Info Parasitology Table Summary

PROTOZOA Location Intestinal tract Urogenital tract Blood and tissue Species E. histolytica G. lamblia C. parvum T. vaginalis Plasmodium T. gondii T. cruzi T.brucei Disease Amoebiasis Giardiasis Crysptosporidiosis Trichomoniasis Malaria Toxoplasmosis Chagas disease, sleeping sickness Entamoeba histolytica Asexual cycle Periodicity P. falciparum 48h Malignant tertian P. vivax 48h Benign tertian P. ovale 48h Benign tertian RBC preference Parasitemia Merozoites Gametocytes Cerebral malaria Recrudescence Relapse Drug resistance All ages Highest 0 Banana-shaped Yes yes No Many young low 12-24 Large round no no yes few young low 8 Small round no no yes few Giardia lambia Cryptosporidium parvum Intestinal Opportunistic Autoinfection Acid-fast Schizogony, gametogony Fecal-oral Man (S/I/GB) Trichomonas vaginalis Urogenital Flagellated, pearshape No cyst (trophozoite only) Trophozoite Trophozoite Biology Intestinal Rhizopods Non-flagellated Pseudopod Binary fission Intestinal flagellates Mastigophora “falling leaf” or gliding motility, pear shaped Binary fission Transmission Host Fecal-oral Man (cecum) Fecal-oral Man (duodenal crypts) Infective stage Diagnostic stage Mature cysts Trophozoites (diarrheal) Mature cysts (wellformed) Immature cysts Cysts Trophozoites “old man’s face” Cysts Thick-walled oocyst Thick-walled oocyst Lectin – adhesion Amebapores – Cysteine proteases – cytopathic (ulcer) Cyst carrier state Amebic colitis – dysentery, no fever “flask-shaped ulcers” Ameboma Amebic liver abscess – MC, anchovy sauce-like Adhesive disc, lectin Coat/carpet Destruction of host cell MCC backpacker’s diarrhea Acute: diarrhea Chronic: steatorrhea “gruelly” stool Self limited nonbloody diarrhea Severe life threatening diarrhea (AIDS) Metronidazole Cyst carrier – diloxanide furoate Bull’s eye karyosome Cigar-shaped CB Metronidazole Nitazoxanide HAART (AIDS) Retracted cytoplasm 4 sporozoites, no sporocyst Pathogenesis Disease Treatment Diagnosis: Sexual (ping-pong) Trichomoniasis – watery, foulsmelling, green vaginal discharge with itching and burning; “Strawberry cervix” Metronidazole 2g PO P. malariae 72h Malignant Quartan Old Lowest 6-12 Compact No Yes No few Miscellaneous Acanthamoeba castellani Naegleria fowleri Disease Granulomatous Amebic encephalitis Primary amebic meningoencephalitis MOT: swimming in contaminated pools Balantidium Coli (pig) ONLY ciliated protozoan to cause human dse Round-based, wide-necked intestinal ulcers Babesia Macroti Babesiosis (ixodes tick) Leishmania spp Flagellated,Phlebotomus sandfly LD: “death fever, dum-dum” Dx: Montenegro test Intraerythrocytic ring-shaped trophozoites (Maltese cross/tear-drop) IS:promastigote DS: amastigote Cutaneous: Leishmania tropica Visceral (kala-azar): Leishmania donovani Mucocutaneous: Leishmania braziliensis DOC: Sodium stibogluconate Cyclosporidium parvum & Isospora belli: diarrhea in ICH Plasmodium spp Toxoplasna gondii Blood and tissue sporozoa Asexual (man): schizogony (merozoite), gametogony (gametocyte) Sexual (mosquito): sporogony (sporozoites) Giemsa or Wright stain – gold std Mosquito bite (Anopheles flavirostris) DH: Mosquito IH: Man (Blood, liver: merozoite) Sporozoites (man), gametes (mosquito) Trophozoite (RBC, ring form) Endemic: Palawan, Kalinga-apayao, Ifugao, agusan del sur Chloroquine resistance: Palawan, Davao del norte, Compostela Valley Hemolysis: release of merozoite Immune: G6PD and sickle cell Susceptible: Duffy factor Tissue protozoan Water-borne Endodyogeny Malaria – paroxysmal fever with malaise, bone pains, HA, jaundice splenomegaly Cerebral malaria – malarial or Durck granulomas ARF – blackwater fever Septic shock – algid malaria Parasitic pneumonitis Heterophile (-) Mononucleosis Encephalitis – ring-enhancing lesions Congenital Toxoplasmosis – intracranial calcifications - Abortion, stillbirth, hydrocephalus, chorioretinitis, hepatosplenomegaly