-walled w/ 4 nuclei. [1 cyst = 2 trophozoites during

PHYLUM MASTIGOPHORA: Giardia lamblia

PATHOGENESIS MOT (major): Ingestion EPIDEMIOLOGY

&

of the cyst in fecallycontaminated water & food. Distribution: Approximately 50% are asymptomatic carriers. Reservoirs: humans & (many) sp. of mammals. Infection is common among male homosexuals (oralanal contact). High incidence is seen in

DISEASE: DIARDIASIS
Non-bloody,

PHYLUM MASTIGOPHORA: Giardia lamblia

smelling diarrhea accompanied by nausea, anorexia, flatulence & abdominal cramps (for weeks or months) . Malabsorption of fat may lead to the presence of fat in the stool

foul-

PHYLUM MASTIGOPHORA: Giardia lamblia

LAB DIAGNOSIS, TREATMENT & DIAGNOSIS: examination PREVENTION Stool

(+ cyst&/trophozoites); microscopic exam is negative the string test may be done. TREATMENT: DOC is metronidazole or quinacrine hydrochloride. PREVENTION: Drinking boiled, filtered, or iodine-treated water (in endemic areas). Proper hygiene & waste disposal must also be observed. (No prophylactic drug or vaccine is available).

IMPORTANT Shape: Pear PROPERTIES

PHYLUM MASTIGOPHORA :

vaginalis

w/ a central nucleus & 4 anterior flagella. It exists only in the trophozoit e form (infective

Trichomonas

PATHOGENESIS, EPIDEMIOLOGY MOT: Sexual DISEASE contact

&

Trichomonas
PHYLUM MASTIGOPHORA :

HABITATION: Vagina & the prostate (male) Epidemiology: T. vaginalis infection is one of the

most common worldwide; the frequency is highest among sexually-active women (in their 30s) & lowest in postmenopausal women. Disease: TRICHOMONIASIS/VAGINITIS watery, foul-smelling, greenish vaginal discharge accompanied by itching (pruritus) & burning sensation. Cervix is very red, w/ small, punctuate hemorrhages giving rise to a straberry cervix. Infection in men is usually asymptomatic (some: manifest symptoms of urethritis or prostatitis.

vaginalis

Trichomoniasis
(Protozoa: Trichomonas vaginalis)

LAB DIAGNOSIS, TREATMENT & DIAGNOSIS: PREVENTIONMicroscopic examination

PHYLUM MASTIGOPHORA :

vaginalis

- + of trophozoite (wet mount of vaginal & prostatic secretions). TREATMENT: DOC is metronidazole PREVENTION: To prevent ping pong infections, there should be simultaneous treatment of both sexual partners. Maintenance of the low pH of the vagina is also helpful. The use of condoms can limit transmission of

Trichomonas

PHYLUM MASTIGOPHORA: Leishmania spp.

IMPORTANT PROPERTIES
Life cycle

Vector: female sandfly, Phlebotomus species. Infective stage: promastigote Pathogenic stage: amastigote

PATHOGENESIS & EPIDEMIOLOGY

Major MOT: Bite of the vector Target tissues: Organs of

PHYLUM MASTIGOPHORA: Leishmania donovani

reticuloendothelial system (liver, spleen, & bone marrow). Epidemiology: Mediterranean basin, Middle East, China & some parts of Africa Three distinct groups of species: 1. L. donovani visceral leishmaniasis 2. L. tropica; L. mexicana; cutaneous leishmaniasis

PHYLUM MASTIGOPHORA: Leishmania donovani

visceral leishmaniasis/Dum Dum Fever at Early nodule

site of sandfly bite seen at times. usually presents with chronic fever. splenomegaly (very large) Lymphadenopa

High mortality from anemia and bacterial superinfections .

KALA AZAR means black - sickness

cutaneous leishmaniasis
tropica & L. mexica na)

(L.

PHYLUM MASTIGOPHORA: Leishmania tropica

There

are several variants basically with skin nodules which ulcerate. L. tropica complex - in Asia, Africa, and Mediterranean (called Oriental sore, Delhi or Bagdad boil). L. mexicana complex

mucocutaneous leishmaniasis
It

PHYLUM MASTIGOPHORA: Leishmania braziliensis

begins as a cutaneous ulcer and metastasizes to mucosa of nose and pharynx leading to destruction, obstruction and death. L. braziliensis - in South and Central America

PHYLUM MASTIGOPHORA: Leishmania spp.

