Para Lec Midterms Merged

PARASITOLOGY
MLS 409 | LECTURE | MIDTERM
INTRODUCTION TO PARASITOLOGY
SYMBIOSIS PARASITISM
• Association / relationship / interaction between two • One species (microbe) benefits at the expense of
living organisms, or organisms that lives together. the other (host)
• Definition of Terms: o Parasite: living organism that takes nourishment
o Symbionts: organisms living together. and other needs through contact with another
o Symbiosis: association/relationship or two species
organisms living together. o Host: organism that supports parasite, and later
1. Mutualism develops disease
2. Commensalism • Ex: Entamoeba histolytica derives nutrients from
3. Parasitism human causing intestinal ulcers and dysentery
MUTUALISM
• Biological relationship between two or more
organisms when both the host and organism
benefit from one another.
• Ex.: Flagellates inside digestive system of termites,
lactobacilli in women’s urogenital tract.
o Termites eat wood without getting harm because
of the flagellates inside their digestive system in
which the termites get nutrients from the wood
and the flagellates get their nutrients from the
wood. Both of them have benefits.
o The woman’s vagina has a normal pH of acidic
pH because of the lactic acid produce by your • This is the typical appearance of Entamoeba
lactobacilli. If the acidic pH is disrupted, women histolytica.
will be prone to develop infection. The vagina also • In the left image is the Entamoeba histolytica
has nutrients for the consumption of lactobacilli. trophozoite – it is the active stage of the E. histolytica.
It has a central nucleus with the ingested RBCs.
• E. histolytica will produce enzymes, will activate,
proliferate and invade mucosa into the submucosa
which will elicit immune response. If there is a breach
in the intestinal epithelium, there will be ulcerations.
PARASITOLOGY
• Is a branch of science that deals with the study of
COMMENSALISM
parasites
• One organism benefits but there is no beneficial or
• Medical parasitology or Human parasitology is
harmful effect to the host
restricted to studying those parasites that are living in
• Ex: Entamoeba coli in intestinal lumen of humans, or on the body of human, their geographic distribution,
Proteus mirabilis is a commensal of GIT the diseases caused by them, clinical picture and the
o Entamoeba coli is a normal flora inside the human response generated by human against them.
body. It does not harm the human body. • OTHER TERMS:
o Anthroponosis: parasitic infection is found in
man alone
o Zooanthroponosis: parasitic infections mainly
affect man; animals become infected in life cycle
of parasites as in taeniasis
o Anthropozoonosis: parasitic infection is mainly
in animal, may be acquired by man as in
trichinosis, echinococcosis
TYPES OF PARASITES
LOCATION
SUMMER 1
PARASITOLOGY
• Ectoparasite – a parasitic organism that lives on the • If the patient has acquired infective filariform larvae,
outer surface of its host, e.g. lice, ticks, mites etc. the parasite can also adapt to exist inside the human
• Endoparasites – parasites that live inside the body body.
of their host, e.g. Entamoeba histolytica. OTHER TYPES OF PARASITES
• Infestation: presence of ectoparasites • Accidental/Incidental Parasite: parasite attacks an
• Infection: presence of endoparasites unnatural host and survives but may or may not
complete life cycle.
o Echinococcus granulosus
▪ This is most common in sheep. If it is found
inside dogs, humans, etc. it is called
accidental parasite since they are not
commonly found inside them.
• Erratic or Aberrant Parasite: parasite that wanders
in to an organ in which it is not usually found
o Ascaris in humans
▪ Ascaris lumbricoides can cause acute
appendicitis. At the junction of cecum and
intestine is the location of the appendix. Adult
worms lives inside the intestine and then
travel to the appendix. Since the appendix is
very small and then once blocked it could
elicit immune response and then it will
• Parasites do not exist alone. They come in groups. inflame thus causing acute appendicitis.
NEED OF HOST ▪ Ascaris could also go to the lungs causing
• Obligate Parasite: completely dependent on the host Loeffler’s pneumonia.
during a segment or all of its life cycle o E. histolytica reaching liver from intestine
o Ex: Plasmodium spp., malaria ▪ Entamoeba histolytica has different enzymes
• Facultative Parasite: exhibits both parasitic and non- or virulence factors.
parasitic modes of living and hence does not ▪ From the intestine they will travel to the liver
absolutely depend on the parasitic way of life but is thus causing liver abscess
capable of adapting to it if placed on a host.
o Ex: Strongyloides stercoralis
• This is an example of Ascaris lumbricoides. (Oh diba

cute siya noh. Luod siya.). They should be in the small
intestine. If they become erratic, they could travel
anywhere, especially to the different openings of the
body.
• In patients of having a heavily burdened with
ascariasis, once they will be treated through
deworming (albendazole, mebendazole), the patients
are usually given an antihistamine to prevent the
• Inside the red circle, this is the Strongyloides
parasite to be erratic. So parang sleepy sila habang
stercoralis free living form, non-parasitic. They can
namatay, peaceful yung pagkamatay nila. Because if
exist in the environment without the host.
SUMMER 2
PARASITOLOGY
they are active there is a tendency that they will travel • Needle or grain (right side pic).
to the nose, mouth, etc. (right side pic). • Hyperparasite: parasite that parasitizes other
parasites
• Female Ixodes tick with a male Ixodes attached to its

underside in typical feeding mode.
• E. histolytica invading the lungs. TYPES OF HOSTS
• Intestines, liver, diaphragm, and lungs are adjacent DEFINITIVE & INTERMEDIATE
structures. E. histolytica can migrate to different • Definitive Host: a host that harbors a parasite in the
organs because they have enzymes that can invade adult stage or where the parasite undergoes a sexual
the mucosa and the different layers. reproduction.
• Intermittent or Temporary Parasites: those that o Ex: Humans in taeniasis
only visit the host from time to time for feeding o In taeniasis, Taenia solium or Taenia
o Ex: Mosquito saginata, humans are the definitive hosts
o Only female mosquitoes feed on blood because this is where their sexual
because it is needed for their babies to live. reproduction occurs.
The male mosquito do note bite humans they o It is where mature adult stage and sexual
feed on fruit (mga sosyal sila). reproduction occurs.
• Permanent Parasite: remains on the host for life • Intermediate Host: harbors the larval stages of the
o Ex: Trypanosomes, Wuchereria parasite or an asexual cycle of development takes
o If they are not removed, they will stay in the place.
body forever (sanaol may forever). o Ex: Pigs for T. solium, cattle for T. saginata
• Spurious or Coprozoic Parasite: organisms that
have been swallowed and passed through the
alimentary tract without causing any effect
• Pseudoparasite: not a true parasite but mistakes as
parasite
o Ex: thread, seeds, air bubbles
o Pag bago palang kayo na medical
technologists or nagapractice palang, you
can misidentify eggs of the parasites from
seed and air bubbles. For example, air
bubbles can be misidentified to be as
hookworm ova.
• This is a Capillaria philippinensis life cycle. The adult
C. philipinensis are inside the intestine of the human,
thus the human is a definitive host.
• The intermediate host is the freshwater fish (3)
because it has the infective larvae. Kung sino yung
may larvae or asexual reproduction occurs is the
intermediate host which harbors the infective stage
• Here (left side pic), the oval shape under copyright is larvae wherein asexual reproduction occurs.
the ova of Trichuris trichiura which is common in the
Philippines. The black circle in the picture is the air
bubble.
SUMMER 3
PARASITOLOGY
• The procercoid larva inside the copepods was
ingested by a small fish. Inside the small fish, the
procercoid became plerocercoid (5).
• In this case, the copepods will be the first intermediate
host where the first asexual development occurs
(coracidia – procercoid).
• The small fish will be the second intermediate host
where the second asexual development occurs
(procercoid – plerocercoid).
• The big fish that ingested the small fish having
plerocercoid does not have a role (6). It is only a way
• This is Taenia. The Taenia solium (pigs) and Taenia for the parasite to transfer into a man through
saginata (cattle). Tapeworms yan sila. ingesting the big fish, kasi diba mas masarap man
• Here in your cows and pigs (leftmost side) is the yung malalaking isda.
oncospheres or the eggs of Taenia. And then they will
encyst inside the muscle in which this will be eaten by
the man.
• Inside the man, it will develop into an adult worm.
Kung saan yung adult yun yung definitive host.
PARATENIC & RESERVOIR

• Paratenic Host: a host that serves as a temporary
refuge and vehicle for reaching an obligatory host,
• Here is the Plasmodium.
usually the definitive host, i.e. it is not necessary for
• (1) This is the mosquito. Here, the oocyst, sporozoite,
the completion of the parasites life cycle.
which are asexual forms of Plasmodia life cycle will
o Ex: Wild boar in Paragonimus westermani
be seen.
(Metacercaria), Trichenilla spiralis in pigs
• Pag napunta na sila sa man, they will form a female
o Here, the big fish
and male gametocyte (center bottom). It is the adult can be a paratenic
stage of the Plasmodia that takes place inside the host, kasi nagdaan
man. lang siya. Walang
• Man – definitive host; Mosquito – intermediate host. development na
nangyari.
INTERMEDIATE HOST • Reservoir Host: a host that makes the parasite
• In some cases, larval development is completed in available for the transmission to another host and is
two different intermediate hosts, referred to as First usually not affected by the infection
Intermediate Host, and Second Intermediate Host. o Ex: Pigs for Balantidium coli, Field Rats for
• For example, in this case, this is Diphyllobothrium Paragonimus westermani, Cats and Brugia
latum – it has a spatula-like shape/scolex. malayi
• From the unembryonated egg to being an embryonic o The term reservoir, meaning nandiyan lang
egg (2). The coracidia is then released and eaten by siya para ma maintain ang kanyang
copepods (3). The coracidia develops into a transmission to another host.
procercoid (4).
SUMMER 4
PARASITOLOGY
NATURAL & ACCIDENTAL
• Natural Host: a host that is naturally infected with
certain species of a parasite.
o Ex: Canines - Echinococcus granulosus
• Accidental Host: a host that is under normal
circumstances not infected with the parasite.
o Unless may accident na makain nila yung meat
ng infected organism
o Ex: Humans - Echinococcus granulosus
• This is an example of a paratenic host.

