PARASITOLOGY LEC

PARASITOLOGY - study of parasites PARATENIC - parasite doesn’t develop, stays as larva

RESERVOIR HOST - transmits parasite
PARASITE - entirely dependent ZOONOSIS-VECTOR - originated from animal infection

VECTOR-AGENT - insects
TYPES OF PARASITE:
ECTOPARASITE - outside/ surface of the host HOST-PARASITE RELATIONSHIP:
ENDOPARASOTE - inside the body SYMBIOSIS - host and parasite are together

COMMENSALISM - only one is benefiting yet the host is

unaffected
3 MAIN CLASSES:
PARASITISM - only one is benefiting while host is harmed
ARTHROPODS - multicellular
MUTUALISM - both benefit
PROTOZOANS - single cell
SOURCE OF INFECTION
WORMS - multicellular
SOIL TRASMITTED
NEMATODES - round worms
ASCARIS LUMBRICOIDES
TREMATODES - flukes (flatworms)
HOOKWORMS
CESTODES - tapeworms (flatworms)
TRICHURIS TRICHIURA

ARTHROPOD/VECTOR
TYPES OF HOSTS:
MALARIA (PLASMODIUM)
DEFINITIVE HOST - final host, sexual stage of parasite
TRYPANOSOMES
INTERMEDIATE HOST - asexual stage of parasite
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LEISHMANIA
FOODBORNE
TAENIA SOLIUM (pork)

TAENIA SAGINATA (beef) PATHOGENICITY - ability of an organism to cause disease

CAPILLARIA PHILIPPINESIS (raw fish) TRAUMATIC DAMAGE - physical injuries
HETEROPHYIDAE (fish) LYTIC NECROSIS - death of cells in living tissue
PARAGONIMUS WESTERMANI (crab) ALLERGIC MANIFESTATION - if there is an allergen

TRICHINELLA SPIRALIS (undercooked meat) NEOPLASIA - abnormal growth of tissue

FASCIOLA HEPATICA (vegetables) SECONDARY INFECTION - if parasite becomes erratic (invade
body organs that they do not normally invade).
WATERBORNE
AMOEBA
IMMUNE CELLS
GIARDIA LAMBLIA
CYTOTOXIC T-CELLS - kills cancer cells
BLASTOCYSTIS HOMINIS
NK CELLS (natural killer) - kills tumors and virally infected
CONTACT BORNE
cells
ENTEROBIUS VERMICULARIS (anus)
ACTIVATED MARCOPHAGES - kill invading bacteria or
TRICHOMONAS VAGINALIS (cervix) infected cells
ANTIBODIES B CELLS - make antibodies against antigens

PARASITIC DISEASE CHARACTERISTICS

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DIARRHEA
ABDOMINAL PAINS PORTALS OF EXIT
ANEMIA STOOL

CHILLS BLOOD
BLEEDING URINE
FEVER SPUTUM
WEIGHT LOSS SEMEN

BLOATING
SPECIMEN COLLECTION AND PROCESSING
I. OP (ova/parasite) EXAMINATION, COLLECTION,
TRANSPORT

AMOEBIASIS - 6 samples in 14 days

TYPICAL HELMINTHIC - 3 samples in 10 days
II. TO BE CONSIDERED FOR STOOL EXAM
MODES OF TRANSMISSION
MEDICATION - barium, bismuth therapy, mineral oils
CONTACT
(stop 5-7 days)
DROPLET
CONTAINER - clean, sterile, water tight, pea size (2-5g)
AIRBORNE
TIME FRAME (from sample to receipt for examination)
VECTOR
LIQUID SAMPLE - within 30 mins.
COMMON VEHICLE (food etc.)
SEMI-FORM - within 1 hr.
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WITH TROPHOZOITE - fresh IRON HEMATOXYLIN - used for permanent stain

FACTORS - suspected disease, travel history, chemical MODIFIED PVA - without mercury chloride as health risk
findings
ALTERNATIVE SINGLE VIAL SYSTEM - less toxic fixative

