PARA LEC B.

According to Host Requirements

COMPREHENSIVE REVIEWER 1. Obligate Parasite – required to be inside the host, without a host, it dies
**There are certain parasites that do not undergo encystation (Entamoeba gingivalis)
PARASITOLOGY **Trophozoite stage are very fragile, die easily (Trichomonas sp.)
- Scientific study of parasite of medical importance and it’s association to the host  Nematode: Ascaris lumbricoides (Giant intestinal roundworm)
- No parasite exists in the absence of the host
- The host acts as the shelter and the nourishment site of the parasite HELMINTHS
 Medical Parasitology – concerned primarily with parasites that affect  Life Cycle: Egg  Larva  Adult
humans and their medical significance, as well as their importance in human  Nematode – roundworms (spaghetti noodle like appearance; 15-30 cm)
communities.  Trematode – flukes (leaf-like appearance)
 Tropical Medicine – branch of medicine that deals with tropical diseases  With the exception of Schistosoma japonium (blood fluke;
and other special medical problems of tropical regions. appears elongated and cylindrical)
 Tropical Disease – an illness, indigenous to or endemic in a  Cestode – tapeworms (ribbon-like/fettucine-like appearance)
tropical area. May also occur in sporadic or epidemic proportions. **Trematodes and Cestodes = platyhelminths (flatworms) =
**Many tropical diseases are parasitic diseases. hermaphrodites (male and female reproductive functions available in one)
 Schistosoma sp. – exception of being a hermaphrodite parasite;
BIOLOGICAL RELATIONSHIPS has male and female counterparts
 Organisms may develop unique relationships due to their habitual and long  Male: smaller and has a long groove/hole
associations with one another  Female: bigger and longer; goes into the male through
 Important to the survival of parasites its long groove
PROTOZOANS
SYMBIOSIS  Diagnostic Stages: Trophozoite  Cyst
 Living together of unlike organisms  PHYLUM SARCOMASTIGOPHORA
 May involve protection or other advantages to one or both organisms  Subphylum Sarcodina (Amoebae) - pseudopods
1. Commensalism – two species live together and one species benefits  Subphylum Mastigophora (Flagellates) - flagella
from the relationship without harming or benefiting the other.  PHYLUM CILOPHORA (Ciliates) - cilia
 E.g. Entamoeba coli **Phylum Sarcomastigophora and Ciliophora - equipped with locomotor apparatus
2. Mutualism – two organisms mutually benefit from each other (trophozoite stage)
 E.g. termites and the flagellates in their digestive system –  PHYLUM APICOMPLEXA – not equipped with any locomotor apparatus
synthesize cellulose (breakdown of ingested wood)
3. Parasitism – one organism, the parasite, lives in or on another for its 2. Facultative Parasite – may or may not have a host to survive
survival and usually at the expense of the host  Exist within the host = parasitic form
 E.g. Entamoeba histolytica  Exist without a host = free living adult forms (found in the
environment)
CLASSIFICTION OF PARASITES:  E.g. Strongyloides stercoralis
A. According to Habitat  Very small nematode parasite
1. Endoparasite – found within the body of the host  Can live without a host
 Endoparasitism = infection  Female: Parthenogenetic = no need of a male to
 E.g Entamoeba histolytica, Giardia lamblia fertilize/nourish the eggs
2. Ectoparasite – found on the surface of the skin 3. Accidental/Incidental Parasite – a parasite which establishes itself in a
 Ectoparasitism = infestation host where it does not ordinarily live in
 E.g. flea (pulgas), tick (garapata – sucks blood) 4. Permanent Parasite – remains on or in the bodt of the host for the rest of
**Erratic = parasite found in an organ that is not its usual habitat its life
5. Temporary Parasite – live on the host for a short period of time

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 6. Spurious Parasite – a free-living organism that passes through the  2nd: either water vegetation or crab
digestive tract without infecting the host. (Paragonimus westermani), snail, ants
7. Intermittent Parasite – visits the host only when they are hungry  Infective Stage: Metaserkaria
 E.g. mosquitoes (Anopheles minimus flavirostris)  MOT: Ingestion
 Only females bite (to nourish the eggs they will  Exception: Schistosome (blood fluke); get the parasite
produce) = agents of diseases through skin penetration
 Males feed from the nectar of flowers 3. Food-Borne
 1º (principal) vector: Plasmodium sp. = malarial  Contaminating the food you are eating
parasites  E.g. Cestodes (Taenia solium [Pork tapeworm] and
 Not found in urban áreas Taenia saginata [Beef tapeworm])
 Bites at a certain angle  Infective Stage: cysticercus
 Active only at night  Cellulose = pork
 Aedes – tiger mosquitoes; may reside along with Culex  Bovis = beef
 Culex – found in Canals 4. Sexually Transmitted
**Aedes and Culex bites horizontally  Infective Stage: Embryonated Egg, Trophozoite for
Trichomonas
C. According to Pathogenecity  MOT: Ingested/Inhalation (small particles/eggs);
 Relative ability of a parasite to cause diseases/infection sexually transmitted
1. Pathogenic – Entamoeba histolytica (only pathogenic intestinal parasite)  Males: Urethral Discharges
 May invade extraintestinally; erratic parasite:  Females: Vaginal Discharges
 In liver – hepatic amoebiasis 5. Vector Transmitted
 Brain: cerebral amoebiasis  Botanical and Environmental
 Skin: cutaneous amoebiasis  MOT: Bite of an infected vector
 Genitalia: genital amoebiasis  Miscellaneous MOT: Breast Feeding (Ancylostoma –
2. Non-pathogenic = commensal – Entamoeba coli hookworms), skin penetration
 Entamoeba hartmanni – parasite of the dog (Hookworm/Schistosoma)
**Both are seen in the intestine and feces  Infective Stage: Filariform larvae
**Happens when the food you eat has minute presence of feces (fecally contaminated  HATS: Hookworm, Ascaris, Trichuris, Strongyloides
food)
TYPES OF HOSTS
D. According to Mode of Transmission (MOT) 1. Definitive/Final Host – harbors the sexual form/stage of mature parasite
 Manner by which the parasite goes into a susceptible host to get  Where the parasite attains sexual maturity
infected.  E.g. taeniasis = humans are the DF
 Infective Stage: Mature Cyst 2. Intermediate Host – harbors the larval/asexual form of a parasite
1. STH (Soil Transmitted Helminths)  IH of Taenia spp = pigs/cattle
 Parasites whose part of the life-cycle is soil  IH of Schistosoma spp = snails
 E.g. Ascaris lumbricoides, Trichuris trichiura, 3. Paratenic Host – harbors the infective stage of the parasite
Enterobius vermicularis (Nematodes)  The parasite does not develop further to later stages
 Infective stage: embryonated egg  Widens the parasite distribution and bridge the ecological gap between
 MOT: Ingestion the DH and IH
2. Snail Transmitted  E.g. Paragonimus metacercaria
 Life cycle requires snails  E.g. Paragonimus westermani (Oriental Lung Fluke)
 Belong to the group of Trematoda  Cough has mucus sample containing blood
 Requires 2 IH (Intermediate Host)  Eat freshwater crabs to obtain (NOT PH)
 1st: Snail  PH: wild boar
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4. Reservoir Host – harbors the adult stage of the parasite  Autoinfection – results when an infected individual becomes his own direct
 Allow the parasite’s life cycle to continue and become additional source of infection.
sources of human infection  Enterobiasis = infection may occur through hand-to-mouth
 Non-human definitive hosts transmission
 E.g. Balantidium coli – pigs; Paragonimus westermani – field rats;  Infective eggs may end up in hands by scratching
Brugia malayi – cats the perianal areas where the gravid females lay
their eggs
TYPES OF STOOL SAMPLE  Capillaria philippinensis – multiply internally
 Classified based on consistency: WHO  Superinfection/Hyperinfection – happens when the already infected
**Consistency = how hard your feces is individual is further infected with the same species leading to massive
1. Formed – very formed shape that is visible infection with the parasite
2. Soft  Alteration in the normal life cycle of Strongyloides result in
3. Loose – presence of sediments/cellular debris a large increase in worm burden = severe debilitation
4. Watery (increase in the proportion of rhabditiform larvae that
 Formed or soft = cyst = use of Lugol’s Iodine (KI +I2 transform into filariform larvae in the gut)
 Loose or watery = trophozoite (should be processed within 30 minutes to
recover the trophozoite) = lab vulnerable stage MODES OF TRANSMISSION
 stain = methylene blue  Most common source of parasitic infection: contaminated food and water
 trophozoites are toxic to toilet water  Mouth: most likely portal of entry
**DFS = stained before unstained 1. Food-Borne
 Taenia solium, Taenia saginata, and Diphyllobothrium
VECTORS Latum from food harboring the infective larval stages
 Responsible for transmitting the parasite from one host to another  Enamoeba histolytica and Giardia lamblia from drinking
1. Biological Vector – transmits the parasite only after the parasite has water contaminated with cysts
completed its development within the host  Clonorchis, Opistorchis, and Haplorchis through ingesting
 essential part of the parasite’s life cycle raw or improperly cooked freshwater fish containing
 E.g. an Aedes mosquito sucks blood from a patient with infective larvae
filiariasis = parasite undergoes several stages of 2. Skin Penetration
development (1st – 3rd stage larva before infective stage) is  Hookworms and Strongyloides enter via exposure of nail to
transmitted to another susceptible host soil; Schistosoma spp enter skin via water
2. Mechanical/Phoretic Vector – only transports the parasite 3. Bites
 E.g. flies and cockroaches – feed on fecal materials and may  Arthropods serve as vectors (Agents of malaria, filiariasis,
carry enteric organisms and transfer these to food (ingestion) leichmaniasis, trypanosomiasis, and babesiosis)
4. Congeital Transmission
EXPOSURE AND INFECTION  Taxoplasma gondii trophozoites can cross the placental
 Carrier – harbors a particular pathogen without manifesting any signs and barrier during pregnancy
symptoms  Ancylostoma and Strongyloides – transmammary infection
 Exposure – process of inoculation an infective agent (breast feeding) through mother’s milk
 Infection – connotes the establishment of the infective agent in the host 5. Inhalation
1. Incubation Period (Clinical Incubation Period) – period between  Airborne eggs of Enterobius and sexual intercourse as in the
infection and evidence of symptoms case of Trichomonas vaginalis
2. Pre-patent Period (Biological Incubation Period) – period between
infection or acquisition of the parasite and evidence or demonstration
of infection