• The eggs in water will then be L1→L2→L3. Then, the
L3 will be ingested by a copepod which will then be
ingested by a big fish and then by a man, still
maintaining the L3 stage. The fish is the paratenic
host kasi nagdaan lang siya na walang development
na nangyari.
• This is the life cycle of Echinococcus.

• The natural host of Echinococcus is dogs. The
intermediate hosts are the sheep, goats, and swine.
• The parasite in the feces of the dogs will go to the
grass that will be ingested by the sheep. That’s why
they are the intermediate host.
• There are hydatid cysts in the liver and then it will
develop into protoscolex and then adult in the small
intestine in the dogs.
• Pag damak tayo, nakakain tayo ng embryonic egg in
the feces, so that’s the time na mainfect yung man.
The role of man in the life cycle of Echinococcus
• Paratenic host of Paragonimus westermani. granulosus is only accidental or incidental host.
TYPES OF LIFE CYCLE
DIRECT LIFE CYCLE
• Direct Life Cycle: parasite does not require an
intermediate host to complete its life cycle
o Monoxenous life cycle
• For the reservoir host, for the Balantidium coli, sila

lang yung nagasupply ng B. coli para mapatuloy lang
ang passing of cyst in feces and contaminated food
and water para ma infect yung man. But the reservoir
host is not affected by the Balantidium coli.
SUMMER 5
PARASITOLOGY
INDIRECT LIFE CYLE o Ex: Capillaria philippinensis, Strongyloides
• Indirect Life Cycle: parasite requires an intermediate stercoralis
host to complete its life cycle • Female adult worms can be oviparous or larviparous
o Heteroxenous life cycle
o Dracunculus medinensis
SPECIAL TYPES OF INFECTION Parthenogenesis

AUTOINFECTION • Strongyloides stercoralis
• Infected individual becomes his o This is a parasitic
own direct source of infection (parthenogenetic) female
o Ex: Enterobiasis through recovered from a mucosal
hand-to-mouth scraping of the small
transmission intestine of a dog. Note the
o Enterobius vermicularis small size, and long
(kigwa) egg is very esophagus. There are no
lightweight, with a D-like shape ova. Pede males in the parasitic
siyang malipad from the lubot tas magkamot portion of the life cycle.
siya tapos amoyin ng bata at mainhale niya. o During sexual reproduction the female kill the
male.
TYPES OF VECTORS
AGENT OF TRASMISSION
• Vehicle or Fomites: non-living entity (towels, hand)
• Vector: living entity (mosquitoes)
o Biological vector:
transports pathogens plus
plays a role in the life cycle
of pathogen (Malaria
inside mosquito)
▪ Method on inoculating
the schizonts or parasites into the man.
o Mechanical Vector:
• This is the entorobius. The life cycle of Enterobius can organism that only
hatch outside or on the anorectal junction. transports a pathogen
• Here, larva hatches and reenters the intestine. (Flies, cockroaches that
HYPERINFECTION OF SUPERINFECTION feed on fecal material with
• Infected individual is further infected with the same parasites)
species leading to massive infection. ▪ Does not have involvement in the life cycle.
SUMMER 6
PARASITOLOGY
MODE OF TRASMISSION ENXYMATIC INTERFERENCE
• Perioral (contaminated food and water): most • E. histolytica trophozoites
common source; majority of cestodes, trematodes secrete cysteine proteases
and intestinal protozoans like amoeba which digest cellular
o This is why handwashing is given importance material
oral-fecal rout is the most common source of
diseases.
• Percutaneous (skin penetration): hookworms,
strongyloides, schistosoma spp.
• Arthropod Vector: malaria, filaria, leishmania,
trypanosoma
o Through insects
• Congenital Transmission: toxoplasma
(transplacental), Ancylostoma and Strongyloides
(transmammary)
• Inhalation of Airborne Eggs: enterobius
(lightweight)
• Sexual Intercourse: trichomona vaginalis, giargia
(male to male), entamoeba
EFFECTS OF PARASITES TO HOST
DIRECT EFFECT
MECHANICAL INJURY
• May be inflicted by a parasite by means of pressure
• Amoeba secretes enzymes to invade mucosa thus
as it grows larger
creating ulceration.
o Hydatid cyst causes blockage of ducts such
as blood vessels producing infraction
• Cyst structure
o At gross
examination, the
vesicles resemble a
bunch of grapes
o Sites of hydatid cyst:
liver (65%), lungs
(25%), muscle,
spleen, kidney, heart, bones, brain, etc.
o Hydatid cysts – slow growing: 2-3cm/yr.
TRAUMATIC DAMAGE
• Here, there is an approximation, so close lang sila

yung intestine and liver. Once na naabot na niya yung
muscle area ng intestine, they can invade the liver,
kasi adjacent lang sila thus causing liver abscess.
• As the word it says, direct trauma. Direct damage to

skin causing redness and signs or erythema. • So, ito anchovy sauce appearance, described in the
book.
SUMMER 7
PARASITOLOGY
INVASION AND DESTRUCTION • Next, this is a hookworm. Hookworm destroy
• Plasmodium invades RBC → RBC rupture intestinal villi thus causing injury.
o The malaria can grow and thrive inside the red NUTRIENT DEPRIVATION
blood cells. They are intracellular parasites. Once • D. latum competes with host Vit B12 supply →
they proliferate inside the RBC, the tendency of megaloblastic anemia
the RBC is to expand and to burst. That’s invasion o The patient is having an appearance of the red
and destruction of the red blood cells of the blood cells is megaloblastic and was consider to
Plasmodium will cause hemolysis. have B12 deficiency, the most likely parasite to
• Schistosoma japonicum to liver → granuloma cause this is Diphyllobothrium latum.
formation o Pag may bat ana payat tapos feeling niyo na
• Hookworms destroying intestinal villi bitikon siya and upon CBC malalaki yung RBC
nila compare to normal value, we consider
megaloblastic anemia and we take note for the
presence of D. latum infection.
o Paano malaman yung RBC na malaki, we look for
the MCV (mean corpuscular volume).
• In the life cycle of malaria, it has exo-erythrocytic (A) INDIRECT EFFECTS

and erythrocytic (B). The schizont proliferating inside • Excessive proliferation of certain tissues due to
the red blood cell will result to rupturing of the rbc. invasion by some parasites can also cause tissue
damage in man
o Ex: fibrosis of liver after deposition of the ova
of Schistosoma
• This is the Schistosoma egg. If there is a foreign

organism or foreign body inside the tissues or cells,
the response of the body is to surround it with
leukocyte, monocyte, and lymphocyte. Thus, causing
the formation of granuloma.
•
•
•
SUMMER 8
PARASITOLOGY
• Duffy blood group system: increases susceptibility
to P vivax malaria
• High protein diet not suitable for intestinal protozoan
development
CLASSIFICATION OF PARASITES
• I. Medical Helminthology (helminths):
MULTICELLULAR
o 1 – Platyhelminths (flat worms)
▪ Class: Trematoda (Flat worms or
• Excessive proliferation of tissue as a response. Flukes)
• Tissue damage may be caused by immunological ▪ Class: Cestoda (Tape worms)
response of the host o 2 – Nemathelminths (round worms)
o Nephrotic and/or nephritic syndrome ▪ Class: Nematoda (Round worms)
following Plasmodium infections • II. Medical Protozology (protozoa): UNICELLULAR
• III. Arthropods. (Entomology)
MECHANISM OF IMMUNE EVASION

