Parasite - Vertebrate host in which

- Organism that spends a significant portion of parasite/disease occurs naturally so

its life in or on the living tissue of a host for that host harbor the parasite and
organism and which causes harm to the host does not cause harm to the host.
without immediately killing it.  Carrier – In commensalism, infected prior,
 Obligate – can live or proliferate only in reinfection occur due to antibodies.
association with a host
 Facultative – can live in or on a host as Helminthes
well as in a free form - general term meaning worm
- Resort in parasitic activity that does - parasitic worms
not rely on host in completion of its life -multicellular, eukaryotic organisms in the
cycle. Kingdom Animalia
- Can live with or w/o host - invertebrates characterized by elongated,
- Live for a certain period if outside the flat or round bodies
host depending on type of parasite -worm-like parasite
 Pathogenic – causes harm to host -clinical relevant groups are separated
 Commensals – benefit from host w/o according to general external shape and
causing harm whose organs they inhabit
 Ectoparasite – live on the outside of the -both hermaphroditic (have male & female
host’s body. reproductive organs) and bisexual species
-arthropods that attack exterior surface -definitive classification is based on the
of host external and internal morphology of egg,
-Ex: ticks (carrier of Borrelia burgdorferi; larval, and adult stages
lyme’s disease), fleas
 Endoparasites – live on the inside of the 2 Major Division:
host’s body - groups are subdivided for convenience
-Ex: tapeworms according to the host organ in which they
reside, e.g., lung flukes, extraintestinal
Host tapeworms, and intestinal roundworms
- Organism or animal that harbors another
organism. Parasitic helminthes - or worms of humans,
- Larger than parasite. belong to two phyla: Nematoda (roundworms)
 Intermediate – harbor the and Platyhelminthes (flatworms)
larval/immature and asexual stage 1. Nematoda or Nematodes
- Does not cause pathogenic as it is in - roundworms
larva/egg stage. - nemato from the Greek root meaning
- Can be 1st, 2nd, or 3rd intermediate ―thread‖
host depending on the parasite, as - most speciose and diverse animals
some parasites need multiple hosts - elongated and tapered at both ends,
before maturing round in cross-section, and
- Ex: Snails in trematodes unsegmented
- Egg > snails (1st host) > larval > can - have only a set of longitudinal muscles,
cause infection if transferred to which allows them to move in a
humans > mature stage in human (2nd whiplike, penetrating fashion
host) - have a complete digestive system that
 Definitive – harbor the adult and sexual is well adapted for ingestion of the
stage host’s gut contents, cells, blood, or
- Attain sexual maturity cellular breakdown products;
- Ex: Dog - Ancylostoma caninum; -have a highly developed separate-
Cattle - Fasciola gigantica sexed reproductive system
 Reservoir – Ensure continuity of the - They shed their tough cuticles (molt) as
parasite's life cycle and act as additional they undergo development from larvae
sources of human infection to adults, and the eggs and larval
 stages are well suited for survival in the - have a bifurcated (divided into
external environment. 2 parts) gut and possess both
- Transmitted by ingestion of the egg or circular and longitudinal
larval stage (fecal-oral), insect vectors muscles
and skin penetration. - lack the cuticle characteristic of
nematodes and instead have a
2. Platyhelminthes syncytial (large shell-like
- flatworms & tapeworms structure) epithelium
- dorsoventrally flattened in cross-section -hermaphroditic, with the
- hermaphroditic with a few exceptions exception of the schistosomes
-platy from the Greek root meaning (blood flukes) which is
―flat‖ dioecious (sexes are separate)
(a) Cestodes – tapeworms Life Cycle:
- flat and have a ribbon-like chain  Initiated when eggs are passed into
of segments containing male and fresh water via feces or urine.
female reproductive structures.  Eggs develop, hatch, and release a
-Adult tapeworms can reach ciliated miracidium, which infects a
lengths of 10 m and have snail host that is usually highly specific
hundreds of segments, with each to the fluke species.
segment releasing thousands of  Within the snail, the miracidium
eggs develops into a sporocyst, which
- At the anterior end of an adult contains germinal cells that ultimately
tapeworm is the scolex, which is develop into the final larval stage—
often elaborated with muscular the cercariae.
suckers, hooks, or structures that  These swim out of the snail and
aid in its ability to attach to the encyst as metacercariae in a second
intestinal wall intermediate host or on vegetation,
- Adult tapeworms have no mouth depending on the species.
or gut and absorb their nutrients  Some would go to other hosts
directly from their host through eventually develop to
their integument. metacercariae.
Life Cycle:  Most fluke infections are acquired by
 Same as nematodes ingestion of the metacercariae.
 usually indirect (involving one or more The cercariae of schistosomes, however,
intermediate hosts and a final host). directly penetrate the skin of their hosts and do
 Eggs are excreted with the feces and not encyst as metacercariae.
ingested by an intermediate host
(invertebrate, such as a flea, or 3 Major Stages in Helminthe Life Cycle:
vertebrate, such as a mammal);  Egg > Larva > Adult
 the larvae develop into certain forms
that are peculiar to the specific
species within the intermediate host
(eg, cysticercus in the case of Taenia
solium or hydatid cyst with
Echinococcus granulosus).
 Generally eaten, and the larva
develops into an adult worm in the
intestine of the final host.

