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Parasitology - area of biology concerned with the phenomenon of dependence of one living organism on another. Medical Parasitology - concerned with animal parasites of humans and their medical significance as well as importance in human communities
Biological Relationships
Commensalism - symbiotic relationship in which 2 species live together one is benefited; the other is not affected ex. Entamoeba coli supplied with nourishment host not benefited nor harmed ( no tissue damage in the host) Mutualism - both are benefited by the association
1. Parasites as to habitat or mode of development: a. endoparasite infection presence of parasite in a host b. ectoparasite infestation presence of ectoparasite on a host c. erratic parasite - parasite found in an organ which is not its usual habitat d. obligate parasite - parasites that cant live without a host
e. Facultative parasite
- survive with or without a host - exist in free-living or may become parasitic when the need arises f. Accidental or incidental parasite - a parasite which establishes itself into a host where does not ordinarily live
it
g. Permanent parasite - parasite that remains in or on the body of the host for its entire life h. Spurious parasite - parasite of animals that parasitizes human but there is no development in the parasite
Host a. intermediate host - harbors the asexual or larval stage of the parasite
b. definitive or final host - one in which the parasite attains sexual maturity.
Vectors
- responsible in transmitting the parasite from one host to another ex. Flies, cockroaches feed on fecal material and transfer enteric organism to food
Mode of Transmission
1.Oral
- ingestion thru contaminated water, food containing infective stage of parasite ex. Taenia saginata (beef tapeworm) Taenia solium (pork tapeworm)
2. Skin penetration ex. A. braziliense and A. caninum - exposure of skin to the soil
3. Transplacental - mother to the fetus 4. Transmammary infection - infection transmitted through the mothers milk
5. Sexual intercourse ex. Trichomonas vaginalis
2 subclasses: a. Phasmidia- with caudal chemoreceptors; chemoreceptors function in modulation of chemorepulsion behavior - cause diseases in man b. Aphasmidia- without caudal chmoreceptors eg. Trichiuris Trichinella Capillaria Amphids- with cephalic receptors; do not cause diseases in man
Characteristics
Cylindrical Non- segmented Dioecious Pseudocoele Cuticle Male smaller Male has coiled posterior ends; female has tapering posterior ends
Ascaris female , cross-section
Intestinal Nematodes
Ascaris lumbricoides
Common name: Giant intestinal roundworm Habitat: lumen of small intestine
3 non-human ascaris: Toxocara cati- cat Toxocara canis- dog Ascaris suum- pig Morphology:
ADULT Whitish or pinkish triradiate lips
Female: larger; straight blunt tail Male: smaller; curved posterior end with 2 spicules
OVA
1. fertilized ova
- oval or spherical, thick- walled - consists of the ff. layers: 1. inner lipoidal vitelline membrane (absent in unfertilized egg) 2. middle glycogen layer 3. outer mammillated albuminous layer (absent in decorticated egg)
fertilized, corticated
fertilized, decorticated
2. unfertilized ova - long, narrow, thin walled - no lipoidal vitelline layer - irregular mammillated albuminous outer layer
embryonated egg
- infective stage - embryonation occurs in the soil
Adults in the intestine: intestinal obstruction, appendicitis, intestinal perforation, biliary ascariasis, cholecystitis, pancreatitis, etc
Diagnosis:
1.Direct fecal smear -eggs are easily found due to a large number of the female oviposition, approximately 240,000 eggs per female per day Therefore, eggs passed in feces is diagnostic 2. Kato-Katz Technique
Quantitative Intensity of infection Per gram of feces
Epidemiology
World wide distribution More than 1 billion individuals are affected 70% from Asia Mode of transmission: Ingestion of food/ water contaminated with embryonated oocysts or from contaminated fingers
Factors favoring the spread of the transmission: 1. Simple life cycle. 2. Enormous egg production ( 240,000 eggs/ day/ female ). 3. These eggs are highly resistant to ordinary disinfectants (due to the ascroside). The eggs may remain viable for several years. 4. Social customs and living habits. 5. Disposal of feces is unsuitable
Prevention 1.Sanitary disposal of feces. 2.Hygienic habits such as cleaning of hands before meals. 3.Health education.