• Immune Suppression – E. histolytica produces HELMINTHIC PARASITES
suppressor factor that inhibits monocyte movement.
• Roundworms – NEMATODA
o E. histolytica invades the mucosa, if there is
• Flatworms
invasion there is chemotactic signals that signals
o Flat and segmented – CESTODA
your neutrophils, monocytes to go to the site of
o Flat and unsegmented – TREMATODA
injury. They produce suppressor factors to avoid
being notice by the monocytes.
• Antigenic Variation – Surface protein variation in T.
gambiense
o For example, T. gambiense produces antigen A,
and then antigen B which confuses the immune
system on what antibodies to produce.
• Host Mimicry – E. granulosus carries blood group
antigens
o Small p antigen blood group
• Intracellular Sequestration – T. gondii multiplies
inside macrophages
o Toxoplasma multiplies inside the macrophages,
so they go unnoticed by the immune system.
EFFECTS OF HOST ON THE PARASITE
• Sickle cell disease: protection against falcifarum
malaria
o Plasmodia loves healthy red blood cells.
SUMMER 9
PARASITOLOGY
PROTOZOLOGY (UNICELLULAR) • Exposure – process of inoculating an infective agent.
• The Main Divisions of Protozoa: • Infection – establishment of inactive agent inside the
o Sporozoa – all are intracellular parasites host.
e.g. Plasmodium in red blood cells INFECTIVE VS DIAGNOSTIC STAGE
▪ Apicomplexa • The stage in the life cycle at which the parasite is able
▪ Peripheral blood smear (lower left to initiate an infection to its host is referred to as an
pic). Inside the RBC are the parasite. infective stage.
Ring forms – malaria; Maltese cross • Diagnostic stage is the life cycle stage that exits the
formation – babesia. definitive host.
o Flagellates – move by beating of one or
more flagella e.g. Trpanosoma
▪ Mastigophora
o Amoeba – move by extending pseudopodia,
no fixed shape, e.g. Entamoeba
▪ Sarcodina
▪ Foot-like structures called
pseudopods.
o Ciliates – move by beating of many cilia, e.g.
Balantidium coli (the only medically
important ciliates)
▪ Ciliophora
• Example (ascaris lumbricoides), makita niyo didto,
from the feces papunta sa lupa ito yung nagexit sa
body so sila yung diagnostic stage. Ito yung makita
natin in the glass slides or in the stool samples.
• The infective stage is: fertilized egg ingested by the
man. Unfertilized egg → fertilized egg, they mature in
the soil. Only the fertilized or the embryonated ascaris
ova can infect man and cause ascariasis.
CLINICAL VS BIOLOGICAL IP
• Clinical Incubation Period/Incubation Period –
between infection and evidence of symptoms
ENTOMOLOGY • Biological Incubation Period/Pre-Patent Period –
between infection and demonstration of infection by
laboratory means
TREATMENT PREVENTION AND CONTROL
• Treatment Terminologies:
o Deworming: use of antihelminthic drugs in an
individual or a public health program.
▪ Cure rate: number of previously positive
subjects found to be egg negative on
examination of stool or urine at a set time
after deworming.
▪ Egg Reduction Rate: percentage fall in egg
counts at a set time after deworming. More of
epidemiology ito ginagamit.
EXPOSURE AND INFECTION o Selective Treatment: individual level deworming
• Carrier – harbors particular pathogen without with selection for treatment based on diagnosis of
manifesting any signs and symptoms infection or an assessment of the intensity of
o For example, Mary Mallon (typhoid fever). She is infection.
considered as a carrier, asymptomatic carrier.
SUMMER 10
PARASITOLOGY
o Targeted Treatment: group level deworming
where the risk group to be treated without prior
diagnosis may be defined by age, sex, or other
social characteristics irrespective of infection
status.
o Universal Treatment: population-level
deworming in which the community is treated
irrespective of age, sex, infection status, or other
social characteristics.
o Preventive Chemotherapy: regular, systematic,
large-scale intervention involving administration
of one or more drugs to selected population
groups
PREVENTION:
• Environmental management like reducing contact
between humans and infective agent/vector.
o Fogging
o Tinatanggal natin yung mga possible source or
reservoir ng infection or parasite.
• Environmental sanitation like safe disposal and
hygienic management of human and animal excreta,
wastewater; control of vectors, IH, and reservoirs.
SUMMER 11
PARASITOLOGY
NEMATODES
INTESTINAL NEMATODES TREMATODES
• Parasites are divided into three main phylum: • Flatten leaf-like
o Protozoa • Sexes are not separated
▪ Unicellular except blood flukes
o Helminths (Schistosoma)
▪ Nematodes, Cestodes, Trematodes • Alimentary canal is
o Arthropods incomplete
▪ Insects • Body cavity absent
HELMINTHS
• “worms”
• Multicellular (Metazoa)
• Free-living or parasitic
o A good example of this is the Strongyloides
stercoralis. They can exhibit a parasitic form if
they are inside a man or they may be free living
form if they are in the environment.
• Most organs of parasitic worms are greatly reduced
but reproductive system is well developed
o The goal of the parasites is to reproduce.
• Dioecious: Nematodes
o Separate sexes (male and female) and complete
digestive tract
• We are concentrating on the helminths.
• Hermaphrodites: Trematodes and Cestodes
• Under helminths we have two classes. We have
o Male and female sexes are not separated in a
platyhelminths, meaning flat, “platy” – “flat”: cestodes
segment.
(segmented) and trematodes (unsegmented).
NEMATODES
• Next class would be the nemathelminths or
Morphology:
nematodes which are roundworms.
• Body wall
HELMINTHIC PARASITES
o Outer cuticle
• Roundworms – NEMATODA
▪ Collagen & cuticulin = protein matrix
• Flatworms
▪ Fibrous layer
o Flat and Segmented –
▪ Modified at the cephalic and caudal ends
CESTODA
o Hypodermis
o Flat and Unsegmented –
▪ Syncytium of cells and fibers
TREMATODA
▪ For secretion of cuticle
NEMATODES
▪ They are resistant to stomach acid due to
• Elongated, cylindrical worms the cuticle.
• Sexes are separated o Somatic Muscles
o Dioecious ▪ Longitudinal cords
• Complete Alimentary canal ▪ Pseudocoele: not lined with mesothelium
• Possess a body cavity
(pseudocoelom)
CESTODES
• Flattened tape-like
segmented
• Sexes are not separated
• Alimentary canal absent
• Body cavity absent
SUMMER 1
PARASITOLOGY
NEMATODES
▪ Caudal ends
• They have epidermis or their cuticle, hypodermis,

• For their receptors, they have lips in the anterior
somatic muscles (which are use for movement),
portion.
ovaire, oviduct, uterus, pseudocoelome (not covered
by mesothelium).
• Digestive tract – well developed