Sulfadiazene (TMP-SMZ) + pyrimethamine Falciparum, malariae – Chloroquine Hypnozoite (ovale/vivax) – Primaquine Pregnant – Quinine, Mefloquine P. vivax – Schuffner dots (punctuate) P. ovale – Schuffner dots, James dots P. malariae – Ziemann dots (fine) P. falciparum – Maurer dots (coarse) Ingestion, transplacental DH: Domestic cat IH: Human Fecal oocyst Trophozoites (bradyzoites) Trypanosoma Cruzi (American Trypanosomiasis) Blood and tissue Flagellates All 4 forms: a/pro/epi/ trypomastigote C or U shaped Reduviid/kissing/Rhodnius/Pa nstronglylus/Triatoma bug Bite of bug DH: Man IH: Rodents Metacyclic trypomastigotes Trypomastigotes (blood) Dinoflagellates Flagellated marine alage Algal bloom (red tide) MCC in the Phils: Pyrodinium bahamense var compressium MOT: bivalve molluscs Heat Stable Toxins: Paralytic: Saxitoxin (15 min) Neurotoxic: Brevetoxin (15 min) Diarrhetic: Okadaic acid (30 min) Amnesic: Domoic Acid (30 min) Tx: gastric lavage with activated charcoal Neostigmine and edrophonium: to improve muscle wweakness Trypanosoma brucei Blood and tissue flagellates 2 forms: epi/trypomastigote Antigenic variation: cyclical fever (every 2 weeks) 2 members: West - T. Brucei gambiense (chronic form) East - T. Brucei rhodesiense (Acute, Rapid & fatal) Bite of tsetse fly (Glossina) D DH: Man IH: Rodents Metacyclic trypomastigotes Trypomastigotes (blood) Epimastigotes (salivary gland) Tachyzoites: Bradyzoites – tissue diagnosis IgM –antibody Cardiac muscle – Most frequently and severely affected Other: glial, RES, plexuses Acute Chagas’ disease - Romaña’s sign: periorbital edema - chagoma: nodule near bite Chronic: -myocarditis, megacolon, megaesophagus (achalasia) 1. Hemolymphatic 2. brain Somnolence (sleeping sickness) → coma d/t demyelinating encephalitis (ARAS, BS) African sleeping sickness Trypanosomal chancre Winterbottom’s sign: posterior cervical LAD Kerandel;s sign: hyperesthesia Encephalitis: (+) Mott cells – plasma cells with cytoplasmic Ig globules Nifurtimox Gambiense: Pentamidine + Eflormithine Rhodisiense: Selarmin + melorsoprol (CNS) BMA or muscle biopsy Xenodiagnosis CSF, BMA, Blood smears Culture: weinman’s CATT for epidemics Xenodiagnosis Nmchico 2016 1 CESTODES (TAPEWORMS) Biology Transmission Host Infective stage Diagnostic stage Pathogenesis Taenia spp Suckers Rostellum T. solium 4 Yes T. saginata 4 No Eggs/larvae in undercooked meat IH: Soium (pig) saginata (cattle) DH: Man (upper jejunum) Cysticerci (both) T. Solium (egg) Gravid proglottids Cysticerci – cause SOL in brain 1o UB in GP 5-10 15-25 Diphyllobothrium latum 2 elongated sucking grooves Operculated eggs Fish or Broad tapeworm Larvae in Undercooked fish IH: fish and copepods DH: man (intestine) Plerocercoid larvae Unembryonated egg Disease T. saginata (GI): abdominal pain, pruritus ani, intestinal obstruction T. solium (mild Gi + CNS): eggs cross BBB → seizure (neurocysticercosis), worms in vitreous humor Abd pain, diarrhea Megaloblastic anemia d/t Vit. B12 def Treatment Diagnosis: Praziquantel Proglottids, Eggs in stool Praziquantel Kato technique Echinococcus granulosus 1 scolex and 3 proglottids Smallest tapeworm Eggs in food contaminated with dog feces IH: sheep/man (liver) DH: dog Embryonated egg Hydatid cysts Cysts acts as SOLS If ruptured: anaphylaxis Hydatid cysts in liver Pulmonary cysts Cerebral cysts – jacksonian epilepsy MISCELLANEOUS Echinoccous multicularis DH:: foxes IH: rodents Multiloculated cysts (honeycomb vesicles) Hymenolopsis nana Dwarf tapeworm, IS: cysticercoid larvae DS: eggs MC in developed countries Polar filaments, 6-hooked larva Hymenolepsis diminuta Rat tapeworm; eggs are bile staned Accidental parasite (ingestion of grain beetles) Dipylidium caninum MC tapeworn in dogs and cats Double pored worm, Barrel shaped proglottids Albendazole, PAIR procedure Puncture, Aspirate, Injection (95% Ethanol), Reaaspiration TREMATODES (FLUKES) Biology Transmission Host Infective stage Diagnostic stage Pathogenesis Disease Treatment Diagnosis: Other name Diseases Habitat IH (snail) Diagnostic (Egg) Eggs/worm/day Schistosoma japonicum Oriental blood fluke Adults: Separate sexes (in copulation) Endemic: Sorsogon, Samar, Leyte, Oriental Mindoro, Bohol, all Mindanao except Misamis oriental Skin penetration IH:: Oncomelania hypensis quadrasi DH: Man (myenteric and portal veins) Fork-tailed Cercaria Eggs in feces (+) eggs → Granuloma form’n liver: presinusoidal obs’n, hepatomegaly, portal HPN) Coats with host Ag Acute: swimmer’s itch, Katayama fever (serum-sickness like) Chronic: CLD,potal HPN etc Praziquantel Kato-katz technique Circumoval precipitin test S. japonicum Oriental blood fluke Katayama Fever Superior myenteric plexus Oncomelania quadrasi Rudimentary spicule 1500-3000 (stool) Paragonimus westermani Oriental Lung fluke Pulmonart distiomiasis Endemic hemoptysis Hermaphrodite Clonorchis sinensis Oriental Liver fluke, leaf-like shape Clonorchis sinensis Opistorchis viverrini Hermaphrodite Undercooked/raw crab meat 1st IH: antemelania asperata 2nd IH : Sundathelphusa philippina Metacercariae UNembryonated egg (+) eggs → Granuloma form’n Cerebral – most serious Cx Undercooked/raw fish 1st IH: C: Parafossarulus O: Bithynia 2nd IH: Cyprinidae Metacercariae Embryonated egg Inflammation → hyperplasia and fibrosis of HBT Paragoniamisis (TB-like) - chronic cough with bloody sputum - CXR:ring shadow opacity Praziquantel Eggs in sputum or stool Acute: fever, eosinophilia, LAD, hepatomegaly Chronic: Cholangiocarcinoma (Klatskin tumor), HBT dse, pancreatitis Praziquantel KMNO4: melon-like ridges in eggs of O. viverrini S. mansoni Mansoni blood fluke Balharziasis Inferior myenteric plexus Biomphalaria Long prominent lateral spine 100-300 (stool) MISCELLANEOUS Faschiola hepatica Sheep liver fluke 1st IH: Lymnaedia 2nd IH: kangkong, watercress Dse: Halzoun – obstructive jaundice and painful pharyngitis Fasciolopsis buski Intestinal fluke (duodenum) 1st IH: Segmentina 2nd IH: aquatic vegetation Dse: gland abscesses worm intoxication (anasarca and coma) Heterophyses heterophyses Intestinal fluke 1st IH: brackish water snails 2nd IH: fish Dse: mimics PUD Echinostoma ilocanum Intestinal fluke (SI) 1st IH: Gyraulus 2nd IH: Pila luzonica (kuhol) S. haematobium Vesical blood fluke Urinary Balharsiasis Vesical plexus Bulinus Prominent terminal spine 20-290 (urine) Nmchico 2016 2 NEMATODES (ROUNDWORMS) BLOOD AND TISSUE INTESTINAL Ascaris lumbricoides Necator americanus Ancylostoma duodenale Hookworms Blood sucking nematodes, STH Necator Ancylostoma New world Old world semilunar Ventral teeth S-shape C-shape Long bursae Broad bursa fused separated Larval skin penetration Man (ileum) Filariform larvae (L3) Feeding stage: rhabditiform Eggs in feces Biology MC and largest roundworm Soil-transmitted helminth (STH) Transmission Host Infective stage Diagnostic stage Pathogenesi s Ingestion of eggs Man Embryonated egg Lungs: main site of tissue rxn 0.25 ml blood/worm/day → microcytic anemia Larva: lung, skin Adult: SI Disease Loeffler’s (eosinophilic) pneumonitis Hepatobiliary ascariasis pancreatitis Intestinal obstruction Malabsorption Loeffler’s pneumonitis Acute: Ground itch, mild GI cutaneous larva migrans, (+) Charcot layden crystals Chronic: microcytic anemia (IDA), hypoalbuminemia Treatment Diagnosis: Albendazole Direct fecal smear Kato-katz Albendazole Direct fecal smear Kato-katz Harada-mori culture Fertilized egg BLOOD AND TISSUE Onchocerca volvulus Female blackfly: Simulium Loa Loa Deer or mango fly (Chrysops) Dracuculus medinensis Guinea fire worm Toxocara canis Dog ascaris Ancylostoma caninum Ancylostoma braziliense Angiostrongylus cantonensis Rodent lungworm Anisakis simplex Zoonotic roundworms Trichuris trichuria Enterobius