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NOMENCLATURE  Can be used in whole populations or in defined risk groups
 Animal parasites are classified according to the International Code of  Targeted Treatment – group-level deworming where the (risk) group to be
Zoological Nomenclature: treated (without prior diagnosis) may be defined by age, sex, or other social
 Phylum  Classes  Orders, Families, Genera, Species characteristics irrespective of infection status
**Further divisions of suborder, superfamily, and subspecies may  Universal Treatment – population-level deworming in which the
be employed community is treated irrespective of age, sex, infection status, or other
 Scientific Names: latinized social characteristics
 Family Names: formed by adding –idea to the stem of the  Preventive Chemotheraphy – the regular, systematic, large-scale
genus type intervention involving the administration of one or more drugs to selected
 Generic Names: consist of a single word written in initial population groups
capital letters  Aims to reduce morbidity and transmission of selected helminth
 Specific Name: always begins with a small letter infections
 Genera and species are written in italicized or underlined  Coverage – the proportion of the target population reached by an
intervention
EPIDEMIOLOGIC MEASURES  E.g. % of school-age children treated during a treatment day
 Epidemiology – study of patterns, distribution, and occurrence of disease  Efficacy – effect of a drug against an ineffective agent in ideal experimental
 Incidence – number of new cases of infection appearing in a population in conditions and isolated from any context
a given period of time  Effectiveness – measure of the effect of a drug against an infective agent in
 Prevalence – number (%) of individuals in a population estimated to be a particular host, living in a particular environment with specific ecological,
infected with a particular parasite species at a given time immunological, and epidemiological determinants
 Cumulative Prevalence – percentage of individuals in a  Measured by means of qualitative and quantitative diagnostic
population infected with at least one parasite tests that detect eggs or larvae in feces or urine
 Intensity of Infection – refers to burden of infection that is related to the  Cure Rate and Egg Reduction Rate are indicators used to measure
number of worms per infected person the reduction in prevalence and intensity of infection, respectively
 May be measured directly or indirectly and is also referred to as  Drug resistance – genetically transmitted loss of susceptibility to a drug in
the worm burden a parasite population that was previously sensitive to the appropriate
 Soil-Transmitted Helminths = measured directly by counting therapeutic dose
expelled worms during treatment, or indirectly by counting
helminth eggs excreted in the feces (number of eggs per gram PREVENTION AND CONTROL
[epg])  Morbidity Control – is the avoidance of illness cause by infections
 Morbidity – clinical consequence of infections or infections that affect an  Achieved by periodically deworming individuals or groups (those
individual’s well-being at risk of morbidity)
 Information-education-communication (IEC) – health education strategy
TREATMENT that aims to encourage people to adapt and maintain heathy life practices.
 Deworming – use of anthelminthic drugs in an individual or a public health  Environmental Management – planning, organization, performance, and
program monitoring of activities for the modification and/or manipulation of
 Cure Rate – refers to the number (%) of previously positive subjects found environmental factors or their interaction with human beings with a view to
to be egg negative using a standard procedure at a set time after deworming preventing or minimizing vector or intermediate host propagation and
 Egg Reduction Rate (ERR) – is the percentage fall in egg counts after reducing contact between humans and the infective stage
deworming based on examination of a stool or urine sample using a standard  Environmental Sanitation – involves interventions to reduce environmental
procedure at a set time after the treatment health risks (safe disposal and hygienic management of human and animal
 Selective Treatment – involves individual-level deworming with selection excreta, refuse and waste water)
for treatment based on a diagnosis of infection or an assessment of the  Control of vectors, IH, and reservoirs of disease
intensity of infection or presumptive grounds  Covers the provision of safe drinking water and food safety

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  Housing that is adequate in terms of location, quality of shelter,  Hemoflagellates and other helminth parasites
and indoor living conditions  The trophozoites of Entamoeba histolytica secrete cysteine proteinases =
 Facilities for personal and domestic hygiene; safe and healthy allows the parasite to penetrate the mucosa and adhere to the underlying
working conditions layer and surrounding tissues
 Sanitation – provision of access to adequate facilities for the safe disposal  The cercariae of Schistosoma contain penetration glands (produce an
of human excreta , usually combined with access to safe drinking water. enzyme capable of digesting the skin; allows entry into the body of the host)
 All cestode embryos have six hooklets (aids in tissue penetration before
ERADICATION VS ELIMINATION developing into encysted larvae)
 Disease Eradication – permanent reduction to zero of the worldwide
incidence of infection caused by a specific agent (result of deliberate efforts) EFFECTS OF PARASITE ON HOST
 If achieved, no more continued measures  The most common mechanism to cause injury to the host is by interference
 Disease Elimination – reduction to zero of the incidence of a specified with the vital processes of the host through parasitic enzymes.
disease in a defined geographic area as a result of deliberate efforts.  Entamoeba histolytica tophozoites = secrete cysteine proteinase (digest
 Continued intervention or surveillance measures are still required cellular materials and degrades epithelial BM = true invasion)
____________________________________________________________________________  Invasion and destruction of host tissue
HOST-PARASITE RELATIONSHIPS  Plasmodium = invades RBCs; after multiplying, RBCs rupture
- Adaptation = changes in the molecular biology, biochemistry, immunology, and and release merozoites
structure of the parasite  Schistosoma japonicum = cumulative disposition of eggs in the
 Parasites are more specialized the greater the change liver (immune response mechanism = granuloma formation 
 Most noticeable = locomotory and digestive organs fibrosis  portal hypertension and massive hemorrhage in the
 Phylum Apicomplexa = no locomotory organelles, mostly venules)
parasitic  Hookworms = cutting plates (attach to the intestinal mucosa and
 Free-living flatworms = have cilia on their epidermis destroy the villi
 Parasitic cestodes and trematodes = tegument (microvilli; obtain  Ascaris = forms tangled masses that can lead to intestinal
nutrients) obstruction; if in the intestine = may invade the appendix and bile
 Flatworms = highly specialized organs of attachment (hook and ducts = surgical emergency
suckers; anchors the parasite inside the body of the host and  Deprive the host of essential nutrients and substances
facilitate tissue migration  Heavy hookworm infections = massive intestinal bleeding =
 Adult Ascaris = maintain position inside intestinal wall by chronic blood loss and iron deficiency anemia
constant movement; integument is thickened (to resist enzymes  Diphyllobothrium latum competes with host for available supply
and juices in the digestive tract; protection against dessication and of Vitamin B12 = megaloblasticanemia
physical injuries)
 Intestinal flukes = tegument is covered with spines (prevent EFFECTS OF HOST ON PARASITE
abrasion); special coverings of ova, larvae, and cysts protect the  Genetic make-up of the host may influence the interaction between host and
parasite during its free-living stage (also aids in resisting digestive parasite
juices one parasite is ingested)  Falciparum malaria = possession of sickle-cell trait confers some
 Reproductive System of flatworms= highly elaborate and complicated protection
 All tapeworms and flukes are hermaphroditic (except  Duffy blood factor = higher susceptibility of an indiv. To
Schistosoma spp) Plasmodium vivax infection
 Flukes undergo asexual reproduction in IH to increase in number  Nutritional status of the host
of progeny  Diet rich in protein is not suitable for the dev’t of intestinal
 Streamlining = loss of certain metabolic pathways common to free-living protozoans
organisms (inability of the parasite to synthesize certain cellular  Low protein diet = appearance of symptoms of amebiasis
components and the need of the parasite to obtain these from the host.  High carbohydrate diet = dev’t of some tapeworms