o Mouth: spines; hooks; cutting
plates or stylets
▪ A good example of which • Histologically, this is what we see.
is the Ancylostoma duodenale • Excretory System
o Oral or pharyngeal cavity o Primitive
o Esophagus with glands ▪ Meaning, they are not well-
o Midgut – INTESTINE – simple columnar developed.
o Rectum – ANUS/ cloaca – in males o Lateral collecting tubules
• Nervous System o Excretory pore: opens midventrally
o Dorsal, ventral, 4 longitudinal trunks • Reproduction
with transverse commissure o Female
o Circumesophageal ring – nerve center ▪ Ovaries; pair of uteri; vagina;
o Papillae – inflations of cuticle for tactile vulva
receptors o Male
o Amphids – laterally (anteriorly) places ▪ Testes; seminal vesicles; vas deferens
minute receptors of the ▪ Ejaculatory duct – cloaca (sa may lubot
cephalic/cervical area of all nematodes banda)
▪ Anterior portion or head part ▪ Posterior end: for holding females
(cephalic) 1. Coiled: T. Trichura
o Phasmids – posterior receptors
SUMMER 2
PARASITOLOGY
NEMATODES
2. Curved tail: A. lumbricoides; E. ▪ Once – Enterobius
vermicularis ▪ Continuous – Syngamus
3. Copulatory bursa: hookworm o Signaled by sex pheromones released by the
Spicules: to keep vulva open females, with structural modification in the vulva.
• Metabolism
o Carbohydrates as primary source of energy
o Glycogen as main storage form
o With selective mechanisms for absorption of
fatty acids
o Anaerobes
• Circulatory System
o Absent
ROUNDWORMS
• Most abundant animal on earth
• Dioecious
o Male and female worm (larger) a few mm-meter
in length
• So, ito na yun siya histologically, makita ninyo ang • Free living in soil, marine and freshwater habitat,
uterus with eggs and then makita niyo merong 500,000 species
ovaries (Ascaris). • Non-segmented, cylindrical, tapered at both
• Same with your male, may testes din sila and may ends
vas deferens yung lighter one. • Body covering
o Cuticle with longitudinal muscles
• Body cavity (pseudocoel) complete digestive tract
with both oral and anal openings
o That is not found in your cestode and trematode
• Mouth
o Provided with spines, hooks, cutting plates,
stylets or other structures for attachment or
penetration of tissue
• Reproductive organs
o Tubular and lie coiled in the body cavity
o Fertilization is internal
• Males have chitinized spicules for copulation
• Sensory organs
o Anterior end (amphids)
o Posterior end – caudal (phasmids) nerve
endings that acts as chemoreceptors
• So this would be the copulatory bursa of your
o Papillae = sensory hairs at the head and tail
hookworm. They have spikes or spicules to open up
• Separate classes of nematodes = Aphasmidea –
the vagina or vulva of the adult female worm.
Phasmidea
• Reproductive System
• Life cycle includes:
o Single: Trichinella, whipworm
o Egg stage
o Double: Ascaris, Enterobius, hookworms
o Larval stage
▪ Eventually unite to form the vagina vera
o Adult stage
which opens to the vulva
• Adult female
o Daily output of eggs: HIGHLY VARIABLE
o Oviparous
o Few eggs: ex. Strongyloides in the intestinal wall
o Larviparous
o >200,000 eggs/female/day: ex. Ascaris
o Parthenogenetic
▪ For ascaris, this is constant.
o Mating – mostly intermittent
SUMMER 3
PARASITOLOGY
NEMATODES
3 Stages: Adult, Ova, and Larva
• For the stages, they have from the egg or the ovum
stage.
GENERAL FEATURES • Then they undergo four larval stages – from L1, L2,
• Males are curved posteriorly while female have flat L3, and L4 before they become an adult.
posteriorly • Take note (right pic): males have curved end and
• Longitudinal muscles; probing & penetrating motion then females are larger but have flat end. This is
• Body cavity is pseudocoel (not covered by your E. vermicularis adult.
membrane) ADULT WORM LOCATION IN HOSTS
o Complete alimentary tract: well adapted for • You can classify your nematodes base on the
active digestion location of the adult worms.
• Sensory Structure • SMALL intestine (Small CHATS)
o Nematodes have amphids, o Capillaria philippinensis
and phasmids o Hookworms (Necator americanus and
o Amphids are on the anterior Ancylostoma duodenale)
o Phasmids are on the posterior o Ascaris lumbricoides
end. o Trichinella spiralis
o Strongyloides stercoralis
Ventral and dorsal nerves
• LARGE intestine (COLON)
Complete digestive tract
o Trichuris trichiura – rectal prolapse
No circulatory system
o Enterobius vermicularis – pruritus ani (itchy na
mga puwet)
HABITAT
• Tissue Nematodes
o Trichinella spiralis
o Wuchereria bancrofti
o Brugia malayi
o Onchocerca volvulus
o Loa loa
o Dirofilaria immitis
o Gnathostoma spinigerum
• Larva Migrants in Man
o Dracunculus medinensis
• They also have ventral and dorsal nerves. Ito yung
o Angiostrongylus cantonensis
dapat tandan niyo dito.
o Ancylostoma caninum
• They have complete digestive tract – well developed
o Ancylostoma braziliense
and complete.
PHASMIDS
• Reproductive system – well developed and complete
• SMALL intestine (Small HAS phasmids)
• No circulatory system
SUMMER 4
PARASITOLOGY
NEMATODES
o Hookwomrs (Necator americanus and
Ancylostoma duodenale)
o Ascaris lumbricoides
• LARGE intestine (COLON)
o Enterobius vermicularis
APHASMIDS
• Trichinella spiralis
• Trichuris trichiura
• Capillaria philippinensis
OTHER NAMES
• Giant intestinal roundworm – Ascaris lumbricoides
• Pinkworm – Ascaris lumbricoides
• Pinworm – Enterobius vermicularis MORPHOLOGY
• Threadworm – Enterobius vermicularis
• Whipworm -Trichuris trichiura
• Sitworm – Enterobius vermicularis
• Pudoc worm – Capillaria philippinensis
NEMATODES
• In Human Host:
o Ingested
▪ Hatch in small intestine
▪ Only embryonated and fertilized that can
infect especially for soil transmitted
helminths
▪ Specific bowel segment > adult
▪ Lung migration (Ascaris)
o Skin penetration • Cylindrical with tapered ends
▪ Lungs > intestine (hookworm/Strongyloides) • Whitish streak
▪ Specific tissue (blood – filaria) o they are like spaghetti, basically this is adult
• Infections are associated with: female because the coiled end/tail
o Poverty and poor living conditions o that is ascaris, adult female
o Inadequate sanitation and water supplies
o Soil quality and climate
o Poor personal hygiene
o Poor health awareness
ASCARIS LUMBRICOIDES
• Found in the temperate and tropical areas of the
globe, under conditions of poor sanitation and where
feces are used for fertilizers. (Cosmopolitan
parasite)
• Affects more of the world’s population than any other
parasitic disease. (1.3 billion; China – 500 million)
• “Giant Intestinal round worm” – (tribute to its
resemblance to the earthworm) – “Lumbricus”
• Pink worm
• A.suum - pigs
• female worms are generally larger than males 20-
40 cm flat straight end and the male worms have
curve tail-end
SUMMER 5
PARASITOLOGY
NEMATODES
• Male adult worm provided with 3 lips and a small triangular buccal
o 10-31 cm x 2-4mm cavity
o Smooth straited cuticle Female: female worm is tapered at both ends and large
o Terminal mouth with 3 lips w/a sensory papillae (20 to 35 cm long, up to 45cm)
o They have ventrally curved posterior end with 2 Male: smaller and slender, curve posteriorly and equip
spicules (used for copulation) with copulatory spicule
• Female adult worm • They are also called pinkworm because it is pinkish
o -22-35/49 cm x 3-6mm
o Smooth straited cuticle "Mouth with 3 lips w/a
sensory papillae
o They have paired reproductive organs in the
posterior 2/3
o Posterior end is conical and straight
o Can lay 200,000 eggs/day
• Ova-Infective stage
o Fertilized - 45-70um x 35-50um
▪ Golden brown
▪ Outer albuminoid coatingcoarsely • Sexes are separate
mamillated which may be absent • Female – 20-40 cm
(decorticated) • Male – 15-30cm with curved tails
▪ Thick, transparent hyaline shell w/ a thick • No. of eggs/female/day – approximately 200,00
outer layer and a delicate vitelline lipoidal
inner membrane Ascaris lumbricoides – female (cross section)
▪ hatch the larva-14 days
o Unfertilitized - 88-94 x 3944um
▪ Golden brown
▪ Thin shelled w/ mamillated irregular coat
filled with refractile granules
▪ Found only in the absence of males
• Cylindrical parasite with whitish strip, it can be

ascaris
Ascaris lumbricoides
Morphology:
• The adult worms are creamy-white to pinkish
yellow when freshly expelled. The head is
SUMMER 6
PARASITOLOGY
NEMATODES
• RIGHT = FEMALE
Ascaris lumbricoides – female (cross section) • LEFT = MALE
1. cuticle and
hypodermis (striations)
2. longitudinal muscle
layer (layer for
movement)
3. ovary
4. oviduct
5. uterus
6. intestine
Ascaris lumbricoides – male (cross section)
1. cuticle and hypodermis