(b) Trematodes – flukes

- flattened and leaf shaped with
two muscular suckers
NEMATODES Ascaris lumbricoides – spaghetti
- termed as roundworms - An adult Ascaris worm: tapered ends; length
-cylindrical rather than flattened 15-35 cm (the females tend to be the larger
- Body wall is composed of an outer cuticle ones).
that has a noncellular, chemically complex - Genital girdle (females) - dark circular groove
structure, a thin hypodermis, and musculature. -Subsist on liquids of intestine
-The cuticle in some species has longitudinal -Does not suck blood
ridges called alae. -Cause sensitization phenomenon: allergic
-The bursa, a flaplike extension of the cuticle reaction to waste. Which causes rashes, eye
on the posterior end of some species of male pain, insomnia, restlessness
nematodes, is used to grasp the female during -Overcrowding can lead to wandering: moves
copulation. to the other areas of the body
- reproduce sexually -Aspiration of worm can cause death
-digestive system with two openings: a mouth Common Name: Large Intestinal Roundworm
and an anus Intermediate Host: None
-Bisexual Definitive Host: Human
- Males are usually smaller than females, have
a curved posterior end, and possess (in some How Infection Is Acquired: Ingestion of Eggs
species) copulatory structures, such as spicules - Ascaris eggs are passed in the feces of
(usually two), a bursa, or both. infected persons. If the infected person
-The males have one or (in a few cases) two defecates outside (near bushes, in a garden,
testes, which lie at the free end of a or field), or if the feces of an infected person
convoluted or recurved tube leading into a are used as fertilizer, then eggs are deposited
seminal vesicle and eventually into the cloaca. on the soil.
- Female system is tubular also, and usually is - They can then mature into a form that is
made up of reflexed ovaries. Each ovary is infective.
continuous, with an oviduct and tubular uterus. - Ascariasis is caused by ingesting infective
The uteri join to form the vagina, which in turn eggs. This can happen when hands or fingers
opens to the exterior through the vulva. that have contaminated dirt on them are put
Copulation - between a female and a male in the mouth or by consuming vegetables or
nematode is necessary for fertilization except fruits that have not been carefully cooked,
in the genus Strongyloides, in which washed or peeled.
parthenogenetic development occurs
(fertilizes egg in which does not need How Infection Is Diagnosed:
copulation) - Microscopic observation of eggs in stool
- Some evidence indicates that sex attractants specimens (40 to 70 micrometers by 35 to 50
(pheromones) play a role in heterosexual micrometers)
mating. - Identification of adult worms in stool or
-During copulation, sperm is transferred into the emerging from the nose, mouth, or rectum
vulva of the female. The sperm enters the - Occasionally, larvae can be found in sputum
ovum and a fertilization membrane is secreted
during the pulmonary phase.
by the zygote. This membrane gradually
- Adult worms may be seen in radiographic
thickens to form the chitinous shell.
-A second membrane, below the shell, makes studies of the gastrointestinal tract.
the egg impervious to essentially all substances -Sticky tape test (less used)
except carbon dioxide and oxygen Eosinophilia - can be marked while larvae
migrate though the lungs but usually subsides
Intestinal Nematodes: later when adult worms reside in the intestine.
 Ascaris lumbricoides
 High eosinophilia means there is
 Enterobius vermicularis
 Necator americanus parasite
 Strongyloides stercoralis - Chest x-ray during the pulmonary phase may
 Trichuris trichiura show infiltrates, which in the presence of
eosinophilia leads to the diagnosis of Löffler - Ingested A. lumbricoides eggs hatch in the
syndrome. duodenum, and the resulting larvae penetrate
the wall of the small bowel and migrate via the
Epidemiology portal circulation through the liver to the heart
- affects all ages, more prevalent in the 5 to and lungs.
9years, incidence is higher in poor rural -Larvae lodge in the alveolar capillaries,
populations penetrate alveolar walls, and ascend the
bronchial tree into the oropharynx.
Symptoms -They are swallowed and return to the small
- People infected often show no symptoms bowel, where they develop into adult worms,
- Light and acute abdominal pain, weight loss, which mate and release eggs into the stool.
anorexia, distended abdomen, intermittent -The life cycle is completed in about 2 to 3
loose stool, occasional vomiting months; adult worms live 1 to 2 years.
- Pulmonary stage: cough, wheezing, dyspnea, - Tangled mass of worms resulting from heavy
sub-sternal discomfort infection can obstruct the bowel, particularly in
-Heavy infections can cause intestinal children.
blockage and impair growth in children - Aberrantly migrating individual adult worms
occasionally obstruct the biliary or pancreatic
Treatment & Prevention ducts, causing cholecystitis or pancreatitis;
 Mebendazole (200mg for adults) and cholangitis, liver abscess, and peritonitis are
100mg for children, for 3 days is effective less common.
- will kill adults but not migrating larvae - Fever due to other illnesses or certain drugs
 Good hygiene (eg, albendazole, mebendazole,
 Albendazole 400 mg orally once, tetrachloroethylene) may trigger aberrant
 Mebendazole 100 mg orally twice a day for migration of adult worms.
3 days or 500 mg orally once
 Ivermectin 150 to 200 mcg/kg orally once is Ascaris suum – pig roundworm
effective. - Ascaris lumbricoides (human roundworm)
 Albendazole, mebendazole, and and Ascaris suum (pig roundworm) are hard to
ivermectin may harm the fetus, and risk of tell apart. It is unknown how many people
treatment in pregnant women infected with worldwide are infected with Ascaris suum.
Ascaris must be balanced with risk of
untreated disease.
 Before treatment with ivermectin, patients
should be assessed for coinfection with Loa
loa if they have lived in areas of central
Africa where Loa loa is endemic because
ivermectin can cause severe reactions in
patients with loiasis and high microfilarial
levels.
 Nitazoxanide is effective for mild but less
effective for heavy infections.
 Piperazine, once widely used, toxic and has
been replaced by less toxic alternatives.
 Obstructive complications: anthelmintic
drugs or require surgical or endoscopic
extraction of adult worms.
 When the lungs are affected, treatment is
symptomatic; it includes bronchodilators
and corticosteroids. Anthelmintic drugs are
typically not used.