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  Immune processes PHYLUM SARCOMASTIGOPHORA
 Absolute immunity to reinfection = occurs rarely ff. protozoan Subphylum Sarcodina Acanthamoeba castellani
infections and never happens with helminth infections in humans Endolimax nana
 Acquire immunity = modifying the severity of disease in endemic Entamoeba coli
areas. Entamoeba dispar
____________________________________________________________________________ Entamoeba gingivalis
PARASITES WITH MEDICAL AND PUBLIC HEALTH IMPORTANCE Entamoeba hartmanni
- All parasites can be classified according to the Linnaean hierarchical scheme: Entamoeba polecki
 Kingdom  Subkingdom  Phylum  Class  Order Family  Genus Entamoeba moshkovski
 Species Entamoeba histolytica
 Based on morphological characterization found in the different stages of Ioadamoeba butschlii
parasitic development Naegieria fowleri
- Molecular studies = provide elucidation of the taxonomic relationship of parasites at
the subcellular level Subphylum Mastigophora
 Molecular Techniques – shows structural differences among parasites; Atrial Flagellates Chilomastix mesnili
useful in the identification of cryptic protozoan parasites and their sibling Dientamoeba fragilis
species Giardia lamblia
 DNA Extraction and Sequencing Trichomonas tenax
 Proteome Analysis Trichomonas vaginalis
 RNA Interference Trichomonis hominis
 Polymerase Chain Reaction (PCR)
Hemoflagellates Leishmania braziliensis
PROTOZOA Leishmania donovani
 Parasitic infections are due to: unicellular protozoan or the multicellular Leishmania tropica
metazoan Trypanosoma brucei complex
 Provided with a nucleus or nuclei, cytoplasm, an outer limiting membrane, Trypanosoma cruzi
and cellular elaborations (organelles) PHYLUM CILIOPHORA Balantidium coli
 Locomotory Apparatus: Cilia, Flagella, Pseudopodia
PHYLUM APICOMPLEXA Babesia spp.
 Presence of Apical Complex (aids the organism in the penetration of target
Cytosporidium hominis
cells)
Cyclospora cayetanensis
 Many require a wet environment for feeding, locomotion, osmoregulation,
Cytoisospora belli
and reproduction (Trophozoite Form)
Plasmodium spp.
 Forms the infective stage (cysts) = relatively resistant to environmental
Toxoplasma gondii
changes compared to the vegetative stages (trophozoite)
PHYLUM MICROSPORA Enterocytozoon bienuesi
 Multiply within the host and may be transmitted through a biological vector
Encephalitozoon spp.
where they can also multiply
Vittaforma cornea
 All protozoa fall under Kingdom Protista
Trachipleistophora hominis
 A diverse group of eukaryotic microorganisms
Pleistophora spp.
 Divided into several phyla
Anncalilia vesicularum
 Major organisms causing disease in man: Phylum Microsporidium spp.
Sarcomastigophora, Phylum Ciliophora, Phylum Apicomplexa,
and Phylum Microspora
PHYLUM SARCOMASTIGOHPORA
1. Subphylum Mastigophora – organelles of locomotion are whip-like
structures arising from the ectoplasm (flagella)

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 2. Subphylum Sarcodina - organelles of locomotion are hyaline foot-like  MOT:
extrusions from the ectoplasm (pseudopodia)  Ingestion of embryonated eggs = Ascaris, Trichuris, and
Enterobius
PHYLUM CILIOPHORA  Skin penetration by filariform larvae = hookworms and
 Organelles of locomotion are hair-like projections from the ectoplasm Stongyloides
(cilia)  Bite of mosquito = Wuchereria and Brugia
 Parasite of medical and public health interest: Balantidium coli  Ingestion of infective larvae = Capillaria (fish), Trichinella
(pork), and Parastrongylus (snails)
PHYLUM APICOMPLEXA  Autoinfection = Capillaria, Strongyloides, and Enterobius
 Its members have an apical complex at the anterior end  Inhalation of embryonated eggs = Enterobius and Ascaris
 Consists of polar rings, subpellicular tubules, conoid processes,  Roundworms with Phasmids – phasmid nematodes (Secernentia)
rhoptries, and micronemes  w/o = aphasmid worms (medical and public health importance =
 These are involved in the penetration and invasion of target cells [Adenophorea] Trichuris, Trichinella, and Capillaria)
 Class Sporozoa – have been reported practically from all organ  Ascaris = Ascaridida
systems of both humans and animals (GI Tract, Genitourinary Tract,  Parastrongylus and hookworms = Strongylida
CNS, Respiratory Tract, Reticuloendothelial System, Blood and Blood  Strongyloides = Rhabditida
Cells, Eyes, Skin, Oral Cavity)  Enterobius = Oxyurida
 Plasmodia, Babesia, Toxoplasma, Cytoisospora,  Kingdom Animalia
Cryptosporidium, and Cyclospora  Metazoan parasites are either: Helminths or Arthropods

PHYLUM MICROSPORA
CESTOIDEA
 Includes Enterocytozoon and Encephalitozoon CYCLOPHYLIDEA Dipylidium caninum
 Consists of spore-forming parasites of both vertebrates and Echinococcus spp.
invertebrates Hymenolepis diminuta
 Contains >100 genera, has similar members Hymenolepis nana
 They possess a unique extrusion apparatus (enables them to insert Raillietina garrisoni
infective material into the host cell); the apparatus includes a highly Taenia saginata
coiled polar filament Taenia solium

NEMATODES PSEUDOPHYLIDEA Diphyllobothrium latum

 Roundworms = elongated and cylindrical in shape, with bilateral symmetry Spirometra spp.
 Have a complete digestive tract and muscular pharynx (triradiate) TREMATODA Artyfechinostomum malayanum
 Provided with separate sexes; some may be parthenogenetic Clonorchis sinensis
 Anterior End Sensory Organ: Amphids Echinostoma ilocanum
 Posterior End Sensory Organ: Phasmids Fasciola hepática
 Can be grouped on the basis of the habitat of the adult worms Fasciolopsis buski
 Most are found in the small and large intestines; some are found outside the Heterophyids
intestines Opistorchis felineus
 Small intestines = Ascaris, hookworms, Strongyloides, and Opistorchis viverrini
Capillaria Paragonimus westermani
 Colon = Trichuris and Enterobius Schistosoma haematobium
 Extraintestinal = Wuchereria and Brugia (lymph nodes and Schistosoma japonicum
lymph vessels), Parastrongylus (eyes and meninges), Larvae of Schistosoma mansoni
Trichinella (encysted; host muscles)