2. longitudinal muscle layer • They have direct life cycle meaning they do not
3. vas deference need intermediate host, upon passing of stool
4. testis infected with ascaris containing unfertilized,
5. lateral line with excretory unembryonated egg, embryonation or development
canal intestine of the soil
6. intestine • Ascaris are considered as soil transmitted helminths
7. pseudocoelom (not line • Once they are embryonated, 14-21days they will be
with mesothelium) fertile, the fertilized egg will develop embryo, divide
until it become a larva
• The larva or the embryonated egg, fertilized egg
ingested by humans via mouth, they will now go to
small intestine
• If they will hatch in small intestine, there is larva
• 4 larval stages
o L1, L2,L3,L4 I
o Larva will only migrate to the lungs
• The habitat of male and female worm is in small
intestine
• Diagnostic stage: unfertilized, unembryonated
ascaris egg
• Excretion canal = lateral portion or side
SUMMER 7
PARASITOLOGY
NEMATODES
• Infective stage: ingested by human, embryonated
a/endocar -Asthma, - Pyrantel
ascaris ova ditis/syndr pneumonitis- Radiograph pamoate
• Disease ome) due to ic images
o Ascariasis eosinophil migration of may also Piperazine
o Ascaris pneumonitis ic the juvenile reveal their citrate
o (loeffler's pneumonia/ endocarditis/ syndrome) pneumoni worm to the presence
a-parasitic lungs Proper
eosinophilic pneumonia-parasitic infection
infxm -Cardiac hygiene-
o Ingestion of fertilized ovaInfective stage (ST) damage- hand
• Clinical features (S&S) Ingestion eosinophilic washing
o Bowel obstruction or obstruction of other of granular
organs (appendix) in heavy infection fertilized proteins Proper
o Asthma, pneumonitis due to migration of the ova- -Fever, malaise sanitation-
infective -Abdominal disposal of
juvenile worm to the lungs
stage (ST) distension and feces
o Cardiac damage- eosinophilic granular proteins tenderness,
o Fever, malaise vomiting Avoid
o Abdominal distension and tenderness, vomiting using fecal
• DX test matter as
o DFS-eggs fertilizers
o Kato-katz
Public
o Recovery of worms in stool, sputum education
o Radiographic images may also reveal their
presence ● Now let’s go to the pathology caused by your
• T/P/C Ascaris. So ang tawag sa sakit sa Ascaris is your
o Mebendazole Ascariasis or pwede rin Ascaris pneumonitis or your
o Albendazole loeffler’s pneumonia or pwede sila mag cause ng
o Pyrantel pamoate endocarditis or syndrome of eosinophilia pneumonia
o Piperazine citrate parasitic infection. So kaya sila magka cause ng
o Proper hygiene-hand washing pneumonia, kasi meron silang heart-lung migration.
o Proper sanitation disposal of feces So if hindi sila mag baba to the small intestine,
o Avoid using fecal matter as fertilizers maganahan sila doon, dun na sila mag stay thus
o Education-public causing loeffler’s pneumonia or endocarditis.
Ascaris lumbricoides ● Infective stage is your fertilized or embryonated ova.
So, pwede sila mag cause ng bowel obstruction or
• Adult worms in the intestine cause abdominal
obstruction of organs.
pain and may cause intestinal obstruction
o For example, appendix. Maging erratic sila. So
especially in children
mag travel papunta dun sa may appendix
• Larvae in the lungs may cause inflammation of
banda, thus causing acute appendicitis.
the lungs (Loeffler’s syndrome) – pneumonia-like
● Next, asthma and pneumonitis kasi nga nag migrate,
symptoms.
due to the migration of the juvenile worm to the
• “tramway sign” on x-ray of abdomen
lungs.
PATHOLOGY ● Next, cardiac damage kasi naga punta rin sila sa
heart
Disease Clinical DX test T/P/C ● Constitutional symptoms, pwede sila mag fever,
features (S&S) body malaise
● Abdominal distension because of the bowel
Ascariasis -Bowel -DFS-eggs Mebendaz obstruction, tenderness, and vomiting.
Ascaris obstruction or -Kato-katz ole ● How will we diagnose them?
pneumonit obstruction of -Recovery
o Direct Fecal Smear examination - makita yung
is other organs of worms Albendazo
(loeffler’s (appendix) in in stool, le egss doon.
pneumoni heavy infxn sputum
SUMMER 8
PARASITOLOGY
NEMATODES
o Keto-katz - We also count the eggs to get the one. Kasi diba yung yield ng ova per female, greater
burden kung gaano na karami or kalala yung then 200,000 eggs per female per day.
Ascariasis ng patient.
o Recovery of worms in the stool/sputum or kung
ma cough out yung worm.
● So for the treatment/prevention, we administer
Mebendazole or yung mga anti-parasitic/anti-
helminthic drugs, Albendazole, Pyrantel pamoate,
Piperazine citrate.
● How do we prevent getting Ascaris? So Ascaris is
soil-transmitted meaning makuha siya sa mga lupa.
So pag yung kuko niyo mahaba tapos may mga lupa
kayo jan, pwede yan maging source of Ascaris eggs.
Always practice proper handwashing.
ASCARIS LUMBRICOIDES
● Adult worms in the intestine cause abdominal pain
and may cause intestinal obstruction especially in
children. ● Ito siya, how do we manage the intestinal
● Larvae in the lungs may cause inflammation of the obstruction? hindi natin pwede ipurga kasi maging
lungs (Loeffler’s syndrome) - pneumonia-like erratic sila so kahit saan na maglabas (nose, mouth,
symptoms pwet). So kailangan operahan, tanggalin yung
● “tramway sign” on x-ray of abdomen obstruction.
● This is the appearance of intestinal obstruction

caused by heavy burden of ascaris lumbricoides ● Lung migration. Adult worm in the small intestine of
adult male and female. Di yan sila naga exist only as man tapos nag pass sila ng non-infective eggs. Ito
yung unembryonated unfertilized egg na napunta sa
lupa, then mag embryonate ng 3 weeks, then
makain ng man, then larva hatch in the small
intestine, it can penetrate the wall or mag migrate
sila going to the lungs via the bloodstream, 1-7 days
after the ingestion. Maging mature sila and mag
migrate to the trachea, esophagus, small intestine
and continue ng kanilang buhay.
SUMMER 9
PARASITOLOGY
NEMATODES
and to the pharynx, then swallowed again to the
esophagus going to the small intestine.
EGG OR OVA MORPHOLOGY
FERTIIZED EGGS
PARAMETER DESCRIPTION
SIZE 40-75 um by 30-50 um
SHAPE Rounder than non-fertilized
version
EMBRYO Undeveloped unicellular embryo
SHELL Thick chitin
OTHER May be corticated or decorticated
FEATURES
● Nakita ko lang ito sa twitter recently, the sample is

broncho alveolar lavage, yung washing ng ating
bronchus. Ito yung larva. They did not specify if this
is the larva of ascaris, hookworm, or strongyloides,
because that 3 exhibit lung-heart migration.
Mga gisabi gud ni Sir Wyne about dito!

• Cortication – mga lubak-lubak (bumps)
o Once sinabi natin na corticated yung ova,
meaning meron siyang “lubak-lubak”, meron
siyang mga “bumps-bumps”, pag smooth gani
iyan, pag hamis iya, wala itong cortification, ang
tawag natin diyan, decorticated.
o Tandaan niyo ha, yung mammillation which is
yung albuminous coating that comprises your
cortication; pag meron yan siya may lubak-lubak
tawag diyan corticated; pag wala gani, smooth,
● Again, emphasizing the life cycle. Yung adult decorticated.
nandun sa small intestine kasi yan yung habitat ng
female and male adult ascaris.
● Ang diagnostic stage natin is unfertilized
unembryonated egg.
● Then mag mature sila sa lupa for 21 days.
● And they form fertilized or embryonated egg which
will be ingested by man and is considered to be the
infective stage.
● Same lang arin, punta sa intestine and going to the
circulation kasi they can penetrate then they will go
to the heart and lungs. Pag mag mature na yung
larva nila (L1, L2, L3, L4). Akyat sila to the trachea
SUMMER 10
PARASITOLOGY
NEMATODES
UNFERTIIZED EGGS
SIZE 85-95 um by 38-45 um;
Size variation possible
SHAPE Varies
EMBRYO Unembryonated; Amorphous mass
of protoplasm
SHELL Thin
OTHER Usually, corticated
FEATURES
3 Layers:
• Outer layer: Embryo membrane
• Middle Later: Chitinous layer
• Inner layer: Lipid layer/ascaroside
o Inside the egg. There is an embryo that
may range from a few blastomeres to a
completely formed larva.
Mga gisabi gud ni Sir Wyne about dito! Mga gisabi gud ni Sir Wyne about dito!
• Larger than fertilized egg • Outer layer niya ito, corticated albuminous layer
• Embryo is parang abog-abog compared to your • Yung naka red, Chitinouos Layer or your middle
fertilized egg which is compact, bilog na bilog yung transparent layer
sa loob. • Lipid layer which is non-permeable or impermeable
o Amorphous – Kalat-kalat or homogenous • Nasa gitna, embryo which will eventually become a
EGGS larva
• Fertilized eggs: (corticated, decorticated) Ovoid,
60 x 40 um.
• Thick shell – (triple layered) inner non-permeable
layer, thick transparent middle later and an outer
mammilated coat
• Ascaris lumbricoides fertilized eggs
SUMMER 11
PARASITOLOGY
NEMATODES
• Trichuris trichiura and adult male and female

