Medfools Parasites Chart for USMLE I

Parasitology Notes for USMLE I

Heeey. fecal oral transmission???

PROTOZOA INTESTINAL and UROGENITAL

Entamoeba Histolytica (bloody diarrhea)
Diseases Characteristics Habitat/Trans Pathogenesis Diagnosis Treatment
Amebic dysentery- bloody, mucus Trophozoite has single nucleus No animal Excyst in ileum, ID trophozoites and Metronidazole,
diarrhea, liver and pulmonary and ingested RBC, cysts have reservoir. Fecal- invade colonic cysts in stool. iodoquinol.
abcess. 4 small nuclei. oral transmision. epithelium, cause Serology positive in
necrosis (teardrop invasive amebiasis Cysts removed by
Mostly asymptomatic. Prevalent among male ulcer), spread (liver, Absence of PMNs. filtration, killed by
homosexuals. lung) boiling, not
chlorination.

Giardia lamblia (Nonbloody diarrhea)

Giardiasis- nonbloody, foul smelling Pear shaped trophozoite, 2 Fecal Excyst in duodenum, Trophozoites/cysts in Metronidazole
diarrhea, nausea, anorexia, flatulence, nuclei, 4 pairs flagella, suction contamination of attaches-NO stool, string test,
abdominal cramps for wks/months. disk. Thick walled oval cyst food/water. invasion, serology. Cysts removed by
Outbreaks at day care centers, w/ 4 nuclei inflammation, filtration, killed by
mental hospitals. Homosexual malabsorption of boiling, iodine, not
5% US stools have cysts, 50% transmission. protein/fat. chlorination.
asymptomatic carriers.
Cryptosporidium (Nonbloody diarrhea)
Cryptosporidiosis in Fecal-oral Complex cycle ID kinyoun acid-fast No effective therapy.
immunocompromised- watery transmision of occurs in epithelial (red) oocytes in stool Try azithromycin
nonbloody diarrhea, fluid loss, oocysts from cells of jejunum, NO smear.
malnutrition human/animal invasion
sources.
Trichomonas vaginalis (NO cyst form)
Trichomoniasis- vaginal itching w/ No cyst. Pear shaped Sexual contact. Infects vagina, Both partners:
watery foul smelling, green vaginal trophozoites, 4 anterior prostate. metronidazole
discharge. Men asymptomatic. flagella, undulating Predisposing factor is
membrane (jerky movement) loss of vaginal acidity