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ARTHROPODS Mites  Segements/Proglottids nearest the neck = immature 
ARACHNIDA Scorpions increasingly mature segments  gravid segments
Spiders (most distal)
Ticks  Medical and Public Health significance: Order Pseudophyllidea
and Order Cyclophyllidea
CHILOPODA Centipedes  Differ in terms of the morphology of the scolex,
CRUSTACEA Copepods, Crabs segments, and eggs, also the number of IH and the type
DIPLOPODA Millipedes of encysted larvae that develop
INSECTA Flies, Fleas, Beetle, Bees, Lice, Wasp, Bugs,  Pseudophyllidean Tapeworms – spatulate scolex with
Mosquitoes sucking grooves (bothria)
PENTASTOMIDA Tongue Worms  Segment has genital pores and uterine pores
(allows release of eggs from the gravid
uterus)
ARTHROPODS  No segments are found during infection
 Bilaterally symmetrical organisms with segmented and jointed appendages  Pseudophyllidean Eggs = operculated and
 The body is covered with chitinous exoskeleton immature; require aquatic dev’t of the
 Pentastomids/Pentastomes – may be included due to having attributes of embryo (coracidium)
both arthropods and annelids  Require 2 IH
 How they affect human health:  1st: eggs encyst as procercoid
 Envenomation – bites of spiders, flies, bugs, mites, and ticks larvae
o Stings of scorpions, ants, wasps, and bees  2nd: placercoid larvae from 1st
 Health hazard = exposure to arthropod allergens  Cyclophyllidea Tapeworms – globular scolex with 4
 Feeds on human blood = flies and mosquitoes (biological vectors to: muscular suckers
Plasmodium, Babesia, Leishmania, filarial, and trypanosomes)  Segment has genital pores but no uterine
 Mechanical vectors of microbes and parasites = flies and cockroaches pores
(inhabit unsanitary environments)  Undergo the process of apolysis (gravid
 Fleas and Lice = dermatologic manifestations (prolonged contact with segment are detached from the main body of
human host) the worms to release the eggs)
 Fly larvae = infestation and invasion of human tissues (myiasis)  Infections = eggs and segments are recovered
 Non-Operculated Eggs; passed out readily
PLATYHELMINTHES and contains hexacanth embryo
 Dorso-ventrally flattened with bilateral symmetry  1 IH
 No circulatory system  Different Species producing different ypes of
1. Cestodes encysted larvae produced in IH:
 Tapeworms  Taenia = cysticercus
 Segmented, ribbon-like appearance  Hymenolepis, Dipylidium, and
 Absent digestive tract Raillietina = cysticercoid type
 Adult = hermaphroditic; Habitat: Intestines of DH  Echinococcus spp = hydatid
 Larva = encysted in the tissues of the IH  Infection w/ Adult Tapeworms = consumption of infected IH
 Anterior structure = Solex (main organ of attachment of the worm  Larval Stage of Taenia solium = cysticercosis
to the DH)  Echinococcus spp = hydatid cyst
2. Trematodes
 Solex  Neck  Strobila
 Flukes
 Neck = region of growth (segmentation or strobilization occurs)
 Unsegmented, leaf-like
 Incomplete digestive tract
“I can do all things through Christ who strengthens me.” (Philippians 4:13) TMSH
  Adult Flukes = has oral sucker, ventral sucker (acetabulum), and Look alikes:
genital sucker/gonotyl (ONLY in heterophids) Entamoeba polecki – swine amoeba
 Require 2 IH in their life cycle Entamoeba hartmanni – small race; dogs
 1st: ALWAYS snail **Differentiate through PCR (polymerase chain reaction)
 2nd: fish/crustacean/another snail/fresh water plants
 Operculated eggs Entamoeba coli
 IS: encysted larva (metacercaria; develops in the 2nd IH) - Bigger than E. histolytica; 8-16 nuclei
 Exception is the schistosomes: IS = cercaria - Chromatoidal bar: witch broom appearance
 Grouping is based on habitat: - Single nucleus with eccentric karyosome
 Adult schistosomes = mesenteric veins (blood flukes) - Coarse granulation in nuclear membrane
 Adult Paragonimus worms = lung parenchyma - Multiple pseudopodia: sluggish; non-directional; bluntly shaped
 Fasciola, Clonorchis, and Opisthorchis = liver and bile - Thick-walled
passages - Commensal
 Fasciolopsis, Echinostoma, and heterophyids = - Dirty looking cytoplasm; inclusions:
intestines Budded form yeast = 2 circular shapes (one big, one small)
 Matured eggs = embryo (miracidium) Bacteria is food for the parasite
 Schistosoma, Clonorchis, Opistorchis, and Fecal debris
heterophyids - Early cystic stage: mononucleated
Binary division
 Immature eggs = miracidium develops in aquatic environment
8 nuclei = infective stage
 Paragonimus, Fasciola, Fasciolopsis, and
Echinostoma
____________________________________________________________________________ DIFFERENTIATING:
# of nuclei = >4 = E.coli
PROTOZOANS
Cystic wall
- Diagnostic Stages: Trophozoite and Cyst (except Entamoeba gingivais)
Chromatoidal bar ** (may or may not be seen in the cyst right away)
AMOEBAE
- 3C’s generalization: MISCELLANEOUS
1. Iodamoeba butschlii
1. All are commensal organisms; except for E. histolytica
2. Cyst; except for E. gingivalis  Trophozoite
3. Colon: habitat; except for E. gingivalis (oral cavity) o Basket of flowers appearance
o Presence of achromatic granules
Entamoeba histolytica o Eccentric karyosome
- Thin walled  Cyst
- Only pathogenic amoebae o Oval in shape
- Finger-like o Mononucleated
- Mucoid and bloody stool o Large iodine stained glycogen vacuole
- Flask shaped ulceration = invasive (cysteine proteinase enzyme) **Blastocystis hominis = yeast-like organism (BEFORE); brings about diarrhea;
- Trophozoite may be confused with cyst form (bigger vacuole and more circular than cyst)
o Contains an RBC 2. Endolimax nana – non-pathogenic
o hematophagous = diagnostic  Cyst
o Bullseye appearance of the nucleus; centrally located karyosome o Cross-eyed appearance
o Fine chromatin in nuclear membrane = clean-looking o Quadrinucletaed
- Early cystic stage: mononucleated o Presence of eccentric karyosome
o 4 nuclei = infective stage
o Binary Division
“I can do all things through Christ who strengthens me.” (Philippians 4:13) TMSH
FLAGELLATES - Cyst:
- Giardia lamblia/duodenalis o Cilia enclosed in a cystic wall
o Ingest at least 10 cysts and you are infected o Non-motile
- Diagnosis: Stool Exam o Macronucleus = metabolic activities
o Entero Test (Beale’s String Test) – capsule with thread = capsule dissolves o Micronucleus = at the concavity of the macronucleus (contains the DNA
= thread stays at intestinal mucosa = thread will stay for 4 hours and will and is for sexual reproduction)
get pulled o Presence of contractile vacuoles
- Giardiasis = Traveller’s Diarrhea/Gay Bowel Syndrome (unusual sexual - Trophozoite
practices)/Beaver Fever, Backpacker’s Diarrhea o Elongated
- Cyst: o Cilia = thrown ball/rolling motion
o 4 nuclei o Swallows using the cytostome (mouth; where the food enters)
o Presence of axoneme o Cytopyge (where excreta exit)
o bigger than E. nana; o Contractile vacuoles present
- Trophozoite: ____________________________________________________________________________
o Presence of axostyle (midline = bilateral symmetry) CHAPTER 2
o Basal bodies = energy source PROTOZOAN INFECTIONS
o 2 ventral sucking disks = for attachment; adheres to intestinal mucosa
o 2 nuclei inside sucking disks INTESTINAL AMOEBAE
- Entamoeba histolytica, Entamoeba dispar, Entamoeaba moshkovskii, Entamoeba
o 4 pairs of flagella coli, Entamoeba hartmanni, Endolimax nana, Iodamoeba butschlii.
o Old man’s face w/ eyeglasses appearance - Entamoeaba polecki – intestinal ameba of pigs and monkeys occasionally seen in
o Falling-leaf motility humans; diarrhea may occur
o Contains specific protection (variant specific surface proteins [enzymes - Trophozoites = divide by binary fission
used for protein degradation protection]) - Cyst-forming amebae = nuclear division and divide again after excystation in a new
o Side view = paddle of table tennis host.
- Using saline and methylene blue, Entamoeba spp. Will stain blue; differentiating them
o Does not go out extraintestinally
from WBCs
o Pathogenic but not invasive - Serological tests – monitoring of a cyst carrier
o Adheres to surface of intestinal mucosa  Indirect hemagglutination (IHAT)
 Increase mucus production o Can detect antibodies of a past infection (even from 10 years ago)
 Blocks/no absorption of nutrients (fats)  Counter immunoelectrophoresis (CIE)
 Stool sample contains a lot of fats (steatorrhea)  Agar gel diffusion (AGD)
 Indirect fluorescent antibody test (IFAT)
 Triglycerides (fats) will stain orange after Sudan III/IV
 Enzyme-linked immunosorbent assy (ELISA)
or Oil Red O
Entamoeba histolytica
PHYLUM CILIOPHORA  Classified under Subphylum Sarcodina, Superclass Rhizopoda, Class Lobosea,
Balantidium coli Order Amoebida, Family Entamoebidae, and Genus Entamoeba
- Found in pigs o Characteristics of Genus Entamoeba:
- Obligate parasite  Vesicular nucleus
 Central (or near central) located small karyosome
- Biggest protozoan
 Varying numbers of chromatin granules adhering to nuclear
- usual treatment: tetracycline
membrane
- Pathogenic and Invasive  To distinguish: Entamoeba spp. Except E. histolyica, E.
o Ulcerating intestinal mucosa (flask-shaped ulceration) = hyaluronidase dispar, and E. moshkovskii (Laredo strain)
enzyme  Morphologically identical
o Bleeding occurs; mucoid and bloody stool = Balantidial dysentery  Same size
- Those handling the pigs may have this parasite  Differentiated through: isoenzyme analysis
- IS: mature cyst polymerase chain reaction (PCR), restriction