Pathophysiology
Enterobius vermicularis  Female - 8 mm x 0.5mm; the male is smaller
- widely known as the human pinworm due to  Eggs (60 micrometers x 27 micrometers) are
the female’s long, pointed tail ovoid but asymmetrically flat on one side.
-Pinworm infection: enterobiasis or oxyuriasis
Symptoms
Common Name: Pinworm, Seatworm,  caused by the female pinworm laying her
Threadworm (also used by Strongyloides eggs.
stercoralis)  usually are mild and some infected people
Intermediate Host: None have no symptoms
Definitive Host: Human  Perianal, perineal and vaginal irritation
caused by the female migration
How Infection Is Acquired: Ingestion of Eggs  Itching results in insomnia and restlessness
(fecal-oral)  Gastrointestinal symptoms (pain, nausea,
vomiting, etc.) may develop
How Infection Is Diagnosed:
 Scotch Tape Method – put in renal area as Treatment and Control
female lay eggs there that is why  The medications used for the treatment of
sometimes it is itchy. pinworm are either mebendazole, pyrantel
-Should be done first thing in the morning pamoate, or albendazole.
before any morning ritual.  Any of these drugs are given in one dose
- best test for diagnosing pinworms initially, and then another single dose of the
- More than one transparent tape test may same drug two weeks later.
be needed to detect pinworm infection.  Two doses (10 mg/kg; maximum of 1g
- quick, cost-effective, and painless test each) of Pyrental Pamoate two weeks
 Pinworm paddle apart gives a very high cure rate. Available
without prescription. Does not reliably kill
Life Cycle pinworm eggs. Therefore, the second dose
 Gravid adult female Enterobius is to prevent re-infection.
vermicularis deposit eggs on perianal folds.  Mebendazole is an alternative.
 Infection occurs via self-inoculation  The whole family should be treated, to
(transferring eggs to the mouth with hands avoid reinfection.
that have scratched the perianal area) or  Bedding and underclothing must be
through exposure to eggs in the sanitized between the two treatment
environment (e.g. contaminated surfaces, doses.
clothes, bed linens, etc.).  Personal cleanliness
 Following ingestion of infective eggs, the  Health practitioners and parents should
larvae hatch in the small intestine and the weigh the health risks and benefits of these
adults establish themselves in the colon, drugs for patients under 2 years of age.
usually in the cecum.  Repeated infections should be treated by
 The time interval from ingestion of infective the same method as the first infection.
eggs to oviposition (lay egg) by the adult  In households where more than one
females is about one month. member is infected or where repeated,
 At full maturity adult females measure 8 to symptomatic infections occur, it is
13 mm, and adult males 2 to 5 mm; the recommended that all household members
adult life span is about two months. be treated at the same time.
 Gravid females migrate nocturnally outside  In institutions, mass and simultaneous
the anus and oviposit while crawling on the treatment, repeated in 2 weeks, can be
skin of the perianal area. effective.
 The larvae contained inside the eggs
develop (the eggs become infective) in 4
to 6 hours under optimal conditions.