Treatment
Albendazole
Drug of choice 400 mg single dose 200 mg for children under 2 year old
Mebendazole
500 mg single dose
Pyrantel Pamoate
10 mg/kg body weight (max. of 1 g)
Trichuris trichiura
MORPHOLOGY Adult
thick posterior portion and long thin anterior portion
Male 30-45 mm Coiled posterior end Single spicule Retractile sheath Female 35-50 mm Bluntly rounded posterior end Can produce over 60 million eggs in an average life span of 2 years
OVA - barrel shaped, football shaped, Japanese lantern shaped - with protuberant bipolar mucus plugs
Disease: Trichuriasis leading to rectal prolapse during heavy infection Infective stage: embryonated egg
Epidemiology
Distributed in warm, moist areas of the world 20% 30% prevalence in temperate countries 60% - 85% in tropical countries Children 5 to 15 years of age are frequently infected
Mode of transmission Ingestion of embryonated egg (Anus to mouth; finger to mouth; airborne retroinfection)
Occurs quite frequently with Ascaris lumbricoides due to similarities in transmission and mode of distribution
Treatment
Mebendazole
Drug of choice 500 mg single dose in light infections 2 3 days of consecutive treatment for moderate and heavy infections Contraindicated during early pregnancy and in hypersensitivity
Albendazole
400 mg single dose Contraindicated during pregnancy
harder to expel because attaches to the mucosa of the caecum by burying its anterior portion in a pin-fashion manner
HOOKWORMS
Soil transmitted Blood-sucking
HOOKWORMS
Necator americanus
Synonym: Uncinaria americana Common name: New World Hookworm Habitat: small intestine (jejunum)
Ancylostoma duodenale
Uncinaria duodenalis
A. duodenale
Bigger C shaped
N. americanus
Smaller S shaped
Points of differentiation
4. Copulatory
N. americanus A. duodenale
Oval (top view) bipartite/bidigitate With fused spicules Circle (top view) tripartite/tridigitate with unfused spicules
Hookworm ova
-resemble each other -thin shelled -Ovoid -in the early stage of segmentation, 2 to 8 cell stage
HOOKWORM LARVAE
Rhabditiform larva (1st stage) Short and tout Filariform larva (3rd stage) Long and slender
Feeding stage larva Non-feeding stage open mouth closed mouth Flask shaped esophagus With pointed tail and sheath With long narrow buccal With pointed tail and chamber and flask sheath shaped esophagus
Pointed tail
Cuticle (sheath)
Buccal cavity Infective filariform larva (third stage) showing its protective envelope
Hookworms can remain in an arrested state of development in the muscle. Adult hookworms migrate, and mature as blood sucking parasites of the small intestine where they reproduce.
Infective stage embryonated egg filariform larvae _____________________________________________________________________ route of infection by mouth by skin _____________________________________________________________________ mode of infection passively actively _____________________________________________________________________ blood-lung pass through the liver dont pass through the liver migration in lungs of host, larvae the larvae dont molt and molt twice and stay stay in the lungs for10 days _____________________________________________________________________ food of the adults intestinal content blood _____________________________________________________________________ life span 1 year several years _____________________________________________________________________
2. Adults in small intestine (1) Epigastric pain as that of a duodenal ulcer. (2) A large worm burden results in microcytic hypochromatic anemia. The symptoms are lassitude, edema, palpitation of the heart. In severe case, death may result from cardiac failure or physical exhaustion. (3) Allotriophagy (or pica ) is due to the lack of trace element iron . (4) Amenorrhea, sterility, abortion may take place in women. (5) Gastrointestinal bleeding (6) Infantile hookworm disease
Diagnosis
Direct fecal smear
only for heavy infections
Kato Technique
Increases detection rate
Epidemiology
Over 900 million people infected Associated anemia causes 50,000 deaths annually