• (Red circle) ito yung head niya banda – anterior 3/5
is thin. Maliit yung ulo ng parasite natin kasi they
don’t need brain, they only need reproductive
system and digestive system for them to thrive.
• (Yellow circle) posterior end of the parasite. If coiled,
then it is male.
• Ascaris lumbricoides unfertilized eggs MORPHOLOGY
Male adult Female adult Ova-infected
worm worm stage
3-3.5 cm in length 3.5-5.5 cm in 5-54um x 22-23um in

length diameter
Spicule protrudes
through a refractile Vulva opens at the Barrel – football-
penial sheath which anterior end which shaped in feces
has a bulbous is the fleshy (lemon)
termination covered portion of the body
with small, recurved Golden brown in color
spines. Has a single
uterus and ovary Intralaminar (refractile)
Distinguished from prominence usually
the female by its Bluntly rounded at referred to as polar
coiled caudal the posterior end plugs at either end.
extremities about 360
or more Produces 3,000- 3 shells – chorionic
20,000 eggs daily layer, albuminous
Adult worm LS = 1 yr. layer, bile-stained
• Diagnostic stage: Unembryonated Egg layer
• Diagnostic specimen: Stool sample When passed out, it is
• Infective stage: Embryonated Egg usually immature
(unsegmented).
• Autoinfection: NO Requires 3 weeks in
• Humans are definitive hosts soil to mature.
TRICHURIS TRICHIURA
• “whipworm” – whip like in appearance • HAT – three most common soil transmitted helminth;
“unholy three”
• Descriptive – anterior 3/5 is very thin and hair like,
o Hookworm
houses the esophagus. While the posterior 2/5 is
thick and stout resembling the handle of a whip o Ascaris
which houses the intestine and reproductive organs. o Trichuris
• Worldwide distribution but common in tropical
countries and in regions where sanitation is poor
• Prevalence rate is high in Asia – 50-80% burden.
Due to defecation onto the soil takes place or when
human feces are used as fertilizers.
SUMMER 12
PARASITOLOGY
NEMATODES
Adult Morphology • Direct life cycle for Trichuris trichiura.
• Flesh colored or pinkish slender worm • They also need soil to mature or to embryonate or to
• Anterior 2/3 of the worm is attenuated and thin in become fertilized.
contrast to the remaining posterior 1/3 which is • Adult male and female which is most commonly
fleshy and robust residing in the cecum of the large intestine. It will
• “Whip like appearance” pass out an unembryonated egg to the stool. Punta
• EGG: siya sa lupa, maging 2 cell stage and undergo
cleavage. And then embryonated egg, either
containing na ng larva will be ingested. Tapos mag
SIZE 50 – 55 UM BY 25 UM mature na naman sila ulit, maghatch yung larva sa
small intestine. But the adults worms will stay in the
SHAPE Barrel-shaped/ Lemon shaped/ cecum.
Football-shaped; Translucent • Diagnostic stage: unembryonated egg (does not
hyaline polar plug at each end. have cortication)
• Infective stage: embryonated trichuris trichiura ova
SHELL Smooth; yellow-brown color
because of host bile contact • NOTE
o Trichuris trichiura has no lung migration in its life
cycle
o Lung migration:
▪ Ascaris
▪ Strongyloides
▪ Hookworm
PATHOLOGY
Disease Clinical DX test T/P/C

features (S&S)
Trichuriasis Asymptomatic – DFS Mebendazole

light infection
Ingestion of Kato-Katz Albendazole
Ova Abdominal pain,
distention, FECT – we Piperazine
appendicitis usually do citrate
concentration
Bloody or mucoid technique if we Pyrantel
diarrhea want to know pamoate
the burden
Tenesmus Loperamide
(distressing urge hydrochlorid
to evacuate) e (Imodium)
Rectal prolapse
(edematous
rectum)
Proper
Moderate hygiene-hand
eosinophilia washing
Nutritional Proper
deficiency - sanitation –
stunned growth disposal of
feces
Avoid using
fecal matter
as fertilizers
Education -
public
SUMMER 13
PARASITOLOGY
NEMATODES
• Occurs elsewhere in the Philippines, and in
Thailand, Taiwan, Japan, Korea, Egypt, Iran,
Colombia
• Various freshwater fish are eaten raw
o If eaten not raw or cooked, an individual will not
be infected
• C. hepatica – hepatic capillariasis
• C. aerophila – pulmonary capillariasis
MORPHOLOGY
Male adult Female adult Ova-infected
worm worm stage
• This is the rectal prolapse. 1.5-3.9 mm in length 2.3-5.3 mm in length 42x20um
• Diba dapat yung rectum niyo nasa loob pero in this Characterized by Body is divided into Single or 2 stage
case, may urge siya to defacate, so sige lang siya caudal alae and 2 equal parts development
long, non-spiny
utong ng utong kaya mag protrude yung kanyang sheaths Anterioresophagus + Similar to trichuris
rectum (right pic) esophageal glands egg but smaller and
Spicule – copulatory more oval in shape
• Nasa colon or cecum yung T. trichiura (left pic) organ Posterior – intestine,
• Infective stage: Embryonated Egg reproductive organs Shell is thick with
with slight prominent striations hence
• Diagnostic stage: Unembryonated Egg in stool vulva peanut shape. With
• Mode of transmission: Ingestion bipolar mucous
2 types of female – plugs but are nor
• Autoinfection: NO Larviparous protuberant
CAPILLARIA PHILIPPINENSIS (population build up),
Oviparous (infection)
• History:
o Was 1st recognized in the Philippines in 1963 at
PGH
o Bacarra, Ilocos Norte
o 1967, epidemic of Capillariasis in Pudoc, West
Tagudin, Ilocos Sur (approximately 1,300
persons became ill and 90 persons died of the
infection)
o Kaya other name niya is Pudoc worm
• Adult worm is usually slender anteriorly and stout
posteriorly, but tapering is gradual and less
pronounce.
SUMMER 14
PARASITOLOGY
NEMATODES
PATHOLOGY
Disease Clinical DX test T/P/C

features
(S&S)
Intestinal Abdominal pain DFS – eggs Mebendazole

Capillaria philippinensis capillariasis passed out
Borborygmi – in feces Albendazole
Common Name NA Ingestion of gurgling of the
Infective Stage Encysted Larvae larvae from stomach Identificatio Fluid and
contaminate n of larva electrolyte+
Habitat Small Intestine d fish Loss of weight and worm in high protein
Mode of Ingestion of raw/undercooked stool diet
Vomiting
Transmission contaminated fish
Diagnostic Specimen Feces Edema
Proper
• NOTE: Hypoproteinemia sanitation –
o Female Capillaria worms are Oviparous and – malabsorption disposal of
due to feces
Larviparous (can lay directly larva) destruction of
o Autoinfection intestinal wall Proper
cooking of
freshwater
fish (IH)
• Infective stage: Encysted larva in freshwater fishes

• Diagnostic stage: Egg in stool
• Mode of transmission: Ingestion of improperly
cooked fish meat
• Autoinfection: YES
• For example, si Mark infected siya ng Capillariasis.

So nagpass out siya ng unembryonated egg, pwede
ding galing siya sa bird. Mag embryonate sila sa
freshwater.
• Eggs passed by birds or man enter the environment
become embryonated and infective and are eaten by
fish. Infective larvae develop in the fish.
• Inside the small fish, mag encyst, meaning mag
punta siya doon sa laman ng fish and then will
become ang infective larva.
• Ingestion of raw or undercooked infected fish.
Magpunta yung infected larva in the intestine and
then doon na siya mag mature.
• We have two types of adult female: oviparous (lay
eggs), and larviparous (directly lay larva)
SUMMER 15
PARASITOLOGY
INTESTINAL NEMATODES: HOOKWORMS

HOOKWORMS • Since the filariform larva is also found in the soil, we
GENERAL CHARACTERISTICS can also say that hookworms are soil-transmitted
• Soil transmitted helminths.
o Ascaris lumbricoides – ingesting of embryonated • After penetrating the skin, the filariform larva will
ovum reach the venous or lymphatic circulation.
o Trichuris trichiura – same as Ascaris • Eventually, these larvae will reach the lungs. So,
o Hookworms – skin penetration hookworms have larval lung migration.
• Food-borne • After reaching the lungs, this larva will eventually
o Capillaria philippinensis – ingestion of encysted climb up the trachea then the larynx, only to be
larva in raw fish meat swallowed into the small intestine.
• Larval lung migration • After several rounds of molting, these larvae will
o Ascaris lumbricoides become the male and female adult worms.
▪ Expect that people with ascariasis will have • Diagnostic stage: ova/egg in stool
pulmonary symptoms. • Infective stage: filiform larva/ third stage larva/ L3
o Hookworms larva
• Autoinfection • Mode of transmission? Skin penetration or soil
o None transmission
LIFE CYCLE OF HOOKWORM • Autoinfection? No
• Larval lung migration? Yes, similar to Ascaris
lumbricoides
SPECIES OF HOOKWORM
• There are two species of hookworms that can
parasitize humans.
• Ancylostoma duodenale (Old World Hookworm)
• Necator americanus (New World Hookworm)
o Characteristics of adult worms
▪ Small-grayish white
▪ Anterior end with conspicuous bend or
hook-like appearance.
• The adult stages of hookworms are found in the small
▪ Females are larger than males.
intestine of the human host and since the human host
harbor the adult stages of the parasite, we are playing
the role of definitive hosts in the life cycle of these
parasites.
• The male and female will copulate and the female will
lay eggs and these are the ones that will come out in
the stool sample of the infected patient.
• Therefore, the diagnostic stage for hookworms is the
presence of egg in the stool.
• This egg will eventually hatch in the oil and release
the next stage which is the rhabditiform larva, the
feeding stage of hookworms which will feed on
organic materials present in the environment.
• Should the source of nutrients will become scarce,
this rhabditiform larva will transform into filariform
larva, and this filariform larva will infect humans
through skin penetration.
• So, the mode of transmission for hookworms is skin
penetration.
• Male nematodes have curved posterior end.
SUMMER 1
PARASITOLOGY