Morphology
Necator americanus  They penetrate into the pulmonary alveoli,
Common Name: New World Hookworm ascend the bronchial tree to the pharynx,
Intermediate Host: None and are swallowed.
Definitive Host: Human  The larvae reach the jejunum of the small
intestine, where they reside and mature
How Infection Is Acquired: Penetration of skin into adults.
by infective larva  Adult worms live in the lumen of the small
intestine, typically the distal jejunum, where
How Infection Is Diagnosed: Observation of they attach to the intestinal wall with
eggs in stool specimens resultant blood loss by the host.
 Most adult worms are eliminated in 1 to 2
Pathology and Pathogenesis years, but the longevity may reach several
 In the intestine, adult worms attach to years.
intestinal villi with their buccal teeth (and
feed on blood and tissue with the aid of Morphology
anticoagulants.  Adult female hookworms are about 11 mm
 A few hundred worms in the intestine can x 50micrometers.
cause hookworm disease, which is  Males are smaller.
characterized by severe anemia and iron  Adult females range in size from 9 mm to 11
deficiency. mm while the smaller males range in size
 Intestinal symptoms also include abdominal from 7 mm to 9 mm.
discomfort and diarrhea.  Anterior end of N. americanes is armed with
 The initial skin infection by the larvae causes a pair of curved cutting plates
a condition known as ―ground itch,‖  Eggs are 60 micrometers x 35 micrometers.
characterized by erythema and intense  As a nematode, Necator americanus has a
pruritus. cylindrical body, and a cuticle with three
 Feet and ankles are common sites of main outer layers made of collagen and
infection due to exposure from walking other compounds, secreted by the
barefoot. If they find an unprotected foot, epidermis.
they use sharp teeth and hooks to burrow  The cuticle layer protects the nematode so
into the skin and enter the blood stream. it can invade digestive tracts of animals.
 Hookworm eggs hatch outside the body of  Eggs range in size from 65-75 micrometers x
the host and develop in the soil. 36-40 micrometers and are virtually
indistinguishable from those of Ancylostoma
Life Cycle duodenale, another common hookworm
 Eggs are passed in the stool, and under  Necator americanus has four larval stages.
favorable conditions (moisture, warmth,  The first stage is referred to as rhabditiform
shade), larvae hatch in 1 to 2 days and larvae because the esophagus has a large
become free-living in contaminated soil. bulb separated from the rest of the
 These released rhabditiform larvae grow in esophagus by a region called the isthmus.
the feces and/or the soil, and after 5 to 10  The third stage is referred to as filariform
days (and two molts) they become larvae because the esophagus has no
filariform (third-stage) larvae that are bulb.
infective.  The mouth of the adults has two pair of
 These infective larvae can survive 3 to 4 cutting plates, one dorsal and the other
weeks in favorable environmental ventral.
conditions.  The males of the species are characterized
 On contact with the human host, typically by fused spicules found on the bursa.
bare feet, the larvae penetrate the skin  The common name "hookworm" comes
and are carried through the blood vessels from the dorsal curve at the anterior end.
to the heart and then to the lungs.
Food Habits
 Adult N. americanus feed from the blood of
their hosts.
 The worm will attach itself to the intestinal
wall and use its cutting plates to cause
bleeding.
 The worm feeds from this blood, possibly
causing anemia (iron-deficiency anemia)
to the host.
 Necator americanus does not permanently
attach itself to the wall.
 This allows movement to new sites for
feeding and reproduction within the host.
 Previous sites continue to bleed, adding the
host's blood loss.

Treatment and control

 Mebendazole, 200 mg, for adults and 100
mg for children,for3days is effective.
 Sanitary disposal of fecal material
 Avoidance of contact with infected fecal
material