III. FIXATIVES (3 parts fixative - 1 part stool)

PROCESSING OF STOOL EXAM
FORMALIN - lasts long, easy to prepare
MACROSCOPIC - color, consistency, gross presence of
5% - trophozoites & cysts parasite, mucus, blood, odor

10% - helminthic eggs/ larva MICROSCOPIC - eggs/ova, cysts (formed), trophozoites

(watery), adult larva stages, crystals, puss, yeast
PVA (polyvinyl alcohol) - for permanent stain
CONSISTS OF:
-plastic powder (adhesive agent for staining)

-schaudinn’s sol’n (zinc sulfate, mercury chloride, copper

sulfate)
ADVANTAGE - PVA>formalin, long shelf life when STOOL EXAM
stored in room temp
I. DFS (direct fecal smear) - most common process
DISADVANTAGE - health hazard (mercury chloride)
Saline & lugol’s iodine sol’n 1-3%
SAF (sodium acetate formalin)
See motility of trophozoites
ADVANTAGE - used for preparing smear with
II. KATO-KATZ - quantitate helminthic eggs
modified Acid Fast stain and coccidia cyst
Unit: eggs per gram
DISADVANTAGE - adhesive property is not good (add
albumin to fix) Clearing agent: glycerin
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Fieldwork DISADVANTAGE - less 10 eggs per gram, cant

recover the rest
Drug monitoring
TEMPLATES:

9mm hole, 1mm thick: 50mg feces

FLOTATION - higher sg than parasite
6mm hole, 1.5mm thick: 41.7mg feces
ZINC SULFATE FLOTATION TECHNIQUE
6.5mm hole, 0.5mm thick: 20mg feces
examine with saline & iodine prep
III. CONCENTRATION
Specific gravity - 1.18-1.20
SEDIMENTATION - lower sg than parasite
ADVANTAGE - small number of fecal debris
FEACT (formalin ethyl acetate concentration
technique) DISADVANTAGE - cant recover dense eggs
(sinks)
ADVANTAGE - provides good recovery of
parasites BRINE FLOTATION TECHNIQUE
DISADVANTAGE - presence of fecal debris qualitative test for the detection of nematode
and cestode eggs and coccidia oocysts in the
AEACT (acid ethyl acetate concentration technique)
feces
DISADVANTAGE - ether is highly explosive
Using saturated saline
MIFCT (merthiolate iodine formalin concentration
SHEATHER’S SUGAR FLOTATION TECHNIQUE
technique)
Sugar sol’n
Sensitive to moderate-heavy infections, not to
light ADVANTAGE - Reveals most nematode eggs and
protozoan cyst.
Based on specific gravity
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DISADVANTAGE - Flukes and tape worm eggs For oocysts, cryptosporidium, isospora, cyclospora
and most nematode larvae dont demonstrate
well.
OTHER INTESTINAL SPECIMENS
IV. PERMANENT STAINS
DUODENAL ASPIRATE - exam of fluid from the duodenum to
- only stain when fixed
check for signs of an infection (such as giardia or
- scan 300 fields before declaring negative strongyloides)
IRON HEMATOXYLIN (with SAF fixative) SIGMOIDOSCOPY - using a flexible tube with a light on it to
look inside sigmoid colon. Helps check for: ulcers. abnormal
ADVANTAGE - will show eggs
cells. polyps.
DISADVANTAGE - time consuming
- MEC (Microsporidia Entamoeba Coccidia)
WETLY TRICHROME (for e. histolytica in amoebiasis)
CELLOPHANE TAPE PREPARATION - enterobius, taenia
ADVANTAGE - most widely used, long shelf life

FECAL CULTURE (helminths)

HARADA MORI CULTURE - differentiating hookworms from
V. SPECIALIZED STAINS strongyloides stercoralis

MODIFIED IRON HEMATOXYLIN DUODENAL MATERIAL (fluid) -

Incorporated with carbol fuchsin to detect protozoa - GCIS (Giardia Cryptosporidium Isospora Strongyloides)
ENTERO TEST (string test) - gelatin-like capsule