Ancylostoma duodenale
Necator americanus
Mode of transmission: skin penetration Direct skin contact with free-living soil larvae (e.g. walking barefoot)
- Deworming of pets
Treatment
Albendazole Drug of choice Ovicidal and larvicidal 400 mg single dse in adults and children over 2 years old Available in chewable tablets or suspension Not recommended for pregnant women Mebendazole 500 mg single dose in adults and children Not recommended for children below 2 years old
Enterobius vermicularis
Synonym: Oxyuris vermicularis Common Name: pinworm or seatworm General Characteristics:
Adult Male - smaller - about 2-5 mm in length - has a curved, relatively blunt posterior end
rarely seen
Female
longer long pointed tail gravid female lays 4, 672 to 16,888 eggs/day (11,105 eggs on average/day) dies after deposition
Ova
- colorless and transparent - thin shell and one of the sides is flattened (D shaped) - content is a larva
Diagnosis
eggs and the female adults removed from the folds of the skin in the perianal regions by the use of the scotch tape swabs made in the morning, before the patient has washed or defecated
Epidemiology
more common in white than colored people more prevalent in children than adults most common where people live under crowded conditions such as orphanages, kindergartens, and large families
Mode of transmission:
Ingestion of eggs from fingers contaminated by scratching Contact with contaminated linens or clothing
Infective Stage:
Embryonated egg
Treatment
Mebendazole
Prevention: 1. treat the patients and carriers 2. individual health 3. public health 4. health education and hygienic habits
Trichinella spiralis
Common Name: Muscle worm Viviparous parasite Habitat: small intestine: adult worms larvae encysted in muscles of the pigs
Female
3.5 mm by 0.06 mm possesses a characteristic clubshaped uterus
Male
1.5 mm by 0.04 mm Possesses a pair of papillae used to hold the female during copulation
Encysted Larva
- Spear-like burrowing
Epidemiology
Occurs whenever meat is part of the diet Human infection: dead end infection
Treatment
Thiabendazole 25 mg/kg body weight twice a day for 7 days during the first week of infection expels the adult worm from the GI tract No effect on migrating larvae and infections detected 2 weeks after exposure Mebendazole Larvicidal Given at 20 mg/kg body weight 6-hourly for 10 to 14 days
Strongyloides stercoralis
Common Name: threadworm a facultativ parasite (a.) free-living: in the soil (b.) parasitic: in the human body no parasitic males because females are parthenogenic Habitat: small intestine
rhabditiform larva - diagnostic stage - smaller, stouter, spindle shaped - short buccal cavity and a muscular esophagus
filariform larva -infective stage -long esophagus -a forked or a notched tail without a sheath
Diagnosis
Eosinophilia Duodenal aspiration Small bowel biopsy Concentration techniques
Harada Mori Culture Baer mann funnel
Epidemiology
50 to 100 million people are infected Frequently found among male children (7 14 years old) Mode of transmission: skin penetration (e.g. walking barefoot) infective stage: filariform larva Larvae penetrate the skin and migrate to the lungs
Treatment
Albendazole
Drug of choice 400 mg for 3 consecutive days for adults and children over 2 yeas of age Eradicate up to 80% of infection
Thiabendazole
50mg/kg (max. of 3 g/day) in 2 divided doses daily for 2 consecutive days after meals
Capillaria philippinensis
Common Name: Pudoc worm Habitat: small intestine (jejenum) Disease: Capillariasis or Pudocs disease or mystery disease (malabsorption syndrome)
Morphology: Adult Female - have eggs in utero arranged in single or multiple rows Male - characterized by chitinized spicule and a long sheath extending beyond the length of the worm
eggs
Ova
Peanut-shaped Striated shell With flattened bipolar mucus plugs
Epidemiology
First recorded in Northern Luzon, Philippines 2,000 cases documented in the Philippines Thailand, Iran, Japan, Egypt, Korea, Taiwan, India
Mode of Transmission
eating raw freshwater fish fish harboring the 2nd stage larva