Clinical Features of Hookworm

Strongyloides stercoralis 52:17  Skin penetration causes itching and red
Common Name: Threadworm/Cochin-china blotches.
diarrhea  During migration, the organisms cause
Intermediate Host: None bronchial verminous pneumonia and, in the
Definitive Host: Human duodenum, they cause a burning mid-
How Infection Is Acquired: Penetration of skin epigastric pain and tenderness
by infective larva accompanied by nausea and vomiting.
How Infection Is Diagnosed: Observation of  Diarrhea and constipation may alternate.
eggs in duodenal aspirates or stool specimens  Heavy, chronic infections - anemia, weight
loss and chronic bloody dysentery.
Morphology  In disseminated infections, gastrointestinal
 Parasitic female is larger (2.2 mmx 45 tract (severe diarrhea, abdominal pain,
micrometers) gastrointestinal bleeding, nausea,
 Free-living worm (1 mm x 60 micrometers) vomiting), lungs (coughing, wheezing,
-does not need host and female and male hemoptysis – sputum has blood), and skin
mate thus produce several generations of (rash, pruritus, larva currens).
worms in the soil, a great example of an
evolutionary adaptation to sustain a Treatment and control
population  Thiabendozole was a therapeutic option
 Eggs, when laid are 55 micrometers by 30 but was discontinued due to its obsecity???
micrometers.  Ivermectin – first line therapy for acute and
 Adult females inhabit the intestine are chronic. Single dose, 200 mcg/kg, orally for
parthenogenic; means they do not need to one to two days.
mate with male worms to reproduce. They - Available for human use in US not in PH.
lay eggs within the intestine; larvae hatch o Contraindications:
from the eggs and are passed into the  Confirmed or suspected
feces. concomitant Loa loa infection
 S stercoralis has a unique evolutionary  Persons weighing less than 15kg
adaptation that can greatly enhance its  Pregnant or lactating women
reproductive success.  Albendazole – alternative; 400 mg orally
two times a day for 7 days.
Pathology o Contraindications:
 Can produce an internal reinfection or o Hypersensitivity to benzimidazole
autoreinfection if newly hatched larvae compounds or any component of
never exit the host but, instead, undergo product
their molts within the intestine. o Use should be avoided in the 1st
 Larvae penetrate the intestine, migrate trimester of pregnancy
throughout the circulatory system, enter the  In patients with positive stool examination
lungs and heart (similar to the migration of for Strongyloides and persistent symptoms,
hookworms upon penetrating skin), and follow-up stool exams should be performed
develop into parasitic females in the 2—4 weeks after treatment to confirm
intestine. clearance of infection.
 These nematodes are able to sustain an  If recrudescence of larvae is observed,
infection for many years and, in the event retreatment is indicated.
of immunosuppression, produce a
hyperinfection in which a fulminating, fatal
infection occurs.
 Larvae migrating from the intestine carrying
enteric bacteria can cause local infections
or sepsis, resulting in death.

Symptoms
 Light infections are asymptomatic.
Life Cycle Trichuris trichiura
Common Name: Whipworm
Intermediate Host: None
Definitive Host: Human
How Infection Is Acquired:
 Ingestion of eggs found in soil
 Often due to poor sanitary conditions,
including open defecation and using
human feces as fertilizer.
 Some recent studies show that people with
certain chromosome traits may be
predisposed or have increased
susceptibility to acquiring trichuriasis.
How Infection Is Diagnosed: Observation of
eggs in stool specimens

 A roundworm that causes trichuriasis in

humans.
 Looks like a whip with wide handles at the
posterior end.
 The whipworm has a narrow anterior
esophagus and a thick posterior anus.
 The worms are usually pink and attach to
the host via the slender anterior end.
 The size of these worms varies from 3 to 5
cm.
-Autoinfection: Rhabditiform larva did not went  The female is usually larger than the male.
out the body  Trichuris is also notable for its small size
 Rhabditiform larvae in the gut become compared with Ascaris lumbricoides.
infective filariform larvae that can  Only individuals with heavy parasite burden
penetrate either the intestinal mucosa or become symptomatic.
the skin of the perianal area, resulting in  Vitamin A deficiency has been seen in
autoinfection. patients with trichuriasis.
 Once the filariform larvae reinfect the host,
they are carried to the lungs, pharynx and Pathology
small intestine as described above, or  Fecal-oral transmission
disseminate throughout the body.  Consumes infected eggs, typically while
 The significance of autoinfection is that eating and drinking contaminated food or
untreated cases can result in persistent water.
infection, even after many decades of  Once the embryonated eggs are ingested,
residence in a non-endemic area, and may the larvae hatch in the small intestine.
contribute to the development of  From there they migrate to the large
hyperinfection syndrome. intestine, where the anterior ends lodge
within the mucosa.
 This leads to cell destruction and activation
of the host immune system, recruiting
eosinophils, lymphocytes, and plasma cells.
 This causes the typical symptoms of rectal
bleeding and abdominal pain.
 The parasite usually takes up residence in
the terminal ileum and cecum.
 In some patients, the entire colon and
rectum may be infested with the worm.
 The worm may live anywhere from 1-4  Improved hygiene
years without treatment.  Sanitary eating habits
 Eggs are expelled in the host feces
unembryonated. Life Cycle
 The eggs will become embryonated in 2–4
weeks and are then infective

Morphology
 Female - 50 mm long with a slender anterior
(100micrometer diameter) and a thicker
(500 micrometers diameter) posterior end.
 Male is smaller and has a coiled posterior
end
 Eggs - lemon or football shaped and have
terminal plugs at both ends

Symptoms
 Less than 10 worms are asymptomatic
 Heavier infections (e.g., massive infantile
trichuriasis)- chronic profuse mucus and
bloody diarrhea with abdominal pains and
edematous prolapsed rectum
 Patients typically reside in or have visited
areas that are endemic to the whipworm.
 Usually complain of abdominal pain, painful
passage of stools, abdominal discomfort,
and mucus discharge.
 Diarrhea and constipation are also
common presenting complaints.
 Nocturnal (at night) passage of stools is a
common occurrence.
 Many patients are asymptomatic as the
clinical disease is dependent on parasite
burden.
 Rectal prolapse (rectum will stretch out thus
protruding occurs like hemorrhoids) is
known to occur in a heavy infestation.
 Children may develop anemia, growth
deficiency, and even impaired cognitive
development.
 The latter 2 are thought to be due to iron
deficiency and poor nutrition secondary to
worm burden and are not a direct cause of
the infestation.