PATHOPHYSIOLOGY/LIFE CYCLE
Amastigotes differentiat e into promastigote s ( inside gut of vector )

Amastigotes ingested by the mosquitoe

Promastigotesar e engulf by macrophages ( transform into ..)

Transmitted to an uninfected human during next bite

PHYLUM MASTIGOPHORA: Leishmania spp.

LAB DIAGNOSIS, TREATMENT, DIAGNOSIS: PREVENTION o

Biopsy preparation amastigotes in a bone marrow, spleen, or lymph node. o Serological Test very high conc of IgG is indicative of infection. o Skin Test use a crude homogenate of promastigotes as the antigen. TREATMENT: DOC- Sodium stibogluconate PREVENTION: 1. Prevention of the bite from the sandfly: b. Wearing of protective clothing c. Use of netting d. Use of insect repellants. 6. Insecticide spraying (kill the sandfly)

OTHER PARASITES:
PARASITE PROPERTIES PATHO/EPIDE DISEASE MIOLOGY DIAGNOSIS TREATMENT PREVENTION

Trypanosomacruzi

Vector:reduviid MOT:biteofthevector CHAGASdisease Acutedemostrationof bug/kissingbug(Triatoma) Occurrence:ruralCentral (Americantrypanosomiasis)- trypomastigotesinpatients &SouthAmerica ROMAASIGN(facial blood(serologicaltest). Acute:USA;chronic: edema),CHAGOMA(noduleOthersbonemarrow LatinAmerika nearthebitesite),fever, aspiration,musclebiopsy, lympadenopathy, xenodiagnosis T.bruceigambienseandT.Vector:tsetsefly Targettissues:skin, AFRICANSLEEPING Microscopicexamination hepatosplenomegaly) bruceirhodesiense (Glossina); blood,lymphnodes, SICKNESStrypanosomal (Serologictest-blood);

DOC:acutephase Protectionfromthebiteof nifurtimox;alternative thereduviidbug; drug:benznidazole; Improvementofhousing chronicnoeffectivedrugconditions;insectcontrol

Toxoplasmagondii (Apicomplexa)

Effectivedrug- Protectionagainstthebite SURAMIN;Alternative ofthefly;useofnetting Reservoir:humans brain. chanceratthebitesite, Aspirationofthechancer(& drugPENTAMIDINE andprotectiveclothing; (gambiense)&cattle& Endemicinsub-Saharan weeklyfever, CSF); (followedby clearingforestaroundthe wildanimals Africa(naturalhabitatof lymphadenopathy, MELASOPROL) villages;usinginsect Definitivehost-domestic tsetsefly);T.gambiense WINTERBOTTOMS MOT:ingestionofthe TOXOPLASMOSIS Acute&congenitalinfection Congenital Thoroughcookingofmeat (rhodesiense); repellants;novaccine cat;Intermediatehost westAfrica&T. cysts(inmeat), resembleinfectious toxoplasmosis tokillthecysts;Refrain Infective&pathogenic SIGNS(lymphnodes available humans&mammals. transplacental monocleosisw/fever, fromhandlinglitterboxes; stagetrypomastigote rhodesienseeastAfrica enlargement),encephalitis, IMMUNOFLUORESCENC SULFADIAZINE& Infectivestagecysts transmission(infected sleepingsickness jaundice;congenitalinfectionEASSAYforIgM PYRIMETHAMINE catsshouldnotbefedraw (oocysts);smallintestine mothertofetus-congenital abortion,stillbirth,neonatalantibodies. meat. (somnolence,muscle (host) infection), disease(encephalitis, Microscopicexamination tremors),coma. tachyzoites/bradyzoites) EPI:Occursworldwide, chorioretinitis& trophozoites;cystsintissues infectionissporadic hepatosplenomegaly);Cause ofBLINDNESSinchildren.

OTHER PARASITES:
PARASITE
Plasmodiumspp.: vivax malariae ovale falciparum(impt.)

PROPERTIES

PATHO/EPIDE DISEASE MIOLOGY

DIAGNOSIS

TREATMENT PREVENTION
DOC: CHEMOPROPHYLAXIS CHLOROQUINE, (mefloquine/doxycycline) PRIMAQUINEfor ofmalariafortravelerto vivax&ovalemalaria, endemicareas. MEFLOQUINE/ Otherpreventivemeasures: QUININE+DOXYCYC (1)avoidanceofthebiteof LINE=forchloroquine- thevectorthrutheuseof resistantstrainsof mosquito,windowscreens, falciparum,insevere protectiveclothing,& cases(cerebral insectrepellants(protection malaria/blackwaterfever)isimportantduringthe PARENTERAL night).(2)reductionof QUINIDINEor mosquitopopulationisalso QUININE helpful(byusing insecticidesprays).No vaccineisavailable.