“I can do all things through Christ who strengthens me.” (Philippians 4:13) TMSH
 fragment length polymorphism (RFLP), and  Infection = cysts are ingested from fecally-contaminated material (food and
typing with monoclonal antibodies water)
 E. hartmanni (“small race” of E. histolytica) is  MOT:
differentiated on the basis of size o Venereal transmission through fecal-oral contact
 Pseudopod-forming non-flagellated protozoan parasite o Direct colonic inoculation through contaminated enema equipment
 Most invasive of the Entamoeba parasites  Excystation occurs in a small or large bowel
 Only member of the family to cause colitis and liver abscess o Cyst undergoes nuclear division followed by cytoplasmic division to
 Life Cycle = 2 Stages: form 8 trophozoites
o Humans are the only hosts implicated in the life cycle  A eukaryotic organism that lacks organelles that morphologically resemble
o Infective Cyst mitochondria.
 Quadrinucleated  Mitochondrial genes (pyridine nucleotide transhydrogenase and hsp60) are
 Resistant to gastric acid and desiccation present, meaning it may have contained a mitochondria
 Can survive in a most environment for several weeks  No Rough ER or Golgi apparatus
 Spherical  Cell surface and secreted proteins contain signal sequences
 Vary in size from 10-20 micrometers  Tunicamycin inhibits protein glycosylation
 Highly refractive cyst wall  Ribosomes form aggregated crystalline arrays in the cytoplasm of the trophozoite
 Lack of glutathione metabolism
 Rod/cigar-shaped chromatoidal bar
 Use of pyrophosphate instead of ATP at several steps in glycolysis
 Never found within invaded tissues
 Inability to synthesize purine nucleotides de novo
 Undergoes 2 successive nuclear divisions to form a
 Glucose is actively transported into the cytoplasm where the end products of
quadrinucleate cyst
carbohydrate metabolism are: EtOH, CO2, and under aerobic conditions, acetate
 For detection: Formalin Ether/Ethyl Acetate Concentration  Mechanism for virulence:
Test (FECT) and Merthiolate Iodine Formalin Concentration o Production of enzymes or other cytotoxic substances
Test (MIFC); note the ff: o Contact-dependent cell killing
 Size of cyst o Cytophagocytosis
 Number of nuclei  In vitro killing of mammalian cells
 Location o Receptor-mediated adherence of amoeba to target cells
 Appearance of Karyosome o Amebic cytolysis of target cells
 Appearance of Chromatoidal Bodies o Amebic phagocytosis of killed or viable cells
 Presence of cytoplasmic structures (glycogen  Susceptibility of humans is associated with specific alleles of the HLA Complex
vacuole)  Asymptomatic infections with cysts being passed out into the stool (cyst carrier
o Invasive Trophozoite form state)
 Highly motile  Amebic colitis
 Possess pseudopodia o Clinically presents with the gradual onset of abdominal pain and
 Vary in size from 12-60 micrometers in diameter (ave 20 diarrhea with or w/o blood and mucus in the stool.
micrometers) o May be sudden after an incubation period of 8-10 days
 Progressive and directional movement o Perforation and secondary bacterial peritonitis
 Multiply via Binary Fission  Fever is not common and only occurs in 1/3 of patients
 Hyaline pseudopodium  Intermittent diarrhea alternating with constipation
 Formed when the clear, glasslike ectoplasm, or  Children = develop fulminant colitis with severe bloody diarrhea, fever, and
outer layer is extruded abdominal pain
 Granular endoplasm flows into it  Ameboma
 Ingested RBC = pale, greenish, refractile bodies in the o Occurs in less than 1% of intestinal infections
cytoplasm of the amoeba o Mass-like lesion with abdominal pain and a history of dysentery
 Have the ability to colonize and/or invade the large bowel o Can be mistaken for carcinoma
 Encyst producing mononucleated cysts o Asymptomatic ameboma may also occur
 Adhere to the colonic mucosa through a galactose-  Amebic liver dysentery (ALA)
inhabitable adherence lectin (Gal lectin) o Most common extra-intestinal form of amebiasis
 Kill mucosal cells by activation of their capase-3 o Cardinal manifestations = fever and right upper quadrant (RQA) pain
= apoptotic death engulfment o Pain is usually at the right shoulder
o In acute cases, Liver is tender (hepatomegaly)
o Rupture into the pericardium (mortality rate = 70%)
“I can do all things through Christ who strengthens me.” (Philippians 4:13) TMSH
 o Rupture unto the pleura (mortality rate = (15-30%) o Mucosal immune response
o Super infections
o Ultrasound, computerized tomography (CT scan), and magnetic COMMENSAL AMOEBAE
resonance imaging (MRI) for early detection - Significant for 2 reasons:
 Killed by activated T-Cells by: 1. The amebae may be mistaken for the pathogenic Entamoeba histolytica
1. Directly lysing trophozoites in a contact-dependent process 2. An indication of fecal contamination of food or water
2. Producing cytokines which activate macrophages and other effector cells - The 3 genera of intestinal amebae can be differentiated through the morphological
(neutrophils and eosinophils) features of their nuclei
3. Provides helper effect for B-cell antibody production o Genus Entamoeba
 Cytokine studies revealed that interferon (IFN) and interlukein (IL-2) have a role o Spherical nucleus
in activating microphages for amebicidal activity o Distinct nuclear membrane lined with chromatin granules
o Activated macrophages produce Nitric oxide (NO) = lethal to o Small karyosome found near the center of the nucleus
trophozoites o Trophozoites usually have only one nucleus
 Tumor necrosis factor (TNF) stimulates NO production o Genus Endolimax
 Acute Stage of Amebiasis = state of immunosuppression o Vesicular nucleus
o T-cell hyporesponsiveness o Relatively large, irregularly shaped karyosome anchored to the nucleus
o Suppressed proliferation and cytokine production by achromatic fibrils
o Depressed delayed-type hypersensitivity (DTH) o Genus Iodamoeba
o Macrophage suppression o Characterized by a large, chromatin-rich karyosome surrounded by a
o Treatment has 2 objectives: layer of achromatic globules and anchored to the nuclear membrane by
1. Cure invasive disease at both intestinal and extraintestinal achromatic fibrils
sites - All species have the following stages: trophozoite, precyst, cyst, and metacystic
2. To eliminate the passage of cysts from the intestinal lumen trophozoite
 Acute amebic colitis should be differentiated from bacillary dysentery of the ff. o Exception of Entamoeba gingivalis (has no cyst stage and does not inhabit
etiology: Shigella, Salmonella, Camylobacter, Yersinia, and enteroinvasive the intestines)
Escherichia coli - Cysts pas through the acidic stomach and remain viable because of protective cyst
o Fever and significantly elevated leukocyte count are less common here walls
o Must first be ruled out before steroid therapy for inflammatory bowel - Excystation occurs in the alkaline environment of the lower small intestines
disease = risk of developing toxic megacolon - Metacystic trophozoites colonize the large intestines and live on the mucus coat
 A minimum of three stool specimens collected on different days should be covering the intestinal mucosa
examined microscopically for the detection of trophozoites and cysts o Noninvasive amebae and do not cause disease
o For detection of trophozoites – fresh stool samples should be examined o Reproduce via binary fission of trophozoites
in 30 mins.from defacation - Encystation occurs as amebae pass through the lower colon where colonic contents
 Using DFS with Saline sol’n only, the trophozoite’s motility are more hydrated
should be observed - Diagnosis is done through stool examination.
 Unidirectional movement should be observed o Formalin ether/ethyl acetate concentration technique (FECT)
 Using saline and Iodine, the nucleus can be observed to differentiate from non- o Iodine stain
pathogenic amebae o Useful to differentiate the species
 Detection of trophozoites with ingested RBCs is diagnostic of amebiasis - Cysts are recovered from formed stools
(Charcot-Leyden crystals may also be seen in the stool) - Trophozoites are best demonstrated by DFS
 Differentiated from E. dispar through PCR (polymerase chain reaction), - In recovering cysts, the use of concentration techniques like FECT and zinc sulfate
enzyme-linked immunoabsorbent assay (ELISA), and isoenzyme analysis flotation is useful
 Metronidazole - No treatment is necessary because these amoebae do not cause disease
o Drug of choice for treatment of invasive amebiasis - Contraction of the organism may be prevented through proper disposal of human
 Tinidazole and secnidazole are also effective waste and good personal hygiene.
o Percutaneous drainage of liver abscess should be done if patients do
not respond Entamoeba dispar
 Asymptomatic cyst passers  Morphologically similar to E. histolytica, but their DNA and RNA is different
o Diloxanide furoate is the drug of choice  Isoenzyme pattern is different from E. histolytica
 50 million infections and 40K-100K deaths per year due to amebiasis
o Vaccines are a cost-effective and potent strategy for prevention and Entamoeba moshkovskii
eradication  First detected in sewage
“I can do all things through Christ who strengthens me.” (Philippians 4:13) TMSH
 Nonpathogenic species that is morphologically indistinguishable from E.  Identification is done via isoenzyme analysis
histolytica and E. dispar
 Differs from the 2 biochemically and genetically Entamoeba gingivalis
 Physiologically unique – osmotolerant (can grow at room temp [25-30C  Found in the mouth/oral cavity
optimum], it is also able to survive at temperatures ranging from 0-41C  Trophozoite:
 Limited pathogenicity in experimental trials in animals o Measures 10-20 micrometers
 Nonpathogenic to humans o Moves quickly
 All human isolates have been reported be to belong to one group: “ribodeme 2” o Has numerous blunt pseudopodia
o Food vacuoles contain cellular debris (mostly leukocytes)
Entamoeba hartmanni o Bacteria are numerous
 Smaller size compared to E. histolytica  Lives on the surface of gum and teeth, in gum pockets, sometimes in tonsillar
 Measure from 3-12 micrometers in diameter crypts
 Mature Cysts:  Abundant in cases of oral diseases
o Measure 4-10 micrometers  Has no cyst stage
o Quadrinucleated  A swab between the gums and teeth is examined for trophozoites
o Have a rod-shaped chromatoid material with rounded or squared ends  Transmission (Direct):
o Does not ingest RBCs o Kissing
o Droplet spray
Entamoeba coli o Sharing of utensils
 Cosmopolitan in distribution
 More common than other human amoebae Endolimax nana
 Trophozoites:  Occurs with the same frequency as Entamoeba coli
o Measure 15-50 micrometers in diameter  Trophozoites:
o Differentiating factors from E. histolytica: o Small (diameter of 5-12 micrometers)
1. More vacuolated or granular endoplasm with bacteria and debris; no RBCs o Exhibit sluggish movement
2. Narrower, less-differentiated ectoplasm o Blunt, hyaline pseudopodia
3. Broader and blunter pseudopodia (feeding > locomotion) o Nucleus has a large, irregular karyosome
4. More sluggish, unidirectional movements o Food vacuoles may contain bacteria
5. Thicker, irregular peripheral chromatin with a large, eccentric karyosome  Cysts:
in the nucleus o Measure the same as trophozoite form
 Cyst differentiation from E. histolytica: o Quadrinucleated when mature
1. Larger size (10-35 micrometers in diameter)
2. More nuclei (8 nuclei at mature form) Iodamoeba butschlii
3. More granular cytoplasm  Trophozoite:
4. Splinter-like chromatoidal bodies o Averages 9-14 micrometers in diameter
o Iodine staining = dark staining, perinuclear masses (glycogen) o Has a large, vesicular nucleus
o Large, centrally located karyosome surrounded by achromatic granules
Entamoeba polecki o No peripheral chromatin granules on the nuclear membrane
 A parasite found in the intestines of pigs and monkeys  Cyst:
 Rarely infects humans o 9-10 micrometers in diameter
 Trophozoites: o Uninucleated
o Sluggish motility o Has a large glycogen body that stains dark brown with Iodine
o Small, centrally located karyosome in nucleus
 Cyst differentiation from E. histolytica: FREE-LIVING PATHOGENIC AMOEBAE
o Consistently uninucleated
o Chromatoidal bars are frequently angular or pointed Acanthamoeba spp.
o Stained fecal smears = nuclear membrane and karyosome are very  Ubiquitous, free-living amoeba
prominent  Culturable Parasite
o Also has a “trailing effect”
Entamoeba chattoni  Characterized by an active trophozoite stage
 Found in apes and monkeys o Thorn-like appendage
 Morphologically identical to E. polecki
“I can do all things through Christ who strengthens me.” (Philippians 4:13) TMSH
 Etiologic agent of Acanthamoeba keratitis (AK) and granulomatous amebic  Polyhexamethylene biguanide, propamidine,
encephalitis (GAE) dibromopropamidine isethionate, neomycin, paromomycin,
 Aquatic organism found in a myriad of natural and artificial environments polymyxin B, ketoconazole, miconazole, and itraconazole
 Can survive in contact lens cleaning solutions  Topical corticosteroids should be AVOIDED (superficial
 No flagellated stage exists as part of its life cycle areas of infection)
 Implicated as possible reservoir hosts for Legionella spp., mycobacteria, and  Deep lamellar keratectomy = procedure of choice
Gram (-) bacilli (E. coli)  Granulomatous Amebic Encephalitis
 Trophozoites: o Documented by Stamm in 1972
o Feed on Gram (-) bacteria, blue-green algae, or yeasts o Causative agent of human GAE
o Reproduce by binary fission o Indirect fluorescence microscopy
o Can adapt to feed on corneal epithelial cells and neurologic tissue o Occurs in immunocompromised hosts (chronically ill and debilitated,
(phagocytosis and secretion of lytic enzymes) those on immunosuppressive agents [chemotherapy and antirejection
o Large Mononucleus medications])
o Centrally located, densely staining nucleolus o AIDS epidemic in 1980 = increase of patients with GAE
o No peripheral chromatin o Signs and Symptoms:
o Large endosome  Destruction of brain tissue
o Finely granulated cytoplasm  Meningeal irritation
o Large contractile vacuole  Fever
o Replicate by mitosis (nuclear membrane does not remain intact)
 Malaise
o IS: Entry = eyes, nasal passages, lower respiratory tract,
 Anorexia
ulcerated/broken skin
o Acanthopodia = small, spiny filaments for locomotion (phase-contrast  Increased sleeping time
microscopy)  Severe headache
 Cysts:  Mental status changes
o Entry = eyes, nasal passages, lower respiratory tract, ulcerated/broken  Epilepsy
skin  Coma
o Ragged edges of outer wall  Hemiparesis
o No peripheral chromatin  Blurring of vision
 Acanthamoeba Keratitis  Dipoplia
o First described in 1974 as an opportunistic ocular surface pathogen =  Cranial nerve defecits
keratitis  Ataxia
o Associated with the use of improperly disinfected soft contact lenses,  Increased intercranial pressure
rinsed with tap water or contaminated lens solution o Post-mortem diagnosis
o Immunocompromised state = increase susceptibility to infection = o Treatment: amphotericin B +, pentamidine isethionate, sulfadiazine,
disseminated disease in the lungs and brain (GAE) flucytosine, fluconazole, or itraconazole
o Symptoms: o DeJonckheere diagnosed it first in 1991
 Severe ocular pain  Hematogenous = route of invasion (from skin/lungs  CNS)
 Blurring of vision  Most affected areas of the brain:
 Corneal ulceration w/ progressive corneal infiltration may o Posterior fossa structures
occur o Thalamus
 Primary/Secondary bacterial infection = hypopyon o Brainstem
formation o Infected areas = leptomeneninges ae opaque and exhibit purulent
 Progression = scleritis and iritis = loss of vision exudates and vascular congestion
 Fungal and Herpetic Keratitis = ruled out  Incubation Period: 10 days
o Diagnosed by epithelial biopsy or corneal scrapings  Clinical manifestations:
o Causative agents: A. castellani, A. culbertsoni, A. hutchetti, A. o Decreased sensorium
polyphaga, and A. rhysoides o Altered mental status
o Treatment: o Meningitis
 Surgical excision of the infected cornea with subsequent o Neurologic deficits
corneal transplantation o Coma  death
 Clotrimazole + Pentamidine, isethionate, and Neosporin