Treatment and Control

 Mebendazole 200 mg, for adults and 100
mg for children, for 3day
 Albendazole 400 mg orally for 3 days
 Mebendazole 100 mg orally twice a day for
3 days
 Ivermectin 200 mcg/kg/day orally for 3
days
BLOOD AND TISSUE HELMINTHES  Albendazole – 400 mg twice per year for
1. Brugia malayi and Wuchereria bancrofti areas endemic of filariasis and loiasis.
2. Loa loa  Ivermectin: 200 mcg per kilogram, with
albendazole – 400 mg in some countries
Brugia malayi and Wuchereria bancrofti with Onchocerciasis.
Common Name: none  Diethylcarbamazine citrate (DEC) – 6 mg
Intermediate Host:Various per kilogram.
speciesofmosquitoes.  Albendazole – 400 mg in some countries
How Infection Is Acquired: Injection of infective without onchocerciasis.
larvae by mosquito  Albendazole, ivermectin, and DEC – safely
How Infection Is Diagnosed: Observation of clear all microfilariae. Recommended by
micro WHO.
 Disease formed: Lymphatic filariasis caused
by Brugia malayi and Wuchereria brancrofti
 Filarial nematodes: Brugia malayi,
Wuchereria brancrofti, and Onchocerca
volvulu.
 Common in Africa
 Located in lymphatic tissue
 Female release microfilariae in the
lymphatic vessels
 Transmitted via mosquitos
 Microfilariae usually situated in lymph, but
can also be situated in the puerperal blood
at specific times of the day. Therefore, it
can be present in the blood.

Morphology
 These two organisms are very similar in
morphology and in the diseases they
cause.
 Adult female W. bancrofti found in lymph
nodes and lymphatic channels are 10 cm x
250 micrometers whereas males are only
half that size.
 Microfilaria found in blood are only 260
micrometersx10micrometers.
 Adult B. malayi are only half the size of W.
bancrofti but their microfilaria are only
slightly smaller than W. bancrofti.
 Brugia malay is smaller (half the size of
wuchereria) than Wuchereria brancrofti

Sign and Symptoms:

 Lymphangitis, fever, painful lymph nodes,
edema, inflammatory spreading from the
affected nodes.
 Elephantiasis (extreme swelling) as
immulogic response – can be in breast or
limbs or genitalia.

Treatment (Recommended by WHO):

 Albendazole: mass drug administration.
Loa loa Onchocerca volvulus
Common Name: Eye Worm Common Name: Blinding Worm
Intermediate Host: Chrysops (MangoFly). Intermediate Host: Simulium (BlackFly).
How Infection Is Acquired: Injection of infective How Infection Is Acquired: Injection of infective
larvae by Chrysops larvae by Simulium
How Infection Is Diagnosed: Observation of How Infection Is Diagnosed: Observation of
adult worm beneath the skin or in the microfilariae in ―skin snips‖
conjunctiva of the eye  ONCHOCERCIASIS / ―RIVERBLINDNESS‖
 LOIASIS  Black fly grinds the tissue. Infected after 1
week.
Morphology  Requires fast growing rivers and well
 Cylindrical, has a cuticle with three main oxygenated water hence the name of the
outer layers made of collagen and other disease is river blindness.
compounds which protects the nematodes  If di maagapan ang disease, kay mag
so they can invade the digestive tract of result siya ng permanent blindness.
animals
 Adults are small, thin worms ranging 20-70 Sign and symptoms:
mm long and 350-430 micrometers wide  Skin changes, severe pruritis. Severe
blindness.
Ecosystem Roles  Common in male.
 An obligate endoparasite, feeding on fluids  They stay in vitreous humor in the eye
in the tissues of humans causing clouding of the eye, photophobia,
then retinal damage.
Pathogenesis/Symptoms
 Infect human host by travelling from the Treatment:
entry site through the SQ causing  Ivermectin (for Onchocerciasis – yung
inflammation in the skin (Calabar swelling). disease ng ongonchocerca) - It does not kill
 These are localized, inflammatory, pruritic adult worm but kills microfilariae but still
subcutaneous edema seen in joints of sterilize the adult female worm para di mag
extremities (wrist and ankle) due to produce ng egg.
allergens and metabolic products released  Doxycycline - not a standard therapy.
by the worm.  Treatment of ivermectin should only be
 It can also travel and infect the eye. In given 1 week prior doxycycline, in order to
deeper tissues, it can cause encephalitis. provide symptom relief.
 Common symptoms are itching, joint pain,  If the patient cannot tolerate 200 mg of
fatigue and death. doxycycline, 100 mg will do.