25-50% sexually active women

infected

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PROTOZOA BLOOD and TISSUE
Plasmodium
Diseases Characteristics Habitat/Trans Pathogenesis Diagnosis Treatment
Malaria- fever, chills, HA, myalgias, Endemic to 91 Female Asexual Schizogony in humans Thick and Acute malaria w/
arthralgias two wks post bite. Fever spikes countries, 300- Anopheles Exoerythrocytic phase: thin Giemsa chloroquine which
accompanied by nausea, vomiting, abdominal 500 million mosquito Mosquito injects sporozoites which attack stained kills merozoites,
pain, drenching sweats. Splenomegaly is cases, mostly hepatocytes, sporozoites replicate, differentiate smears. sporozoites in blood.
into merozoites which infect RBCs.
common. Anemia due to lysis of RBCs, sub-Saharan Erythrocytic phase:
Usually ring Mefloquine used in
splenic sequestration of damaged RBCs. Africa. Merozoites in RBCs, diferentiate into ring shaped shaped P.falciparum resistant
trophozoites, develop into schizonts filled with trophozoites to chloroquine.
P. falciparum causes most severe malaria-can merozoites. Merozoites lyse RBCs at regular are ID. Primaquine to get
infect RBCs at all stages and causes adherence intervals and further infect RBCs. hepatic stages of P.
of RBCs to cerebral vascular endothelium via Sexual Sporogony in mosquitoes ovale and P. vivax.
knob proteins (cerebral malaria.) Some blood merozoites develop into male/female
gametocytes in RBCs. Female mosquito eats these Prophylax w/
RBCs, form one female macrogamete or 8
P.ovale, P. vivax cause benign malaria. chloroquine/
spermlike microgamete in gut. Diploid zygote
differentiates into motile ookinete which burrows
mefloquine.
P. malariae produces fevers each 72 hours, through gut wall. Oocyst w/ haploid sporozoites
others every 48 hrs. P. falciparum can cause form on stomach wall, sporozoites released and Prevent w/
almost constant fever. migrate to mosquito salivary glands. Female pyrimethamine
mosquito injects sporozoites into next human impregnated bednets.
victim (sucker.) (kills mosquito cycle)
Toxoplasma gondii
Toxoplasmosis- usually asymptomatic, can cause 5-50% Cat host. Cysts rupture and invade gut mucosa, ingested Serology or Sulfadiazine and
hererophil antibody-negative infectious seropositivity Humans eat by macrophages, differentiate into tachyzoites crescent shaped pyrimethamine
mononucleosis. Life threatening encephalitis in rate in US cysts in meat (rapidly multiplying trophozoites), trophozoites
immunocompromised b/c reactivation of or cat feces disseminate to brain, muscle.
dormant cysts. Transplacental transmission
results in stillbirth or fetal infection (encephalitis,
retinitis, microcephaly, mental retardation)
Trypanosoma cruzi (Chagas disease)
Chagas diesease- Acute: edematous nodule Rural Central Humans, Reduviid bug ingests trypomastigotes from Thick and thin Nifurtimox kills
(Chagoma) at bite site (periorbital, perioral), and South animal animals blood, trypomastigotes multiply in blood smears for trypomastigotes,
fever lymphadenopathy, H/Smegaly, resolves in 2 America, reservoirs. gut, excreted at bite, invade skin, disseminate trypomastigotes. NO therapy for
months Southern US Reduviid in blood, amastigotes proliferate inside Serology chronic form.
Indeterminate- low levels of parasitemia, (kissing) bug macrophages and myocardium, amastigotes Muscle biopsy
serological evidence of infection as vector differentiated into blood borne revealing
Chronic- myocarditis (arrythmia, dilated trypomastigotes which are taken up by amastigotes.
cardiomyopathy, CHF), megacolon, reduviid bug at next meal. Xenodiagnosis
megaesophagus. Death usually by arrythmia.

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Trypanosoma gambiense/rhodesiense (African sleeping sickness)
Trypanosomal chancre (many organisms) at Trypomastigotes, Tsetse fly vector. Skin to blood/LN to CNS ID Suramin in pre
no amastigotes.
bite site. Sleep-Sleep fly trypomastigotes encephalitis stage.
African sleeping sickness- Cyclical fever, Human and animal Antigenic variation of VSGs variable in blood smear, Melarsoprol for
lymphadenopathy, demyelinating encephalitis, Sub-Saharan reservoirs. surface glycoproteins LN or CSF. CNS involvement.
HA, insominia, slurred speech, ataxia, mood Africa
changes, somnolence, coma.
Leishmania donovani (Kala-azar)
Kala-azar (visceral leishmaniasis)- RES Sandfly Female sandfly ingests macrophages ID amastigotes Sodium
involvement. Chronic low grade fever, anorexia, Mediterranean/ vector. Dog, containing amastigotes, amastigotes in spleen, LN, stibogluconate
weight loss, skin hyperpigmentation. Bone Middle East, fox, rodent differentiate into promastigotes in sandfly BM biopsy.
marrow involvement results in anemia, Saharan reservoirs gut, multiply, migrate to pharyx, transmitted
leukopenia, thrombocytopenia and secondary Africa, India to humans w/ bite, in human macrophages Leshmanin
infections, coagulopathies. Massive promastigotes differentiate back into DTH skin test
splenomegaly. Disease lasts months to years. amastigotes. negative, poor
cellular response.
Leishmania tropica, mexicana, braziliensis (Cutaneous, mucocutaneous)
Ulcers confined to skin/mucous membranes, often superinfected Sandfly Basically like L. donovani ID amastigotes Sodium
by bacteria. Multiple satellite nodules coalesce and ulcerate. In vector. in skin lesions stibogluconate
diffuse cutaneous leishmaniasis, lesions grow/spread all over skin. Forest
Disfiguring granulomatous lesions destroy nasal cartilage (like rodent
lepromatous leprosy) reservoirs
L. tropica Cutaneous Old world
L. mexicana Cutaneous Americas
L. braziliensis Mucocutaneous -- Central/South America