vermicularis Whipworm STH Egg: “Chinese lantern” “football with polar bump” Pinworm, Seatworm MC STH in developed countries → “cosmopolitan worm” Threadworm Facultative parasite Pudoc worm Only nematode that involves a migratory bird in life cycle Ingestion of eggs Man Embryonated egg Ingestion/Inhalation of eggs Man (cecum) Embryonated egg Larval skin penetration Man (duodeno-jejunal) Filariform larvae “free living” Eggs in undercooked fish Bird, man Infective larvae Mosquito bite Man Microfilariae Larva in undercooked pork IH: pig Encysted larvae UNEmbryonated egg Eggs on perianal folds Rhabditiform larvae UNEmbryonated egg 3rd stage larva Encysted larvae Burrow hairlike anterior ends into intestinal mucosa No significant anemia NO eosinophilia Rectal prolapse diarrhea Autoinfection Female lays egg on perianal folds NO eosinophilia Autoinfection Hyperinfection Autoinfection → ulceration Hyperinfection Nocturnal periodicity Adult worms cause obstruction → lymphedema Nocturnal Pruritus ani Eosinophilic enterocolitis Vulvovaginatis Appendicitis (oxyuriasis) Acute: borborygmus, fever, abdominal pain, eosinophilia Chronic: watery diarrhea, edema, wasting Protein-losing enteropathy Mebendazole Barrel shaped eggs with bipolar plugs Pyrantel pamoate Graham’s scotch tape test - D-shaped egg Loeffler’s pneumonitis Acute: ground itch, mild watery diarrhea Chronic: larva CURRENS, duodenitis, paradoxical asthma, hyperinfection syndrome Ivermectin Harada-Mori culture String test Acute: adenolymphangitis. Filarial fever Nocturnal wheezing (tropical pulmonary eosinophilia) Meyers-Kouvenaar bodies - small epitheliod granulomas Expatriate syndrome Chronic: hydrocele, elephantiasis. chyluria Diethylcabamazipine (DEC) Thick blood smear: curved or kinky microfilariae Intestinal stage: liberates worm by gastric juices Muscle stage: dissemination (striated sk. M.) → nurse cell No eosinophilia Mild: periorbital edema, hemorrhagic phenomena Severe: myocarditis. Encephalitis. Pneumona, respiratory myositis Disease Dermal nodules, hanging groin, lizard skin, river blindness DOC: Ivermictin – kills microfilariae (mazzotti Rxn) Calabar swellings – subcutaneous edema Worm crawling across the conjunctiva IH: copepods “fiery serpents of Israelites” Pruritic painful papule, live worm in skin ulcer VISCERAL larval migrans DOC: Albendazole Ocular toxociariasis: ocular larva migrans, uveitis, endolphthalmitis CUTANEOUS larva migrans, DOC: Thiabendazole Dog and cat hookworms Undercooked seafood MCC of parasitic meningitis – eosinophilic meningitis Ingested raw seafood Eosinophilic gastroenteritis Appearance Terminal nuclei Prevalence Mosquito Vectors Lymphatics SSx Severity Wuchereria Smoothly curved (-) Strongyloides stercoralis Brugia Kinky (+) Mansonia Limb Elephantiasis less Albendazole Peanut shaped eggs with flattened bipolar plugs ARTHROPODS OF MEDICAL IMPORTANCE Organism Scientific name Lice Bedbug Mites Pediculus humanus (human louse) Phthirus pubis (crab louse) Dermatobia hominis (Human botfly) Cimex lectularius Sarcoptes scabei Ticks Dermacentor widespread Culex, Aedes Anopheles Scrotal Hydrocephalus More Capillaria philippinensis Flies Wuchereria bancrofti Brugia malayi Filiariae - threadlike Most debilitating nematode infection Farmer abaca plantation Bancrofti: Sorsogon, samar. Leyte, Palawan, camarines, albay, Mindoro, Marinduque, Romblon. All Mindanao Malayi: Eastern Samar, Agusan del sur, Palawan, Sulu Trichinela spiralis Thiabendazole Muscle biopsy Elevated CPK Xenodiagnosis Disease features Treatment Nits seen on hair shaft Pruritus of scalp and trunk Nits seen on pubic hair shaft Pruritus in pubic area Larva may be seen emerging from nodule Pruritic, painful, erythematous nodule Pruritic erythematous wheal Scabies: Pruritic erythematous papules and linear tracts Ascending paralysis 1% Permethrin 1% Permethrin 5% Permethrin Nmchico 2016 3