“I can do all things through Christ who strengthens me.” (Philippians 4:13) TMSH
 Have a protean distribution (isolated from a multitude of natural and artificial  Mechanisms: secretion of lytic enzymes,
aquatic environments [fresh and salt water, sewage, hospital equipment, contact membrane pore-forming proteins, factors that
lenses and lens solution]) induce apoptosis, and direct feeding on cells by the
 Ubiquitious in nature = unavoidable exposure amebae
 Robust immune system = prevent infection  Present as fever , nausea, vomiting, headache, nuchal
 Rinsing contact lenses with tap water should be avoide rigidity, and mental status changes (rapid progression to
coma and death)
Naegleria spp.  CSH Characteristics
 Free-living protozoans with two (2) vegetative forms:  Elevated WBC Count with neutrophilic
o Amoeba = trophozoite form predominance
o Flagellate = swimming form  High protein
 Trophozoite  Flagellate = rapid movement towards food  Low glucose
sources  Postmortem examination
**A dormant cyst form is produced in unfavorable conditions  Hemorrhagic necrosis in olfactory bulbs
 Thermophilic organisms (thrives best in hot springs and other warm aquatic  Congestion and edema of neural tissue
environments  Inflamed and congested leptomeninges
 Non-pathogenic and Pathogenic forms exist  Microscopic Examination
 Trophozoites can be identified by the presence of blunt, lubose pseudopodia and  Fibrinopurulent exudate consisting of neutrophils
directional motility. in the leptomeninges and brain tissue
 Most persons infected die prior to institution of effective treatment  Pockets of amebae with scant inflammatory
 Initial CSF results are suggestive of bacterial etiology = treatment with exudates in necrotic areas
antibiotics = no effect/activity against Naegleria  Death of Individual
 Naegleria philippinensis = morphologically indistinguishable; biochemically  Result of cerebral or cerebellar herniation
distinct from other known spp. (increased intercranial pressure)
o Isolated from a thermally polluted stream, an artificially heated pool,  Diagnosis:
and brain aspirate of a young patient  Persons with a compatible history of exposure and
o Responds well to amphotericin B infusion a rapidly progressive meningocephalitis
 Incidental exposure is unlikely to lead to disease  Demonstration of characteristic trophozoites in the
brain and CSF.
Naegleria fowleri  Aspirates from suspected infections,
o Cases disease in humans; some non-fowleri spp. May cause when introduced into bacteria-seeded
opportunistic infections agar culture medium = exhibit active
o Can be nasally infected from contaminated dust trophozoites w/in 24 hours
o Found in Cerebrospinal Fluid (CSF)  Treatment:
o Culturable parasite  Amphotericin B in combination with clotrimazole
 Plated medium must not contain any media at all is synergistic
 Solid  Amphotericin B
 Studded with Escherichia coli  Produces deleterious changes in the
 Trailing effect (clearing) on culture media nucleus and mitochondria of the ameba
 Eating the E. coli growing there  Decreases number of food vacuoles
o Causative agent of primary amebic meningoencephalitis (PAM)  Increases the formation of autophagic
 A rare but rapidly destructive and fatal meningoencephalitis vacuoles.
 Occurs in previously healthy adults with a history of  Exposed ameba = decreased pseudopod
swimming formation and form blebs on the plasma
 Symptoms are indistinguishable from bacterial meningitis membrane
 Route of entry is through the olfactory bulb after accidental  Azithromycin and voriconazole = in vitro and in
inhalation of water containing the organism. vivo
 The sustentacular cells of the olfactory system o Considered a true pathogen
phagocytose the amebae and transport them o Able to survive in elevated temperatures and reproduces rapidly in
through the cribriform plate and into the brain temperatures above 30°C
 Produces a cytopathic effect on host tissues.