Pneumocystis carinii (PCP)

Pneumonia- acute fever, nonproductive cough, Classified as Inhalation of Cysts establish life long latent infection in Silver stained TMP-SMZ
dyspnea, tachypnea. CXR shows diffuse, a fungus cysts. NOT lungs. In immunocompromised, cysts induced sputum Pentamidine
bilateral infiltrates or may be normal. person-person reactivate and induce exudative inflammation specimen,
Untreated cases fatal. which compromises gas exchange in the bronchoalveolar Prophylax when
alveoli. lavage fluid, CD4 < 200
bronchial tissue
biopsy reveal
pneumocystis.

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CESTODES Hermaphroditic flatworms
Taenia solium (Pork tapeworm)
Diseases Characteristics Habitat/Trans Pathogenesis Diagnosis Treatment
Cysticercosis- HA, vomiting, seizures, Solex w/ 4 Gravid proglottids ingested by pigs ID gravid proglottids Niclosamide
uveitis, retinitis suckers, circle of (intermediate hosts), develop into larvae w/ 5-10 uterine Praziquantel
Taeniasis- usually asymptomatic hooks which burrow holes in blood vessels, go to branches in stool.
skeletal muscle. Humans eat raw pork Treat
containing cysticerci (encysted larvae), Cysts by Xray or CT. asymtomatics to
mature in gut. If humans eat eggs, larvae prevent
spread to eyes/brain where they encyst to Larvae may be autoinnoculation,
form cysticerci. Space filled/calcified lesions. floating in vitreous. cysticercosis
Taenia saginata (Beef tapeworm)
Taeniasis- asymptomatic Solex w/ 4 suckers, Same life cycle, except cattle host. Gravid proglottids w/ Niclosamide
No cysticercosis in humans no hooklets 15-25 uterine Praziquantel
branches. (remember
COWS are bigger than
PIGS, more branches)
Diphyllobothrium latum (Fish tapeworm)
Mostly asymptomatic or Solex w/sucking Scandinavia and Eggs in fresh water, ingested into Niclosamide
Megaloblastic anemia (B12 deficiency) grooves, no hooks. Japan. crustaceans, differentiate into larvae Praziquantel
due to preferred uptake of B12 by worm. Gravid uterus in for fish. Humans infected by eating
rosette form. Eggs undercooked fish.
oval w/ operculum.
(diagnostic)
Echinococcus granulosus (Dog tapeworm)
Unilocular hydatid cyst disease- Scolex and 3 Dogs definitive Worms in dog intestine dump eggs, Niclosamide
usually asymptomatic, may cause proglottids (small) hosts, sheep ingested by sheep or humans. Praziquantel
hepatic dysfunction. intermediate, Oncospheres form and spread to
humans dead end. organs (liver), form hydatid cysts. Stop feeding the
Cyst contents cause anaphylaxis Dogs eat slaughtered sheep, cycle dogs sheep bits!
complete
Hymenolepsis nana (Dwarf tapeworm)
Usually asymptomatic Most common No intermediate Eggs directly infectious for humans. Eggs in stool Niclosamide
tapeworm in US, host Many worms found, unlike others Praziquantel
esp. SE USA which exist singly