• Both male and female adult worms have curved • This is most likely a male hookworm because it has
anterior ends making them appear as if they have curved anterior and posterior ends and the posterior
hooks. Thus, these worms are called hookworms. portion has that copulatory or caudal bursa.
• Characteristics of adult worms • 2nd arrow (from the top) is a female hookworm
o Adult female is larger than male because it doesn’t have the copulatory or caudal
o Posterior end of male has expansion called bursa.
caudal bursa for copulation • 3rd arrow is a male hookworm, 4th is female.
▪ Caudal bursa is use to hold females during HOOKWORM: MORPHOLOGY
copulation ADULT
● The adult parasites are small cylindrical worms, 0.5-
1.5 cm long (Ancylostoma duodenale being slightly
larger than Necator americanus).
● Two hookworms can parasitize humans

o Ancylostoma duodenale or Old World Hookworm.
Shaped like that of the letter C.
o Necator americanus or New World Hookworm.
Shaped like that of the letter S.
● To identify Necator americanus from Ancylostoma
duodenale, check the curvatures of their bodies.
● Left picture – The head of N. americanus adult worms
are curved opposite to the curvature of their bodies,
• Take a look at the example above, they are both male thus making them appear like the letter S.
wearing skirts which serves as the copulatory or the ● Right picture – While the head of Ancylostoma
caudal bursa of male nematode worms. duodenale adult worms are curved in the same
direction as their bodies, making them appear like the
letter C.
• The photo above will show you how small hookworms

are thus; they cannot cause intestinal obstruction ● Under the microscope we wan also differentiate these
similar to the giant intestinal roundworm or the worms based on some of their parts, We can
Ascaris lumbricoides. differentiate them based on their buccal capsule –
SUMMER 2
PARASITOLOGY

particularly in their teeth; copulatory bursa; and
spicules embedded within this copulatory bursa.
CHARACTERISTICS OF ADULT WORMS
BUCCAL CAPSULE
SPICULES
● Ancylostoma duodenale has two spicules

● Necator americanus has fused spicules
● Ancylostoma duodenale: 2 pairs of curved teeth
● Necator americanus: pair of semilunar cutting plates

o half-moon like shaped cutting plate
● The First column – Ancylostoma duodenale; In panel

two there are two spicules in the male A. duodenale
worm.
SUMMER 3
PARASITOLOGY

● Second column – Necator americanus; In panel 2,
there is a fused single spicule.
COPULATORY BURSA
● Left picture – is a picture of the copulatory bursa of

Morphologically it is not possible to differentiate eggs between
male hookworms. This structure is used to hold the A. duodenale and N. americanus
females during copulation.
● In the copulatory bursa you have there the spicule,
and this spicule will be supported by the dorsal rays
as it is inserted into the vulva of the female worm.
● We can differentiate ancylostoma duodenale from
Necator americanus based on these dorsal rays.
● These are the eggs of hookworms. There is a thin

shell, a clear space between the shell and the cleaved
embryo.
● It is difficult to differentiate the eggs between A.
duodenale and N. americanus that is why we
● Left – Dorsal ray of N. americanus is bifid – has 2 differentiate them based on the adult stages.
extensions.
● Right – Dorsal ray of A. duodenale is tridigitate – has
3 extensions.
HOOKWORM EGGS
● The eggs of hookworms are easily identified because
of this thin shell and inside the thin shell has a cleaved
embryo.
● The embryo is known to contain 2-8 cells, but in some
book, it was mentioned that these cells can reach as
high as 16.
● There is also a clear space between the embryo and
the thin shell. ● Thin shells, cleaved embryo with 2-8 cells but can
● 60x40 um in size, oval in shape, the shell is thin and reach as high as 16 cells.
colorless; content is 2,4, or 8 cells; a clear space is
always present between the cells and the egg shells
SUMMER 4
PARASITOLOGY

● Ground itch or dew itch is characterized by the
presence of an Itchy and erythematous
maculopapular rash.
o Irythematous - highly inflamed
● Hookworms along with Ascaris and Trichuris are

referred to as the holy trinity because they can be
found in the stool sample of a single patient since all
of them are soil-transmitted.
PATHOGENESIS AND CLINICAL MANIFESTATION
● As shown in this picture, the lesion also shows the

path of where the filariform larvae penetrated the skin.
● In terms of clinical manifestation, remember that the

first organ affected by the infection of hookworms is
the skin because that is the point of entry for filariform
larva, and this larva will go to venous or lymphatic
circulation to reach the lungs. So expect that the ● These are other photos of ground itch or dew each.
patients with hookworm infection will have pulmonary As you can see there is marked inflammation.
symptoms as well.
● And lastly, the adult worms have effects on their
habitat, which is the small intestine.
● The pathology of hookworm infection involves:
o (1) the skin at the entry of the filariform larva
o (2) the lung during the larval migration
o (3) the small intestine
● (1) The skin at the entry of the filariform larva
● In terms of the pathology involving the skin, patients
who come in contact with the soil infested with
filariform larva or hookworms will develop Ground ● (2) the lung during the larval migration
itch or dew itch refers to the inflammatory reaction ● Since there is larval lung migration in the life cycle of
resulting from invasion of the skin by the filariform hookworms, expect that the lungs would also be
larva involved in the infection. So patients with hookworm
o It is called dew itch because some cases are infection will also have manifestations of Loeffler’s
acquired through contact with soil in a dewy syndrome.
morning.
SUMMER 5
PARASITOLOGY

● Loeffler’s syndrome mucosa of the intestine, they will cause
o This syndrome results from the allergic bleeding. The bleeding will not stop because of
reactions to the presence of the worm. That’s the anticoagulant in their saliva.
why these patients will manifest: ● Patients with hookworm infection will complain of
▪ Dry cough, wheeze, dyspnea and Abdominal pain, diarrhea and steatorrhea
fever (also seen in attacks of o Steatorrhea - the presence of fats in the stool.
asthma) WHY? because majority of the luminal surface
▪ Esonophilic pneumonia. In X-rays, of the intestine cannot anymore absorb
you will see infiltrations, and mostly nutrients because of the presence of the
these infiltrations are rich in hookworms.
eosinophils. ● Hookworm feed on blood of humans
▪ Then if you’ll check the CBC of the o Chronic infection or severe infection will now
patient, the differential count will lead to loss of massive blood.
also demonstrate eosinophilia. o Loss of albumin - hypoalbuminemia
▪ Albumin is the most abundant
protein in the blood.
o Loss of iron - microcytic hypochromic type of
anemia.
▪ Iron is also significantly lost in the
red blood cells in the blood. Thus,
these patients will have iron
deficiency anemia.
▪ Iron deficiency anemia is a
microcytic hypochromic type of
anemia.
● This is the biopsy of the intestines with hookworms HOOKWORM DISEASE
attached to their mucosa. ● To summarize, patients with …
● The reason why these hookworms are provided with ● Ancylostomiasis; Necatoriasis (simply hookworm
teeth or semilunar cutting plates in their buccal infection)
mucosa is that they will use these structures to anchor o Site of entry “ground itch”
themselves in the small intestine. o Bronchitis and pneumonitis
o Loeffler's syndrome involving the lungs
o Abdominal pain, steatorrhea, diarrhea (small
intestine)
o Eosinophilia
o Chronic infection: microcytic hypochromic
anemia of iron deficiency type,
hypoalbuminemia
DIAGNOSIS
● Direct fecal smear - demonstration of the egg in stool
sample
o The one who will process the stool on the lab
will look for the eggs.
o Other processes:
▪ Kato-katz technique
● (3) the small intestine ▪ Concentration techniques
● Buccal capsule attaches worm to intestinal wall, ● Harada-Mori Culture
saliva contains anticoagulant which keeps the area
bleeding
o These hookworms have anticoagulants in their
saliva. So once they are already attached to the
SUMMER 6
PARASITOLOGY

o There are already proven cases of
transmammary transmission of ancylostoma
doudenale.
o In some cases, the filariform larvae of
Ancylostoma doudenale can stick on
vegetations. So, eating raw vegetables with
filariform larvae can also predispose someone
to develop the infection with the said parasite.
Filariform larva will just eventually penetrate the
wall of the small intestine and continue with the
larval lung migration. It will climb up the trachea
o In Harada-Mori culture, we usually place two and will be swallowed to reach the small
samples in filter paper and the setup is intestine and molt to form the adult worms.
immersed in water. o In skin penetration, ingestion of filariform larva,
o The water will then diffuse towards the tissue and transmammary route, the infective stage
paper and then the stool sample. If there are will still be the filariform larva.
hookworm eggs in the sample, they will
eventually hatch to form the rhabditiform larva.
Some of this rhabditiform larva will eventually
form the filariform larva.
o So, after the procedure you can sample the
water for the presence of the hookworm
rhabditiform larva or filariform larva
TREATMENT
● Albendazole - drug of choice
● Mebendazole - alternative drug
● Anemia (microcytic hypochromic) - iron
supplementation
● Hypoalbuminemia - adequate diet
PREVENTION
● We can prevent this infection by wearing slippers or

shoes and not allowing our skin to come in contact
with the soil.
● Another thing is proper human waste disposal.
● Deworming activities can also lessen the number of
infected individuals thus lessen the chance of them
transmitting the infection to other people.
VERY IMPORTANT THINGS TO TAKE NOTE OF:
● Ancylostoma doudenale can be transmitted through
ingestion of larvae and transmammary route.
SUMMER 7
PARASITOLOGY
PHYLUM NEMATODA PART 2 (STRONGYLOIDES STERCOLARIS)