 Vectors (flies) by genus Chrysops: C. silacea

and C. dimidiate.
 Can be seen during the day: purpureal
blood, Non-circulation phase: lungs.
 3rd stage: infective form
 Drug of choice for loiasis: DEC
 Prophylactic: DEC – 300 mg once a week. If
you were travelling in endemic areas,
where loa loa is endemic.
Mebendazole  Considerable biliary excretion and
enterohepatic recycling of albendazole
sulfoxide occurs.
 High dose, prolonged therapy required for
clonorchiasis or echinococcal disease
therapy can result in adverse effects such
 Methyl 5-benzoyl-2- as bone marrow depression, elevation of
benzimidazolecarbamate is a broad hepatic enzymes, andalopecia.
spectrum anthelminthic effective against  broad spectrum
nematode infestations, including pinworm,  inhibit tubulin polymerization
whipworm, roundworm and hookworm.  almost similar in mebendazole
 It irreversibly blocks glucose uptake in
susceptible helminthes, thereby depleting
glycogen stored in the parasite. It
apparently does not affect glucose
metabolism in the host. It also inhibits cell
division in nematodes.
 Adverse reactions are uncommon and
usually consist of abdominal discomfort. It is
teratogenic in laboratory animals, and
therefore should not be given during
pregnancy
 Inhibit the production of microtubule
though colchicine binding site ng beta
tubulin.
 Glucose uptake and digestive and
reproductive of parasites are interrupted,
results in death.
 Poorly absorb in digestive drug

Albendazole (Ezkazole, Zentel)

 Methyl 5-(propylthio)-2-
benzimidazolecarbamate
 Effective as a single-dose treatment for
ascariasis, New and Old hookworm
infections, and trichuriasis.
 Multiple-dose therapy with albendazole
can eradicate pinworm, threadworm,
capillariasis, clonorchiasis, and hydatid
disease.
 It occurs as a white crystalline powder that
is insoluble in water. Oral absorption is
enhanced by a fatty meal.
 The drug undergoes rapid and extensive
first-pass metabolism to the sulfoxide, which
is the active form in the plasma.
 The elimination half-life of the sulfoxide
ranges from 10 to 15 hours.
POSSIBLE QUESTIONS: (C) Cyclosporiasis
1. A mother states that she has observed (D) Hookworm infection
her 4-year-old son scratching his anal area (E) Trichuriasis
frequently. The most likely cause of this (F) Ascariasis
condition is
(A) Trichomonas vaginalis 5. Pathologic effects of filariae in humans
(B) Enterobius vermicularis are caused by the adult worms in all but
(C) Ascaris lumbricoides one species. In this case, the principal
(D) Necator americanus damage is caused by the microfilariae of
(E) Entamoeba histolytica (A) Brugia malayi
(B) Mansonella ozzardi
2. Chagas disease is especially feared in (C) Dracunculus medinensis
Latin America because of the damage that (D) Wuchereria bancrofti
can occur to the heart and (E) Onchocerca volvulus
parasympathetic nervous system and the
lack of an effective drug for the 6. An 18-year-old male complains of
symptomatic later stages. Your patient is abdominal pain, bloating, frequent loose
planning to reside in a Venezuelan village stools, and loss of energy. He returned a
for 1–2 years. Which one of the following month ago from a 3-week hiking and
suggestions would be of special value for camping trek to the Mount Everest Base
avoiding Chagas disease? Camp in Nepal. The trek involved only
(A) Boil or treat all of your drinking water. high-elevation hiking, since he flew in and
(B) Sleep under a bed net. out of the 12,000-ft starting point. Which of
(C) Do not keep domestic pets in your the following is an important consideration
house. for the diagnosis?
(D) Never walk barefoot in the village (A) Exposure to high-level UV radiation
compound. (B) The source and purification of water
(E) Do not eat lettuce or other raw (C) The use of insect repellents while hiking
vegetables or unpeeled fruit. (D) The presence of domestic animals en
route
3. A sexually active 24-year-old woman (E) The degree of contact with villagers en
complains of vaginal itching and vaginal route
discharge. To verify your tentative diagnosis
of trichomoniasis, you should include which 7. Which one of the following diagnostic
of the following in your workup? tests should be conducted for the patient in
(A) Specific serologic test Question 6?
(B) Ova and parasite fecal smear (A) Blood and urine bacteriologic
(C) Wet mount of vaginal fluid examination
(D) Enzyme-linked immunoassay (ELISA) test (B) Series of ova and parasite tests and
of serum fecal smears
(E) Stool culture (C) ELISA or hemagglutination serologic
tests for malaria
4. You are working in a rural medical clinic (D) Skin snip microfilarial test
in China and a 3-yearold girl is brought in (E) Endoscopic exam for whipworms
by her mother. The child appears
emaciated and, upon testing, is found to 8. The parasite most likely to be responsible
have a hemoglobin level of 5 g/dL. Her feet for the illness of the patient in Question 6 is
and ankles are swollen, and there is an (A) Leishmania major
extensive rash on her feet, ankles, and (B) Plasmodium vivax
knees. The most likely parasitic infection (C) Trichomonas vaginalis
that causes the child’s condition is (D) Naegleria gruberi
(A) Schistosomiasis (E) Giardia lamblia
(B) Cercarial dermatitis
9. Several Papua New Guinea villagers (B) Toxoplasma gondii
known to eat pork during celebrations were (C) Strongyloides stercoralis
reported to be suffering from an outbreak of (D) Entamoeba histolytica
epileptiform seizures. One of the first things (E) Naegleria fowleri
you should investigate is
(A) The prevalence of Ascaris infections in 13. How could the person have acquired
the population the parasite in Question 12?
(B) The prevalence of schistosomiasis in the (A) Ingesting cysts from fecally
population contaminated drinking water
(C) The presence of Trypanosoma brucei (B) Eating improperly cooked fish
gambiense in the villagers (C) Eating improperly cooked beef
(D) The presence of Giardia cysts in the (D) Walking barefoot in the park
drinking water (E) Engaging in unprotected sexual
(E) The presence of Taenia solium in the intercourse
pigs (F) Getting bitten by a sandfly
(G) Plunging into a natural hot spring
10. A 32-year-old male tourist traveled to
Senegal for 1 month. During the trip, he 14. A 37-year-old sheep farmer from
swam in the Gambia river. Two months after Australia presents with upper right quadrant
his return, he began complaining of pain and appears slightly jaundiced. A
intermittent lower abdominal pain with stool exam was negative for ova and
dysuria. Laboratory results of ova and parasites but a CT scan of the liver reveals a
parasites revealed eggs with a terminal large 14-cm cyst that appears to contain
spine. Which of the following parasites is the fluid. Which of the following parasites
cause of the patient’s symptoms? should be considered?
(A) Toxoplasma gondii (A) Toxoplasma gondii
(B) Schistosoma mansoni (B) Taenia solium
(C) Schistosoma haematobium (C) Taenia saginata
(D) Ascaris lumbricoides (D) Clonorchis sinensis
(E) Taenia solium (E) Schistosoma mansoni
(F) Echinococcus granulosus
11. What type of specimen was collected (G) Paragonimus westermani
for laboratory analysis based on the answer
in the previous question? 15. An apparently fatigued but alert 38-
(A) Thick blood smear year-old woman has spent 6 months as a
(B) Stool sample teacher in a rural Thailand village school.
(C) Urine sample Her chief complaints include frequent
(D) Blood for serology headaches, occasional nausea and
(E) Sputum sample vomiting, and periodic fever. You suspect
malaria and indeed find parasites in red
12. A previously healthy 23-year-old blood cells in a thin blood smear. To rule
woman recently returned from her vacation out the dangerous falciparum form of
after visiting friends in Arizona. She malaria, which one of the following choices
complained of severe headaches, saw is NOT consistent with a diagnosis of
―flashing lights,‖ and had a purulent nasal Plasmodium falciparum malaria based on a
discharge. She was admitted into the microscopic examination of the blood
hospital with a diagnosis of bacterial smear?
meningitis and died 5 days later. Which of (A) Red blood cells containing trophozoites
the following parasites should have been with Schuffner’s dots
considered in the diagnosis? She had no (B) Red blood cells containing >1 parasite
prior history of travel outside of the United per RBC
States. (C) Banana-shaped or crescent-shaped
(A) Plasmodium falciparum gametocytes
(D) Parasites within normal-sized red blood
cells
(E) Parasites with double nuclei