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TREMATODES Flukes
Schistosoma (snails)
Diseases Characteristics Habitat/Trans Pathogenesis Diagnosis Treatment
Schistosomiasis- itching at site of penetration Schistosomes Free swimming cercariae penetrate Characteristic Prizaquantel
(swimmers itch), fever, chills, diarrhea, are separate human skin, differentiate into larvae, eggs in feces,
lyphadenopathy, eosinophilia. Chronic infection sexes that live enter venous circulation, mature into urine.
leads to GI hemorrhage, H/Smegaly, death by attached to each adult form. Females lay eggs spread to
ruptured esophogeal varicies. other. Females gut or bladder, excreted in feces or
reside in male urine. Eggs hatch in fresh water,
S. haemoatobium infection can cause bladder grooves. 200 penetrate snails, differentiate to free
cancer. million cases swimming cercariae.
worldwide
Pathogenesis mediated by host granuloma
Trematode Affected veins Eggs Endemic areas response to antigenic eggs in organs.
S. mansoni Large intestine Large lateral spine Africa, Caribbean Schistosomes coast themselves in host
S. japonicum Small intestine Small lateral spine Orient antigens, immune evasion.
S. haematobium Bladder Large Terminal spine Africa, Mid East
(think of bladder as terminal organ of GU system)

Chlonorchis sinensis (snails, fish)

Oriental liver fluke- mostly asymptomatic, or
upper abdominal pain, anorexia, hepatomegaly,
eosinophilia with high worm burden
Paragonimus westermani
Lung fluke- chronic cough w/ bloody sputum
(resembles TB), Dyspnea, pleuritic chest pain,
recurrent secondary bacterial pneumonias.
Korea, Humans infected by eating undercooked fish Typical Prizaquantel
China, containing encysted larvae. Larvae excyst in operculated eggs
Japan duodenum, immature flukes enter biliary in stool
ducts. Host inflammatory response causes
hyperplasia/fibrosis of biliary tree. Adults
pass eggs in feces. Eggs eaten by fresh water
snails (1st intermediate host), hatch in snail gut
into free swimming cercariae. Cercariae
encyst under scales of fish (2nd intermediate
host) and cycle repeats
(snails, crabs)
Orient, Humans eat undercooked crabs, containing ID operculated Prizaquantel
India encysted larvae which excyst in small intestine. eggs in sputum
Larvae penetrate intestinal wall and through or feces
diapragm into lung. Adults make eggs which
are coughed up, swallowed, excreted into fresh
water. Eggs develop into miracidia and enter
fresh water snails (1st host) in which they
develop into free-swimming cercariae which
enter crabs (2nd host) and cycle repeats.
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NEMATODES - INTESTINAL Roundworms
Enterobius vermicularis (Pinworm)
Diseases Characteristics Pathogenesis Diagnosis Treatment
Perianal itching Life cycle confined Humans infected by ingesting eggs. Eggs hatch in small Recover eggs by Mebendazole kills
to humans intestine, larvae migrate to colon. Male/female mating, famous Scotch tape adults.
female migrates to anus at night to release eggs. Larvae method
carried to mouth my fingers which have scratched itchy skin,
cycle repeats Eggs NOT in stool

Trichuris trichiura (Whipworm)

Mostly asymptomatic, maybe diarrhea Worldwide, Humans eat eggs in soil contaminated with human feces. Eggs in stool Mebendazole
Southern US Adult worms burrow into intestinal mucosa, do not cause
anemia, unlike hookworms
Ascaris lumbricoides
Ascariasis- mostly asymptomatic, but Common in Humans eat eggs in soil contaminated with human feces. ID corrugated eggs in Mebendazole
ascaris pneumonia can result from tropics. Eggs hatch in small intestine, larvae migrate through gut Stool Pyrantel pamoate
damage of larvae migration through mucosa into bloodstream to lungs, coughed up and
lung, inducing inflammation with Largest nematodes, swallowed. Mature in small intestine, persist in lumen, do not
eosinophilic exudate 25cm. attach, live off ingested food. Thousands of eggs laid daily,
passed in feces, form embryos in warm soil. Human ingestion
completes cycle.
Ancylostoma/Necator (Hookworm)
Microcytic anemia- weakness pallor, Cycle like Ascaris, except larvae in soil penetrate skin. Adults Eggs in stool. Mebendazole
pneumonia with eosinophilia use cutting plates to attach to intestine. Major damage is by Pyrantel pamoate
loss of blood.
Strongyloides stercoralis
Strongyloidiasis- mostly Tropics, SE Asia, Two life cycles. One in humans, one in soil. Infectious larvae LARVAE, not eggs Thiabendazole
asymptomatic, pnemonitis can occur, Southern US penetrate skin, migrate to lungs, alveoli, trachea where in stool
and gut mucosal damage. they are swallowed. In small intestine, larvae become adults,
enter mucosa and produce eggs. Eggs hatch, larvae passed in
Eosinophilia can be striking. stool. In soil, larvae differentiate into male/females, mate,
produce infectious larvae.
Trichinella spiralis
Trichinosis- Gastroenteritis, followed Worldwide, esp. E. Pigs reservoir in US. Infection by eating raw pork (or Bear!) Muscle biopsy. No Treatment for
1-2 wks later with fever, muscle pain, Europe, containing larvae encysted in muscle. Adult forms arise and trichinosis.
periorbital edema, eosinophilia. W. Africa release larvae into blood with dissemination to organs. Thiabendazole for
Larvae only develop in striated muscle. early infections
kills adult worms.