MODIFIED TRICHROME -used to detect the presence of parasites in the upper

part of the small intestine
For blastocystis hominis, microsporidia
MODIFIED ACID FAST STAIN (for SAF fixative)
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IMMUNOHISTOCHEMISTRY - fatal malaria from

plasmodium falciparum
KNOTT’S CONCENTRATION TECHNIQUE - detection of
BLOOD
microfilariae
Parasites
10mL 2% formalin, 1mL blood
PLASMODIUM
Centrifuge 1 min,
LEISHMANIA
Examine thin smear
TRYPANOSOMA
BUFFY COAT SLIDE - detection of leishmania, trypanosoma
BABESIA
Centrifuge using wintrobe’s tube (slim tube) 30 mins.
MICROFILARIAE
Examine thick smear with giemsa stain
THICK SMEAR - quantification
THIN SMEAR - identify species

PERMANENT STAIN
WRIGHT’S STAIN (modification of romanowsky stain)
GIEMSA STAIN - differentiation
BLOOD CULTURE - detection of leishmania, trypanosoma
WBC differentiation
NNN (Novy-MacNeal-Nicole) MEDIUM - culture medium
GRANULAR (neutro, baso, eosino)
1 drop blood to medium
AGRANULAR (monocyte, leukocyte)
Contains penicillin
MALARIA KIT (anemia)
Examine every other day on HPO (1 month)
Slow growing parasites
 PARASITOLOGY LEC

SPECIES SEEN:
CSF (CEREBROSPINAL FLUID) PARAGONIMUS WESTERMANI
CULTURE: NON-NUTRIENT AGAR SEEDED WITH E.COLI, ASH
incubate in 35℃(to see feeding amoeba)
ENTAMOEBA GINGIVALIS
NAT
SPECIES SEEN:
URINE & GENITAL SECRETIONS
TOXOPLASMA
TECHNIQUE: CULTURE POUCH
TAENIA SOLIUM CYSTICERCUS LARVAE
SPECIES SEEN:
ECHINOCOCCUS
TRICHOMONAS VAGINALIS
FOUND IN: 3RD AND 4TH LUMBAR VERTEBRAE
SCHISTOSOMA
ENTAMOEBA
TISSUE AND BIOPSY SPECIMENS
TECHNIQUE: IMPRESSION SMEAR (hematoxylin stain)
EYE SPECIMEN
SPECIES SEEN:
TECHNIQUE: CORNEAL SCRAPINGS
ENTAMOEBA HISTOLYTICA
STAIN: CALCOFLUOR WHITE STAIN
FLUORESCENT MICROSCOPE
SPUTUM
SPECIES SEEN:
FOR DECONTAMINATION OF SPUTUM:
ACANTHAMOEBA KERATITIS (will appear apple green on
N-ACETYLCYSTEINE+NaOH (for 30 mins.)
stain)
 PARASITOLOGY LEC

Conjunctivitis, encephalitis PLANT FIBER MISTAKEN AS STRONGYLOIDES STERCORALIS

LARVAE
CHARCOT-LEYDEN CRYSTALS (by-product of eosinophils)
XENODIAGNOSIS - exposing possibly infected tissue to a vector
MISTAKEN AS ABNORMAL CELL
and then examining the vector for the presence of the
microorganisms or pathogens it may have ingested. EPITHELIAL CELLS & RBC MISTAKEN AS AMOEBA
SPECIES SEEN:
TRYPANOSOMA CRUZI (from american reduviid bug/ NEMATODES
african tsetse fly from feces)
ENTRY:
INGESTION
SKIN SNIPS
SKIN PENETRATION
TECHNIQUE: place into 0.2 mL saline for 30 mins. on wet
SYMPTOMS:
mount
DIARRHEA
MOVEMENT: JERKING
VOMITING
SKIN LESIONS

3 TYPES:
ARTIFACTS
OVIPAROUS - nematodes laying eggs
FUNGI MISTAKEN AS GIARDIA LAMBLIA
UNSEGMENTED:
POLLEN GRAIN MISTAKEN AS TRICHURIS TRICHIURA &
TAENIA ASCARIS LUMBRICOIDES
(operculum - caplike cover of the parasite) TRICHURIS TRICHIURA
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SEGMENTED:
NECATOR AMERICANUS MOLTING - shedding of skin (3rd molting= infective)
ANCYLOSTOMA DUODENALE