MainMOT:biteofthe Vector&definitivehost: Malaria-paroxysmsare Bloodexamof femaleAnophelesmosquito; femalemosquito;others: divideinto3stages:(1)cold Giemsaistainedsmears(+ humans(intermediatehost) acrosstheplacenta,in stageabruptonsetofchills trophozoitesintheinfected bloodtransfusions,IVdrugaccompaniedbyheadache, RBCs). Lifecycle:(1) SPOROGONY-sexualcycle abuse. myalgias,&arthralgias,(2) P.falciparumw/bananaP.Falciparuminfects (occursinmosquito),(2) hotstagespikingfever shapedgametocytes. SCHIZOGONYasexual bothyoung&oldRBCs;P.reachingupto410C NOTE:Ifmorethan5%of vivax&ovaleinfects cycle(occursinhumans). accompaniedbyshaking RBCsareparasitized,the youngRBCS;P.malariae chills,nausea,vomiting& diagnosisisusuallyP. Infectivestage:sporozoite. infectsoldRBCs. Erythrocytic phase abdominalpain,(3)sweating falciparummalaria. Timingoffevercycle: merozoitesintheRBCs; stagedrenchingsweats. Quartanmalaria(4th day/72 Exoerythrocytic phase hrs.)P.malariae, Manifestations: sporozoitesintheliver. Malignanttertianmalaria splenomegaly&anemia, (3rd day/2448hrs)P. cerebralmalaria&kidney falciparum,Benigntertian damage,blackwaterfever malaria(3rd day/48hrs) darkcolorofurinedueto kidneydamage. P.vivax&P.ovale. EPI:Occursworldwide(in tropical&subtropicalareas asia,africa&Central& SouthAmerica. Philippines:Catanduanes, Cebu,Bohol,&Leyteare malaria-free;High endemicityPalawan, Kalinga-Apayao,Ifugao,& AgusandelSur;70%of casesareduetofalciparum

PARASITE
Balantidiumcoli

PROPERTIES

Largestprotozoantoinfect humans. cystsinfood&water Reservoirhost:domestic Mostinfectedindividualsare contaminatedw/animalor asymptomatic. animalsespeciallypigs. humanfeces. Infectivestage:cysts Pathogenicstage: trophozoites

PATHO/EPIDE DISEASE DIAGNOSIS Itisworldwide. Extraintestinallesionsdonot Stoolexamination MIOLOGY MOT:ingestionofthe occur.

TREATMENT PREVENTION
Tetracycline

Avoidingcontaminationof foodandwaterbyfecesof domesticanimals

CESTODES/TAPEWORMS
Flat worms w/ 2 main parts:

(1)head/scolex w/ hooks, suckers or sucking grooves, (2) body divided into PROGLOTTIDS (multiple segments) A series of proglottids is called STROBILA. All are hermaphroditic. GRAVID PROGLOTTIDS contains both male & female reproductive organs and are capable of laying eggs. Intermediate hosts: cattle, pigs & fish.

INTESTINAL CESTODES
PARASITE IMPORTANT PROPERTIES
Infectivelarva:cysticercus Pathogenicstage:adultworms (10mlong) Intermediatehosts:cattles Definitivehosts:humans

PATHOGENESIS DISEASE & EPIDEMIOLOGY

Cosmopolitan(universal) distributionoccuring worldwide. EndemicinAfrica,South America&easternEurope. Taeniasaginataismore commoninthePhilippines thaninfectionw/T.solium (pigtapeworm)

DIAGNOSIS

TREATMENT

PREVENTION

Taeniasaginata(beef tapeworm)

Taeniasismildabdominal Stoolexamination DOCispraziquantel cramps&malaise;itchiness demostrationofproglottids intheanus(PRURITUS oreggs. ANI)

Properwastedisposal& adequatecookingofbeef; freezingofmeatat-20oCfor 10daysmaykillthe encystedlarvae.