16. Given a diagnosis of uncomplicated

Plasmodium falciparum malaria for the
patient in Question 15, which one of the
following treatment regimens is appropriate
where chloroquineresistance is known?
(A) Oral artemisinin-based combination
therapy (ACT)
(B) Oral chloroquine
(C) Intravenous chloroquine
(D) Oral proguanil
(E) Intravenous quinidine

17. Given a diagnosis of Plasmodium

falciparum, you should tell the patient in
Question 15 that (select one)
(A) Relapse occurs with Plasmodium vivax
and Plasmodium ovale, not Plasmodium
falciparum and therefore no treatment for
hypnozoites is necessary.
(B) Primaquine is used to prevent relapse of
Plasmodium falciparum.
(C) Returning to the tropics would be
dangerous because hypersensitivity to the
parasite may have developed.
(D) The use of insecticide treated bednets
in endemic areas is not necessary since she
already had malaria.
(E) It is not necessary for her to take
antimalarials when traveling in endemic
areas.

18. A 52-year-old male, returning from a

travel tour in India and Southeast Asia, was
diagnosed with intestinal amebiasis and
successfully treated with iodoquinol. A
month later, he returned to the clinic
complaining of the following conditions.
Which of the conditions is most likely the
result of systemic amebiasis (even though
the intestinal infection appears to be
cured)?
(A) High periodic fever
(B) Bloody urine
(C) Tender, enlarged liver
(D) Draining skin lesion
(E) Enlarged painful spleen