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NEMATODES - TISSUE Roundworms
Wuchereria bancrofti (Filariasis)
Diseases Characteristics Pathogenesis Diagnosis Treatment
Filariasis- adult worms cause obstruction Tropics, 200-300 Female Anopheles mosquito deposits infective larvae on Thick blood Diethylcarbamzaine
of lymphatics, causing edema. Fever, million infected skin while biting. Larvae penetrate skin, enter LN, mature smears taken effective vs.
lymphangitis, cellulitis develop. one year later into adults that produce microfilariae. at night show microfilariae.
These circulate in blood, esp. at night, and are ingested microfilariae
Elephantiasis- occur in patients repeatedly by mosquitoes in which they produce infective larvae. No tx vs. adults
infected. Microfilariae do NOT cause symptoms

Oncocerca volvulus (River Blindness)

Subcutaneous inflammation, pruritis, Millions infected in Female blackfly (THINK BLACK=blindness)deposits Microfilariae Ivermectin vs.
papules, nodules form in response to adult Africa, Central infective larvae on skin while biting. Larvae enter wound, in tissue biopsy microfilariae.
worm proteins. Microfilariae migrate through America migrate to subcutaneous tissue, where they differentiate
tissues, ultimately concentrating in the eyes. into adults in dermal nodules. Female produces Suramin vs. adults.
Leads to blindness. microfilariae that are ingested when another blackfly bites.
Microfilariae develop into infective larvae to complete the
cycle.
Loa loa
Loiasis- hypersensitivity rxn results in Only tropical central Deer fly (mango fly) deposits infective larvae on skin. Microfilariae Diethylcarbamazine
localized subcutaneous edema. Adult worm and western Africa Larvae enter wound, wander around body, develop into in blood smear
may be seen crawling across conjuctiva, adults. Females release microfilariae which enter blood
usually harmless. during the day (compare to Wuchereria). Deer fly infests
microfilariae which differentiate into infective larvae.
Dracunculis medinensis (Guinea fire worm disease)
Dracunculiasis- worm protrudes from skin W.H.O. says just 17 Humans infected by tiny crustaceans (copepods) Wind worm up on a
ulcer, wind up on stick over days. countries have this swallowed in drinking water. Larvae released in small stick over days.
disease as of 4/3/98. intestine, migrate to body, develop into adults. Adult
All in Africa. females ulcerate skin, release larvae which are eaten by
(109 countries copepods.
Dracunculis free!)
Toxocara canis (Visceral larva migrans)
Visceral larva migrans- Blindness due to Dog is definitive Dog sheds T.canis in eggs in soil. Humans eat eggs, hatch Larvae in tissue. Diethylcarbamazine
retinal involvement. Fever, hepatomegaly, host in small intestine, larvae migrate to organs (eyes, liver, Hypergammaglobulinemia,
eosinophilia.
eosinophilia are common. brain), but are eventually encapsulated and die. Life cycle
NOT completed in humans (dead end host.)
*Note: if youre really interested about Dracunculis, visit the World Health Organization at http://www.who.org/

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