EGGS CONTAINING LARVAE: GROUPS:

ENTEROBIUS VERMICULARIS INTESTINAL
VIVIPAROUS - nematodes hatching larvae TRICHURIS TRICHIURA
DRACUNCULUS MEDINENSIS ENTEROBIUS VERMICULARIS

WUCHERERIA BANCROFTI ASCARIS LUMBRICOIDES

BRUGIA MALAYI CAPILLARIA PHILIPPINESIS
OVO-VIVIPAROUS - hatches immediately HOOKWORM
STRONGYLOIDES STERCORALIS STRONGYLOIDES STERCORALIS

MAN IS OPTIMUM HOST INTESTINAL TISSUE

DRACUNCULUS MEDINENSIS
1 HOST ALL THROUGHOUT EXCEPT FOR: ANGIOSTRONGYLUS
FILARIOIDEA (mosquito) TRICHINELLA

DRACUNCULOIDEA (cyclops)
EXTRA INTESTINAL (blood or conjunctiva)
PARASITE LIFE STAGES: 4 LARVAL STAGES & 1 ADULT STAGE WUCHERERIA BANCROFTI
 PARASITOLOGY LEC

BRUGIA MALAYI ONCHOCERCA VOLVULUS

ONCHOCERCA VOLVULUS LOALOA
LOALOA (conjunctiva)

HABITAT:
SMALL INTESTINE
CAPILLARIA PHILIPPINESIS

STRONGYLOIDES STERCORALIS
ASCARIS LUMBRICOIDES INTESTINAL NEMATODES:
TRICHURIS TRICHIURA
ANGIOSTRONGYLUS THROUGH INGESTION:

NECATOR AMERICANUS SMALL INTESTINE

CAPILLARIA PHILIPPINENSIS (fishworm)
LARGE INTESTINE - male patient residing in ilocos norte (1963)
TRICHURIS TRICHIURA - pandemic in compostella valley
ENTEROBIUS VERMICULARIS - Capable of AUTOREINFECTION (same as strongyloides)

LARVIPAROUS REPRODUCTION - hatches larva

immediately
SUBCUTANEOUS
ADULT MALE: 1.5-3.9mm, ADULT FEMALE: 2.3-5.3mm
DRACUNCULUS MEDINENSIS
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Peanut-shaped MODE OF INFECTION - ingestion of contaminated soil

DEFINITIVE HOST - fish-eating birds and humans TREATMENT - albendazole
DIAGNOSTIC STAGE - unembryonated egg

INFECTIVE STAGE - filariform larva LARGE INTESTINE

MODE OF INFECTION - ingestion of raw fish TRICHURIS TRICHIURA (whipworm)
INTESTINAL CAPILLARIASIS - loss of fluid, severe -Linnaeus, 1771
enterotherapy, malabsorption
- most common in warm & moist regions
DURATION - 2-3 months
- float in brine solution
TREATMENT - albendazole, mebendazole
- no intermediate host
OVIPAROUS, UNSEGMENTED
ASCARIS LUMBRICOIDES (giant roundworm)
ADULT MALE: 30-45mm, ADULT FEMALE 35-50mm
- prevalent in tropical areas, 25% of world’s population
Barrel-shaped
- malnourished people - highest prevalence
DEFINITIVE HOST - pigs
OVIPAROUS, UNSEGMENTED
PATHOGENICITY - rectal bleeding
ADULT MALE: 10-31cm, ADULT FEMALE: 22-35cm
DIAGNOSIS - DFS, KATO-KATZ, AEACT
digestive and respiratory organs contain a toxic fluid
DIAGNOSTIC STAGE - unembryonated egg
known as ascaron - causes allergic reaction
INFECTIVE STAGE - embryonated egg
DEFINITIVE HOST - humans
MODE OF INFECTION - ingestion of contaminated soil
DIAGNOSTIC STAGE - unfertilized/fertilized egg
INFECTIVE STAGE - embryonated egg
 PARASITOLOGY LEC