Intermediate Hosts
Brackish water fish: bagsit Fresh water fishes: ipon, birot, bagsing or bagtu
Treatment
Electrolyte replacement High protein diet Antidiarrheal drugs Antihelminthic drugs
Albendazole
400 mg once a day for 10 days Drug of choice Destroys larval stages
Mebendazole
200 mg 2x a day for 20 days
Blood Nematodes
Wuchereria bancrofti
Wuchereria malayi
Points of Differences Wuchereria bancrofti synonym Filaria bancrofti microfilaria Vectors (mosquitoes) urban: rural: No terminal nuclei Aedes poecilus Anopheles minimus flavirotris
Wuchereria malayi Brugia malayi 2 terminal nuclei Mansonia bonneae Mansonia uniformis
pathology
Edema in the legs and genitalia Elephantiasis occurs in patients who have been repeatedly infected
Diagnosis: Giemsa-stained
microfilaria in thick blood smear diagnostic stage: demonstration in the peripheral blood of the microfilaria obtained during the night (8 am to 4 pm) because of nocturnal periodicity; microfilaria are minute snake-like organisms moving about the red cells in fresh blood specimen infective stage: filariform larva (3rd stage larva)
Epidemiology
More than 1 billion people in over 80 countries are at risk Over 120 million peole are affected 43 million are seriously affected In the Philippines: Camarines Norte Camarines Sur Albay Sorsogon Mindoro Palawan Romblon Mountain Province All provincrs of Mindanao
Treatment
Diethylcarbamazine (DEC)
Drug of choice 6 mg/kg body weight for 12 days Divided doses after meal
Ivermectin
200 to 400 ug/kg body weight in a single oral dose
CHARAC- HABITAT MOT and TERISTIC Infective FEATURES Stage 1.Ascaris -adult w/ SI -ingestion of lumbricoides trilobed (lumen) embryonated anterior or egg thru Giant triradiate lips contaminated Roundworm food &drinks Male smaller, curved post. Non-human ascariscaris end with 2 copulatory Toxocara spicules
cati: cat ascaris Toxocara canis: dog as Ascaris suum: pig ascaris
NEMATODE
Diagnosis DISEASE TREAT/DIAGNOSTIC MENT STAGE Stool exam Ascariasis MebendaAscaris zole EGG pneumoPyrantel A) Unfertilized nitis Pamoate -Long narrow Loefflers albendazole - no vitilline syndorme membrane B)Fertilized - with 3 layers a. Inner lipoidal vitelline b. Middle glycogen c. Outer albuminous mammillary
LI
Mebendazole
3. Hookworms a. Necator americanus New World Hookworm b. A. duodenale Old World Hookworm
N. americanus - S shaped - No true teeth; semilunar cutting plates; bursa is bipartite - smaller A.duodenale - C shaped -2 pairs of teeth; bursa
SI:
jejenum
Direct skin contact with free-living soil larvae (filariform) Rhabditiform larva (feeding stage)- short and stouter Filariform larva (non feeding stage)- long and slender with pointed posterior
Egg occurrence -Ovoid, thin shelled -In the early stages of segmentation (2-8 cell stage)
Mebendazole Albendazole
duo den um
4.Enterobius vermicularis
pinworm/ seatworm
- spindle shaped with wing like cephalic alae - female dies after oviposition - male dies after copulation
Ingestion of embryonated ova Transmiss ion: Anus to mouth; Finger to mouth; airborne and retroinfect ion
-Smallest SI: Nematode in duodeman num -Facultative parasite -Females are parthenogen ic
Rhabditi form larva:smal ler & stouter Eggs not normally seen because hatch to rhabditifor m while in small intestine Peanut shaped ;mucus plugs not protruding
Thiabendazole Albendazole
-Very delicate and tiny - with chitinized spicule - eggs in uterus in single or
SI Jejenum
-Ingestion of fresh water fish harboring the 2nd stage larva IH (ipon, birot, bagsang,
-minutethread-like worms Male -with conical papillae Female -with club shaped uterus
Eating Encysted inadequately larva cooked pork with encysted larvae Requires 2 hosts to complete life cycle Hosts: rat man,
8.Blood Nematode a.W. brancrofti Bancrofts filaria b. W. malayi Malayan filaria/ Brugia No terminal Nuclei
-Bite of mosquito (Aedes, Anopheles, and Mansoni) with the filariform larva (3rd stage)
Giemsa Filariasis stained microfila ria which is snakelike with 2-3 rows of nuclei ; exhibit nocturna