“I can do all things through Christ who strengthens me.” (Philippians 4:13) TMSH
 o May proliferate due to warm geothermal plans effluent into lakes and o 30-150 micrometers long and 25-120 micrometers wide
streams o Locomotion = covered with cilia arranged in a longitudinal pattern
o Easily killed by chlorination of water at 1 ppm or higher extending from the oral to the caudal region
o 2 Trophozoite Forms: o Cytostome = tapered anterior end, through which it acquires food (mouth)
 Ameboid – found in humans o Cytopyge = rounded posterior end through which it excretes waste (anus)
 10-35 micrometers; if rounded = 15 micrometers o Macronucleus = bean-shaped; easily identified in stained specimens
in diameter o Micronucleus = round and lies in the concavity of the macronucleus
 Granular cytoplasm and contains many vacuoles o Two contractile vacuoles that act as osmoregulatory organelles
 Large mononucleus o Inhabit the lumen, mucosa, and submucosa of the large intestines, primarily
 Large, dense karyosome the cecal region
 Lacks peripheral chromatin o Contains extrusive organelles = mucocysts (located beneath the cell
 Ameboflagellate membrane)
 Can transform into flagellated forms o Attacks the intestinal epithelium
 Move to an area with food through its extension  Creates a characteristic ulcer
o 3 Stages/Forms in Life Cycle:  Rounded base and wide neck
 Cyst  In contrast to the flask-shaped, narrow necked ulcers of amebiasis
 Not seen in brain tissue o Ulceration caused by the lytic enzyme hyaluronidase
 Thick and smooth cyst wall o Abundant in exudates on mucosal surfaces
 Trophozoite o Inflammatory cells and trophozoites are numerous in the base of the ulcers
 Bluntly shaped pseudopodia o Invade the submucosa and the muscular coat, including blood vessels and
 Sluggish movement lymphatics
 Replicate by promitosis (nuclear membrane o Sigmoidoscopy = diagnostic for presence of trophozoites in biopsy
remains intact) specimens from lesions
 Can turn into temporary non-feeding flagellated o Bronchoalveolar washings may also contain B. coli trophozoites in the case
form (usually reverts back to trophozoite stage) of pulmonary infection
 Infect humans or animals by penetrating the nasal  Cysts
mucosa and migrating to the brain (via olfactory o 40-60 micrometers in diameter
nerves)\found in cerebrospinal fluid (CSF) and o Spherical to slightly ovoid in shape
tissues. o covered with thick cell walls (double walled)
 Flagellated o Unlike amebae, encystation does not result in an increase in number of
 Occasionally found in CSF nuclei
o ingested cysts excyst in the small intestines and become trophozoites
CILIATES AND FLAGELLATES o Infective Stage
 Factors affecting host susceptibility:
Balantidium coli o Nutritional status
 Initially identified/named as Paramecium coli o Intestinal bacteria flora
 Causative agent of the zoonotic disease called balantidiasis, balantidiosis, or o Achlorhydria
balantidial dysentery o Alcoholism
 Largest protozoan parasite affecting humans o Presence of chronic disease
 Only ciliate known to cause human disease  Mucocysts:
 Attacks the intestinal epithelium o Adhesion of parasitic ciliates contributing to parasite virulence
o Ulcer formation = bloody diarrhea; similar to that of amebic dysentery
o Mucocysts in B. coli trophozoites from symptomatic pigs were more
 Normal host: pigs
numerous compared with trophozoites obtained from asymptomatic hosts
 Cause pathologic changes in the colonic wall and mucosa
 Parasite reproduction occurs asexually through asymmetric binary fission,  Clinical Manifestation
although sexual reproduction through conjugation has been reported 1. Asymptomatic carriers
 Parasites encyst during intestinal transport or after evacuation of semi-formed o Do not present with diarrhea or dysentery
stools o Serve as parasite reservoir in the community
 MOT: ingestion of food and/or water contaminated with B. coli cysts 2. Fulminant balantidiasis, or balantidial dysentery
 Incubation period: 4 to 5 days o Diarrhea with bloody and mucoid stools, sometimes indistinguishable
 Trophozoite from amebic dysentery

“I can do all things through Christ who strengthens me.” (Philippians 4:13) TMSH
 o Acute cases o Pair of oval nuclei, one on each side of the midline
 6 to 15 episodes of diarrhea per day o Dorsal side = convex
 Accompanied by abdominal pain, nausea, and vomiting o Ventral side = concave with a large adhesive disk used for attachment
 Associated with immunocompromised and malnourished o Bilaterally symmetrical
o Axostyle = medial line
states
o Propelled into an erratic tumbling motion by 4 pairs of flagella arising
3. Chronic form from superficial organelles in the ventral side
o Diarrhea may alternate with constipation o Divide by Longitudinal Binary Fission
o Accompanied by nonspecific symptoms (abdominal pain or cramping, o Found in diarrheic stools
anemia, and cachexia) o May be found in the jejunum after excystation
 Can spread to extraintestinal sites (mesenteric nodes, appendix, liver, o Feces enters colon  dehydrates  encystation
genitourinary sites, pleura, and lungs) o Have a falling leaf-like motility
 Detection of a cavitary lesion in the right upper lobe of the lung on chest o Detection: Enterotest
radiograph  Patient swallows a gelatin capsule attached to a nylon string
 Bronchoalveolar lavage revealed B. coli trophozoites  One end of the string is attached to the patient’s cheek
 Direct examination or concentration (sedimentation or flotation) techniques  After 4-6 hours, the string is removed and any adherent fluid
 Pulmonary hemorrhage and iron deficiency anemia, and revealed numerous B. is placed on the slide for microscopic examination
coli trophozoites by bronchial biopsy and lavage.  Cysts:
 Complications of balantidiasis o Ovoid
o Include intestinal perforation and acute appendicitis o Measure 8-12 micrometers long by 7-10 micrometers wide
o Young cysts = 2 nuclei
o Associated with intestinal hemorrhage and shock, intestinal
o Mature cysts = 4 nuclei
perforation, or sepsis
 If ingested, pass safely through the stomach and excyst in the
 Tetracycline for adults and older children; contraindicated in children less than duodenum (around 30 mins)
eight years of age and in pregnant women  Develops into trophozoites that rapidly multiply and attach
 Alternative treatments = Iodoquinol, doxycycline and nitazoxanide to the intestinal villi = pathologic changes
 Prevention and Control: o Flagella retracted into axonemes, the median or parabasal body
o Proper sanitation o Deeply stained curved fibrils surrounded by a tough hyaline cyst wall
o Safe water supply secreted from condensed cytoplasm
o Good personal hygiene o Transferred to the mouth via contaminated hands, food, or water
o Protection of food from contamination o Passed out into feces and are infectious after encystation
o Limit contact of pigs with water sources and food crops o Detection: concentration techniques
o Use of pig feces as fertilizer should be avoided. o At least 3 stool examination on alternate days due to spotty shedding
o Easily inactivated by heat and by 1% sodium  Infection may be gained after ingesting 10 cysts
 Ability of parasite to cause disease = ability to alter mucosal intestinal cells once
Giardia lamblia it has attached to the apical portion of the enterocyte
 Also referred to as Giardia duodenalis or Giardia intestinalis o Attached to the intestinal cells via an adhesive sucking disc =
 An intestinal parasitic flagellate of worldwide distribution mechanical irritation in the affected tissues
 Known to cause epidemic and endemic diarrhea o Attachment may be due to temperature (body temp) and pH (7.8-8.2)
 First discovered in 1681 by Antoine van Leeuwenhoek in his own stool o May produce lectin which induces attachment if activated by duodenal
 First described by Lambl in 1859 who called it Cercomonas intestinalis secretions
 Renamed by Stiles in 1915 o Causes alteration in the villi = villous flattening and crypt hypertrophy
 Disease = giardiasis = manifests as a significant but not life-threatening  Decreased electrolyte, glucose, and fluid absorption
gastrointestinal disease  Causes deficiencies in disaccharidases
 Flagellate that lives in the duodenum, jejunum, and upper ileum of humans  Result in malabsorption and maldigestion
 Has a simple asexual life cycle that includes trophozoites and quadrinucleated  Once attached, it is able to avoid peristalsis by trapping itself in between the villi
infective cyst stages or within the intestinal mucus
 Trophozoites:  Rearranges the cytoskeleton in human colonic and duodenal monolayers
o Measure 9-12 micrometers long and 5-15 micrometers wide o Cytoskeleton = Essential for proper cell attachment to the extracellular
o Pyriform or teardrop shaped matrix and the other neighboring cells
o Pointed posteriorly  Changes observed in apoptotic cells

“I can do all things through Christ who strengthens me.” (Philippians 4:13) TMSH
 o Disruption of the cytoskeleton that leads to structural disintegration  Direct oral-anal sexual contact among men who have sex with men may increase
o Detachment from the substrate the risk of giardiasis and infection with other intestinal protozoans
 Causes enterocyte apoptosis  Most giardiasis is water-borne (recreation water or drinking water)
 Disrupts cellular tight junctions  Food-borne outbreaks have also been reported
 Increases epithelial permeability = loss of epithelial barrier function  Low infective dose, prolonged communicability, and relative resistance to
o Luminal contents may penetrate the submucosal layers = more damage chlorine to facilitate the transmission of Giardia through drinking and
in the intestinal tissue recreational water, food, and person-to-person contact
 From ingestion of cysts = 1-4 weeks (average of 9 days) for the disease to  Proper and sanitary disposal of human excreta to prevent contamination of food
manifest and water supply must be done to prevent and control giardiasis
 Half of the patients may be asymptomatic o Food = can be contaminated by the use of night soil as fertilizer, by
 Acute Cases flies, or by infected food handlers
o Abdominal pain, associated as cramping o Water = normal water chlorination will not affects cysts, but usual
o Associated with diarrhea water treatment should be adequate
o Excessive flatus with the odor of “rotten eggs” = Hydrogen sulfide
o Abdominal bloating Trichomonas vaginalis
o Nausea  Sexually transmitted disease = trichomoniasis
o Anorexia  First observed in purulent secretions of male and female urogenital tracts
o Diarrhea = most common symptom (89% of cases)  Often described as the most prevalent non-viral sexually transmitted infection
o Malaise  Flatulence  Cannot live without close association with the vaginal, urethral, or prostatic
 Spontaneous recovery occurs within 6 weeks in mild to moderate cases tissues
 Chronic infections:  Exists only in the trophozoite stage
o Steatorrhea (passage of greasy, frothy stools)  4-28 days after introduction into the vagina,
o Weight loss o Proliferating colonies of the flagellate cause degeneration and
o Profound malaise desquamation of the vaginal epithelium
o Low-grade fever o Followed by leukocytic inflammation of the tissue layer
o Giardiasis should be considered as a possible cause  Trophozoite:
 Cause of the failure-to-thrive syndrome o Pyriform shape = 7-23 µm
 If not found in the feces, duodeno-jejunal aspiration may be done o 4 free anterior flagella that appear to arise from a simple stalk
 Antigen detection tests and immunofluorescent tests are already available as o 5th flagellum embedded in the undulating membrane
commercial kits o Membrane extends to about half the organism’s length
 Immunochromatographic assays detect the presence of Giardia antigen in stool o Median axostyle
 Cyst Wall protein 1 (CWP1) is one of the antigens used for these diagnostic tests o Mononucleated
 Direct fluorescent antibody assays = gold standard o Found in the urogenital tract
o Such assays have the highest combination of sensitivity and specificity o In women, it is found in the vagina but may ascend as far as the renal pelvis
 Giardiasis o Isolated from the urethra, prostate, and less frequently, in the epididymis in
o Treated with metronidazole 250 mg three times a day for 5-7 days men
 Well-tolerated in adults o Multiply by binary fission
 Has a cure rate of 90% o Transferred passively from person to person
o Tinidazole = single dose of 2g for adults and 50 mg/kg for children o MOT: sexual intercourse.
o Furazolidine = 100 mg 4 times daily for 10 days for adults and o Inflammation of the vaginal mucosa occurs several days after inoculation
6mg/kg/day in four divided doses for 7-10 days o Infect the surface but do not appear to invade the mucosa
o Albendazole = alternative at 400 mg/day for 5 days in adults and 10  Acute inflammation
mg/kg/day for 5 days in children o Liquid vaginal secretions
 Equally effective as metronidazole at the above doses  Greenish or yellow in color
o Nitrazoxanide = drug-resistant cases  Covers the mucosa down to the urethral orifice, vestibular glands,
o Treatment = reduces cyst passage and possible transmission especially and clitoris
among high-risk groups such as food handlers, institutionalized  Very irritating and may cause intense itchiness and burning
patients, children attending day care, and day care workers sensation
 In the PH, groups in areas with poor sanitation and hygiene practices have a  Chronic Stage Inflammation
prevalence of giardiasis o Secretion loses its purulent appearance due to:
 Prevalence of giardiasis is significantly higher in male adults rather than females  Decrease in the trichomonads and leukocytes