DURATION - 3-4 weeks (tropical), 6-12 months SMALL INTESTINE

(temperate)
STRONGYLOIDES STERCORALIS (threadworm)
TREATMENT - Albendazole, mebendazole
- Norman (1876), manure of french troops

- prevalent in tropical climates

ENTEROBIUS VERMICULARIS (pinworm/sitworm)
- immunocompromise host
-pandemic in cosmopolitan
- gravid female, 5-10 eggs in each uterus
-common in cold & temperate climates
OVO-VIVIPAROUS
-prevalent in young children
RYLE TUBE- detection of strongyloides and hookworms
- adult male - 7 weeks, adult female - 5-13 weeks
DIAGNOSTIC STAGE - rhabditiform larvae
- don’t have systemic migration
INFECTIVE STAGE - filariform larvae
-simplest cycle
TREATMENT - thiabendazole, albendazole & ivermectin
PATHOGENICITY - anal and perianal pruritus (anal
ANCYLOSTOMA DUODENALE (old world hookworm)
itching)
- Dubin (1843)
DIAGNOSIS - scotch tape method
- cooler & drier regions
DIAGNOSTIC STAGE - adult worm or eggs in feces
- adult female - 2.5k-5k eggs per day
INFECTIVE STAGE - embryonated eggs
ORAL CAVITY - 4 hook-like teeth (buccal capsule)
TREATMENT - albendazole, mebendazole, pyrantel
pamoate, piperazine citrate COPULATORY BURSA - part of male worm that clings to
female during copulation

THROUGH SKIN PENETRATION:

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PATHOGENICITY - produces 3 lesions, ground itch, -africa & indian subcontinent

cutaneous larva migrans, pulmonary lesions, hookworm
- after 1 yr. Female worms will make blisters & go to lower
anemia
extremities
DIAGNOSIS - direct microscopy or concentration method
ADULT FEMALE: up to 800mm (largest)
DIAGNOSTIC STAGE - rhabditiform larvae
TRANSMISSION - ingesting crustaceans (water
INFECTIVE STAGE - filariform larvae fleas/cyclops)
TREATMENT - albendazole, mebendazole LAB DIAGNOSIS - increase eosinophils

NECATOR AMERICANUS (new world hookworm) DIAGNOSTIC STAGE - adult worm

- residing in moist & tropical areas INFECTIVE STAGE - filariform larvae (L3 larvae)
ORAL CAVITY - pair of cutting plates (buccal capsule) TREATMENT - albendazole, mebendazole, thiabendazole,
niridazole, metronidazole, acriflavine (cream that
DIAGNOSTIC STAGE - rhabditiform larvae
prevents infection)
INFECTIVE STAGE - filariform larvae
PREVENTION - treating water sources
TREATMENT - albendazole, mebendazole
SMALL INTESTINE MUCOSA
TRICHINELLA SPIRALIS (trichina worm)
INTESTINAL-TISSUE NEMATODES:
- nurse cell - cell formed by larvae in muscle tissues

- europe & usa

THROUGH INGESTION:
- buried in duodenal (upper small intestine)/jejunal (mid
SUBCUTANEOUS TISSUES small intestine) mucosa of pig, rat or man

DRACUNCULUS MEDINENSIS (serpent worm, guinea worm, ADULT MALE: 1.4-1.6mm x 0.04mm
medina worm)
ADULT FEMALE: 3-4mm x 0.06mm
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LARVA: 80um x 7-8um TREATMENT - albendazole, mebendazole, thiabendazole,

ivermectin
LAB DIAGNOSIS - biopsy, stool detection (occasional),
blood examination, ELISA (enzyme-linked
immunosorbent assay), x-ray exam
BLOOD NEMATODES:
PREVENTION - keep raw pig meat in -20℃ within 3 days