Taeniasolium(pork tapeworm)

Infectivelarvae:cysticercus MOT:similarw/T.saginata. Taeniasis[asymptomatic, SameforTaeniasaginata. cellulosae. Worldwideindistribution althoughanorexia& CystsintissuesSurgical Pathogenicstage:smallwormsbutendemicincertainareas diarrheamayoccur]caused removalandCTscan &adultworms(5metersin inAsia,SouthAmerica& bytheadultworms& length) EasternEurope cysticercosis [musclepain, Intermediatehost:pig intheeyes-uveitis&renitis] causedbythelarvae(inthe brainitisknownas NEUROCYSTICERCOSIS mostfeared&severe complication).

DOC:PRAZIQUANTEL (intestinalinfection&for cysticercosis); ANTICONVULSION(for neurocysticercosis); ALBENDAZOLE (alternativedrugfor cysticercosis)

Properwastedisposal& adequatecookingofpork meat. Treatingpatientstoprevent autoinfection. Properhygienetoprevent contaminationoffoodw/the eggsoftheparasite.

Diphyllobothriumlatum Thelongestofthetapeworms MOT:ingestionof (fishtapeworm) (13metersinlength). improperlycookedorraw Infectivelarvae: fishcontaningtheinfective PLEROCERCOID/ larvae. SPARGANUM Hasworldwidedistribution Firstintermediatehost: butisendemicincountries copepods whereeatingrawfishisa Secondintermediatehost:fish custom. (e.g.trout)

DIPHYLLOBOTHRIASISDemonstrationof DOC:PRAZIQUANTEL abdominaldiscomfort& characteristicseggsinstool diarrhea,deficiencyofVit ofinfectedindividuals. B12leadingtomegaloblastic anemia.

Properwastedisposal& adequatecookingoffish. Freezingfor2448hrsat -180Ckillsalllarvae.

PARASITE

PROPERTIES

PATHO/EPIDE DISEASE MIOLOGY

DIAGNOSIS

TREATMENT

PREVENTION
NOspecificmeans ofprevention. Properdisposalof humanwaste& environmental sanitationmayhelp limitthespreadof theparasite. Rodentcontrolmust beobserved. Foodmustbe properlystored& protectedfrom infestationw/flour PREVENTION &grainbettles.

Hymenolepisnana Thereisno MOT:ingestionof HYMENOLEPIASI Findingtheeggsin DOC: (dwarftapeworm) obligatory foodorwaterthatis Sseverecaseis thefeces PRAZIQUANTEL intermediateanimal contaminatedbythehyperinfection host(thoughcanbe eggsoftheparasite. syndrome(high ingestedby Autoinfectionmay wormburden); rice/flourbeetles alsooccur. secondarybacterial intermediatehosts). Dwarftapewormis infections Directlifecycle. themostcommonin theUS;itis endemicinthe southeasternUS, mostlyin children;alsoseenin EXTRA - INTESTINAL CESTODE EastAsia&the PARASITE PROPERTIES PATHO/EPIDE DISEASE DIAGNOSIS TREATMENT Philippines.

MIOLOGY

Echinococcusgranulosus Primarilyazoonotic (dogtapeworm) infection. Definitivehost:dogs Accidental/dead-endhost: humans. Intermediatehost:sheep.

MOT:ingestionoffood& waterthatiscontaminated bydogfeces(w/the parasite). Commoninthe Mediterraneanregion,the MiddleEast&Australia.

HYDATIDCYST Microscopicexamination DISEASEliver ofspecimen(sputum)-+ dysfunction,obstructive protoscoloces. jaundice(livercysts); CTscaninthecaseof cough&bloodysputum liver&braininvolvement. (pulmonarycysts); Serologictestsindirect increasedintracranial hemagglutinationtest. pressure-headache, vomiting&seizures (cerebralcysts);ruptureof thecystmayleadtofatal anaphylacticshock.

ALBENDAZOLE, Reducetheinfected accompaniedornotby populations&minimizing surgicalremovalofthe transmission. cyst. CHEMOPROPHYLAXIS Hypertonicsalineor1% shouldbegiventodogsin formalinmaybeinjected endemicareas. intothecyst. Healtheducationis Surgicalremovalprevent essential. anaphylaxis.

TREMATODES (FLUKES)
Flat, fleshy, leaf shaped worms Member of the phylum

Platyhelminthes. Flukes have a digestive tract (unlike cestodes). Have 2 muscular suckers: ORAL TYPE - beginning of an incomplete digestive system; VENTRAL SUCKER serves for attachment. (most) Hermaphroditic, except for Schistosoma spp. (blood flukes). Never use humans as