“I can do all things through Christ who strengthens me.” (Philippians 4:13) TMSH
  Increase in epithelial cells  Associated with greater frequency of sexual intercourse with multiple partners
 Establishment of a mixed bacterial flora and with commercial sex workers
 Vulvitis, and dysuria, trichomonads appear to be associated with an increased
incidence of postpartum endometritis NON-PATHOGENIC FLAGELLATES
 Speculum examination = punctate hemorrhages of the cervix (strawberry cervix) Trichomonas hominis
 Infection in males may be latent and essentially asymptomatic  Occurs only as a trophozoite
 Prostatitis is the most common complication  It has five anterior flagella
 Diagnosis:  Posterior flagellum projecting from an undulating membrane
o Female  The cytostome and the nucleus are situated at the anterior end.
 Saline preparation of vaginal fluid  An axostyle extends from anterior to posterior along the mid-axis.
 The quickest and most inexpensive way to diagnose  MOT: occurs rapidly through fecal contamination of food and drinks.
trichomoniasis  Habitat: Cecal area of the large intestine of humans and primates
 Sensitivity of this technique is low at 60 to 70%
 Culture Trichomonas tenax
 Accepted gold standard  Pyriform in shape
 Takes 2 to 5 days  Observed only in the Trophozoite stage.
 Using Diamond’s modified medium, and Feinberg and  Smaller and more slender than T. vaginalis
Whittington culture medium  It has four free equal flagella and a fifth one on the margin of an undulating
 Unstained wet drop preparations membrane which does not reach the posterior end of the body
 May be fixed and stained by Giemsa, Papanicolau,  Lacks a free posterior extension
Romanowsky, and acridine orange stains  Mononucleated
 Pap smear  Has a cytostome.
 May show trichomonads (sensitivity 60%; specificity  Multiplies via binary fission.
95%).  Thrives on the organisms found in its environment.
 MOT: Kissing, droplet spray from the mouth and usage of contaminated glass
 Antigen detection tests and polymerase chain reaction (PCR)
and plates.
assays
 Harmless and commensal.
 Commercially available, but not widely used locally
 PCR among females does not seem to offer an added  Habitat: Tartar around the teeth, in cavities of carious teeth, and in necrotic
diagnostic advantage mucosal cells in the gingival margins.
 Can survive for hours in drinking water
o Male
 Resistant to sudden changes in temperature
 Diagnosis is more difficult
 Diagnosis: cavity swabs.
 Best results = combination of cultures of urethral swabs
 Pulmonary trichomoniasis has been reported among those with underlying
and urine sediment
chronic pulmonary disease, entering the lungs most probably by aspiration.
 Unable to cause disease on its own
 PCR  The presence of bacteria most probably allows it to proliferate profusely
 Appears to detect more cases than culture among males.
 Treatmeant: metronidazole results in rapid improvement.
 InPouchTM TV Test
 Allows the specimen to be inoculated into a sealed Chilomastix mesnili
pouch with culture media  Lives in the cecal region of the large intestine.
 Growth can be monitored microscopically directly  Well-defined trophic and cystic stages
through the pouch  Corck-screw like motility
 Comparable sensitivity to Diamond’s modified  Presence of spiral grooves
medium culture  Trophozoite
 Treatment: o Asymmetrically pear-shaped as a result of a spiral groove extending through
o Metronidazole or Tinidazole the middle half of the body.
 reported cure rates of these drugs range from 86 to 100%  Cyst
 Sexual partners must be treated concomitantly to prevent o Pear- or lemon-shaped, broadly rounded at one end
reinfection o Somewhat bluntly conical at the other end which has a knob-like
 In pregnancy, metronidazole remains the drug of choice for protruberance.
trichomoniasis. o “Nipple shaped”, American lemon shaped.
 Higher among women of child-bearing age  MOT: ingestion of cysts in food and drinks.
“I can do all things through Christ who strengthens me.” (Philippians 4:13) TMSH
OTHER INTESTINAL PROTOZOANS
Dientamoeba fragilis
Blastocystis hominis  Described as an ameba, is actually a flagellate with only the trophozoite stage
 Infection = Blastocytosis known
 Multiple stool samples should be collected from patients showing clinical signs  Measures 7-12 µm
and symptoms
 One or two (rarely three or four) rosette-shaped nuclei formation
 Life Cycle is unclear
o Begins with ingestion of cysts from contaminated food or water  Nuclear membrane does not have peripheral chromatin
o Upon ingestion, the cyst possibly develops into other forms, which may in  Karyosome consists of four to six discrete granules
turn re-develop into cyst forms  Cytoplasm may contain vacuoles with ingested debris
o When excreted with stools, the cysts contaminate the environment and are  Closely related to and resembles Trichomonas
eventually transmitted to humans and other animals through the fecal-oral  Lives in the mucosal crypts of the appendix, cecum, and the upper colon
route, repeating the cycle  Unknown life cycle
 Multiply via binary fission
 Direct human to human transmission is via:
 Four morphological forms:
o Vacuolated o Fecal-oral route
o Most predominant forms in fecal specimens o Transmission of helminth eggs (Enterobius vermicularis)
o Considered to be the main type of Blastocystis that causes  Mononucleated and binucleated forms have been observed in the lumen of
diarrhea Enterobius adults and eggs present in the intestines
o spherical in shape  Stools from macaques, gorillas, and swine were found to carry D. fragilis
o 5-10 μm in diameter o Animal reservoirs may also be potential sources of human infections
o Large central vacuole pushes the cytoplasm and the four nuclei to
 Does not invade the tissues
the periphery of the cell
 Serves as a reproductive organ  Presence in the intestines
o Sometimes, a very thick capsule surrounds it o Produces irritation of the mucosa
o Amoeba-like/Amoeboid o Secretion of excess mucus
o measuring between 2.5-8 μm o Hypermotility of the bowel
o Occasionally observed in stool sample  Infections are usually asymptomatic
o Exhibits active extension and retraction of pseudopodia.  Onset of infection in symptomatic individual:
o Nuclear chromatin, when visible, characteristically shows
o Usually accompanied by loss of appetite
peripheral clumping.
o Granular o Colicky abdominal pain
o multiple fission o Intermittent diarrhea with excess mucus, abdominal tenderness, a
o More recently, additional cyst and avacuolar forms have been recognized bloating sensation, and flatulence
 Hematoxylin or trichrome staining offers a very convenient and easy method to o Pruritus
differentiate the various stages of Blastocystis  Chronic infection can mimic the symptoms of diarrhea-predominant irritable
 Can be cultured using the Boeck and Drbohlav’s or the Nelson and Jones media
bowel syndrome (IBS)
 Difficult to eradicate
 Hides in the intestinal mucus, as well as sticks and holds on to intestinal  Binucleated trophozoites in multiple fixed and stained fresh stool samples
membranes o Fresh stool samples are necessary since the trophozoites degenerate
 Treatment: after a few hours of stool passage
o Metronidazole, given orally o Multiple samples increase the sensitivity of detecting the organism
o Iodoquinol o Not detected by stool concentration methods
o Trimethroprimsulfamethoxazole (TMP-SMX) o Prompt fixation of the fresh specimen with polyvinyl alcohol fixative
o Nitazoxanide
or Schaudinn’s fixative has been found to be helpful
 Resolves symptoms in 86% of patients after 3 days of
administration  Treatment:
 Occurrs most commonly in tropical, subtropical, and developing countries o Antimicrobial therapy is followed by resolution of symptoms and
 All ages are affected, but symptomatic cases are more often found in children eradication
and in those with weakened immune systems o Iodoquinol
 Prevention and Control: o Tetracycline and metronidazole have also been found to be effective.
o Consuming safe drinking water
“I can do all things through Christ who strengthens me.” (Philippians 4:13) TMSH