FILARIAL WORMS
CENTRAL NERVOUS SYSTEM
- major tissue-dwelling nematode
ANGIOSTRONGYLUS CANTONENSIS (rat lungworm)
- male: no copulatory bursa, only copulatory spicules
- barber’s pole appearance
- female: produces microfilariae
- female - could lay 15k eggs per day
- microfilariae will remove sheath (protection) & transfer to
LARVAE - on humans lymphatic from circulatory (adult worms)

EGGS - on pulmonary arteries of rats VIVIPAROUS

- elongated, ovoidal with delicate hyaline shell PERIODICITY

INTERMEDIATE HOST - snails (achatina fulica, hemiplecta NOCTURNAL - seen during night (9pm-2am)
sagittifera, helicostyla, microstoma, vaginulus plebeius,
WUCHERERIA BANCROFTI
veronicella altae)
BRUGIA MALAYI
DEFINITIVE HOST - rats
DIURNAL - daytime (4am-8:59pm)
ACCIDENTAL HOST - humans
LOALOA, sometimes
DIAGNOSIS - CSF examination, CT scan, ELISA
ONCHOCERCA VOLVULUS, sometimes
NONPEROIDIC - anytime of the day
 PARASITOLOGY LEC

LOALOA Funiculitis - inflammation of spermatid cord

ONCHOCERCA VOLVULUS Epididymitis - inflammation of epididymis (storage
of sperm)
SUBPERIODIC - higher rate at night
DIAGNOSIS - PBS (peripheral blood smear), DNA probes,
VECTORS - mosquitoes (culex, anopheles, aedes)
immunodiagnosis
LAB TEST - 3 drops (thick smear)
TREATMENT - diethylcarbamazine
PREVENTION (prophylaxis) - mosquito repellent

COMPARISON W. BANCROFTI B. MALAYI

WUCHERERIA BANCROFTI (bancroft’s worm)
size 300 x 10 um 260 um
- ancient eqyptian, hindu & persian physicians - 1st to note
from elephantiasis lie Graceful curves Kinked (acute
angles
- no nuclei on tail

PATHOGENICITY Head space Short Long

Lymphatic obstruction - dead worms Nuclei Countable Overlapping, has

tail nuclei
Lymphedema - leakage to tissues
BRUGIA MALAYI (malayan filarial worm)
Tropical pulmonary eosinophilia
- Lichtenstein - 1st to discover in blood films in northern
Elephantiasis sumatra
Chyluria - milky urine - no chyluria when infected
Hydrocele - swollen testicle - Far east & SEA
Orchitis - inflammation of testicle - resemblance to W. bancrofti but smaller
 PARASITOLOGY LEC

DIAGNOSTIC STAGE - sheathed microfilariae

INFECTIVE STAGE - filariform larvae (L3) ONCHOCERCA VOLVULUS (convoluted filarial worm)
DIAGNOSIS - PBS, PCR (polymerase chain reaction), DNA - tropical africa, central america
probes
- onchocerciasis, river blindness
TREATMENT - diethylcarbamazine
- unsheathed, no tip of nuclei on tail
LOA LOA (eye worm)
- rarely in blood, sputum & urine
- central & western tropical africa
HABITAT
- unsheathed
BLOOD & SKIN - microfilariae
- microfilariae resembles W. bancrofti
NODULES & SUBCUTANEOUS TISSUE - adult
220-320 um x 5.9 um in diameter
VECTOR - simulium
HABITAT
PATHOGENICITY - fibrous nodules (knees, hips, ilia chest),
BLOOD & SKIN - microfilariae skin itching
SUBCUTANEOUS CONNECTIVE TISSUE & DIAGNOSIS - skin snips, demonstration of adult worms,
SUBCONJUNCTIVAL TISSUE OF EYE -adult serologial tests

VECTOR - mango flies (genus CHRYSOPS) TREATMENT -nodulectomy, suramin, ivermectin,

diethylcarbamazin
PATHOGENICITY - calabar swelling (fugitive swelling),
oedema in the eyelid
DIAGNOSIS - detection of microfilariae on PBS
(10am-2pm), removal of adults from eye
TREATMENT - diethylcarbamazine