STRONGYLOIDES STERCORALIS: FREE LIVING • Thus, Strongyloides stercoralis is also a soil
CYCLE transmitted helminth and just like Ascaris and
hookworms, it has larval lung migration in its life cycle.
• The filariform larva will climb up the trachea to be
swallowed into the small intestine.
• It will undergo two molting processes before it will
become adult worms.
• (8) in the human body, what only exists is the female
adult worm. So, male adult worms of Strongyloides
stercoralis are only found in the environment. In the
human host, due to unknow reason, only females
• The life cycle of Strongyloides stercoralis has two exist and these females can produce embryonated
components: free-living cycle and parasitic cycle. ova on their own. The process is called
• Since Strongyloides stercoralis can exist as parasite parthenogenesis.
to humans, and as a free-living organism, it is • The female adult worms of Strongyloides stercoralis
considered as facultative parasite. would embed themselves in the mucosa of the
• (1) what is released in the stool sample of an infected intestine of the definitive host causing now tissue
human host is the rhabditiform larva. destruction.
• If this rhabditiform larva is released in an environment • The filariform larvae of Strongyloides stercoralis can
where there is a scarcity of nutrients, this rhabditiform also cause tissue destruction in the lungs that’s why
larva will eventually form the filariform larva (1→ 6 that some patients will have hemorrhages within their lung
is the direct development of the filariform larva) tissue.
• If the filariform larva is released in an environment • The females embedded in the mucosa of the small
where there is abundance of nutrients, and the intestine will produce embryonated ova which will
condition is favorable to its growth, the rhabditid form hatch while still inside the intestine of the definitive
larva will become the male and female adult worms. host. Expect that these ova will release rhabditid form
larvae which will come out in the stool sample of an
• Male and female adult worms will copulate and
infected human host.
produce eggs (3).
• (Look at 9 and arrow with broken lines) sometimes the
• This eggs will hatch to form rhabditiform larvae which
rhabditiform larva even if it is still inside the intestine
will soon form filariform larvae.
can already transform to form the filariform larva. This
• Just like in the case of hookworms, the infective stage
filariform larva will penetrate the wall of the small
of Strongyloides stercoralis are their filariform larvae.
intestine to gain entrance into the venous and
They are capable of penetrating the human skin.
lymphatic circulation and will now have larval lung
STRONGYLOIDES STERCORALIS: PARASITIC
migration.
CYCLE
• (9-10) demonstrating autoinfection
• Diagnostic stage: rhabditiform larva and
occasionally filiform larva in stool
• Infective stage: filiform larva
• Mode of transmission: skin penetration, can also be
soil transmitted
• Larval lung migration? Yes
• Autoinfection? Yes
GENERAL CHARACTERISTICS
• Soil transmitted
• The parasitic cycle begins with the penetration of the
o Ascaris lumbricoides – ingestion of embryonated
skin by the filariform larval stage.
ovum
• Just like with hookworms, this filariform larva will enter
o Trichuris trichiura – same as Ascaris
the venous or lymphatic circulation only to reach the
o Hookworms – skin penetration
lungs.
o Strongyloides stercoralis – skin penetration
SUMMER 1
PARASITOLOGY

• Food-borne of Strongyloides
o Capillaria philippinensis – ingestion of encysted stercoralis have entered
larva in raw fish meat the body
• Larval lung migration o Accompanies with
o Ascaris lumbricoides pruritus and urticaria
o Hookworms o Usually look like more of
o Strongyloides stercoralis an allergic reaction than
• Autoinfection inflammatory reaction
ADULTS: ESOPHAGUS INTERTWINED WITH
UTERUS
• Looks like an allergic reaction and it is caused by

rapidly moving filariform larvae.
GROUND ITCH vs LARVA CURRENS
• (Photo C) the female adults of Strongyloides

stercoralis have uteri that are intertwined with their
esophagus making them appear like intertwined
threads.
• That’s why Strongyloides stercoralis is commonly
know as threadworm.
COMMON NAMES • Left photo is ground itch. There is really marked
• Giant intestinal roundworm inflammation brought about with the slow-moving
• Pinkworm filariform larvae of hookworms.
• Pinworm • Right photo is the serpiginous larva currens caused
• Threadworm by Strongyloides stercoralis filariform larva.
• Whipworm PATHOGENESIS AND CLINICAL MANIFESTATION
• Sitworm • (2) Migration of the larva through the body
• Pudoc worm o They can cause lower pneumonia with
PATHOGENESIS AND CLINICAL MANIFESTATIONS hemorrhages in the lungs because they can
• The pathology of infection with Strongyloides cause tissue destruction
stercoralis involves: • During the larval migration phase, the lungs are
1. Invasion of the skin by the filiform larva destroyed causing lobar pneumonia with hemorrhage
2. Migration of the larva through the body • Cough and tracheal irritation mimicking bronchitis
3. Penetration of the intestinal mucosa by the o As they climb their way up to the trachea to be
female adult swallowed, they can also cause irritation and that
• (1) invasion of the skin by the filiform larva can mimic bronchitis
• Larva currens
o Erythematous serpiginous skin lesion at the site
of entry caused by the rapid moving filiform larva
SUMMER 2
PARASITOLOGY

villi there would be an effect on the absorption and
digestion of nutrients
• Black box – indicates the presence of the adult worms
embedded within the mucosa of the small intestine.
o Those worms are highlighted in photo b. As you
can see they are cylindrical which is very typical
of nematodes
STRONGYLOIDES INFECTION IN A CAT
• Shown in the picture is the small intestine of an

infected cat. As you can see, you have the presence
of the nodules.
• Effects of having female adult worms in the small

• This is how the nodules appeared under the
intestine:
microscope
o The right photo is an endoscopic picture showing
female Strongyloides stercoralis worms
embedding themselves in the wall of the intestine.
Take note that these worms can embed
themselves from the pylorus of the stomach down
to the rectum. But most of the time they are found
in the small intestine
o Take a look at the blue arrows on the right photo.
Beside these blue arrows you can find the adult
worms embedded within the mucosa of the small • This is the closer look at one of the nodules in the
intestine intestines of the cat.
• Blue arrow – pointing to a nematode that has
embedded itself in the mucosa of the intestine which
led now to inflammation and eventually the
development of the nodule
• Right photo shows us that there is destruction and

atrophy of the finger like projections of the small
intestine, and we call them as villi. With the loss of this
SUMMER 3
PARASITOLOGY

• Left Blue Arrow – intestine appetite, GIT bleeding, anemia, intestinal
• Right Blue arrow – one of is uteri obstruction, and malabsorption leading to
• This will also happen in humans. Strongyloides cachexia
stercoralis female worms will also embed themselves ▪ Why there is GIT bleeding? Because of the
in the walls of our intestine presence of embedded females on the
PATHOGENESIS AND CLINICAL MANIFESTATION mucosa of the intestine
• (3) Penetration of the intestinal mucosa by the female ▪ If there is bleeding that can also cause
adult anemia
• Light infection does no cause intestinal symptoms ▪ In the presence of females on the walls of the
• Moderate infection causes diarrhea alternating with intestine, there could be a loss of peristaltic
constipation movement which later on can cause intestinal
• Heavy infections produces intractable, painless and obstruction
intermittent diarrhea (Cochin-China diarrhea) ▪ With the loss of the villi or atrophy of the villi,
o Intermittent – the person will fell normal now and malabsorption can also occur
maybe tomorrow the person will have another HYPERINFECTION
episode of diarrhea and then the next day the • The problem of Strongyloides infection is the
person will feel okay again probability of hyper infection. This is define as a
o This diarrhea is painless but intractable, meaning syndrome of accelerated auto infection.
it does not usually respond to treatment o Meaning there are a lot of rhabditiform larvae
o This heavy infection leading to intractable transforming into filariform larva in the intestine.
diarrhea is referred to as Cochin-China Diarrhea This filariform larva will penetrate the wall of
because it was first discovered among French intestine and add on to the number of the existing
soldiers who came from Cochin, China adults
o For you to remember that Cochin-China is • Syndrome of accelerated auto infection that occur
caused by Strongyloides stercoralis, which is also with immunocompromised patients
known as threadworm, just say strong threads o What do you think is the reason behind hyper
from China infection?
CHRONIC STORNGYLOIDIASIS ▪ Immunocompromised state. If the patient is
• There could be a probability of chronic immunocompromised brought about
strongyloidiasis, meaning you have the infection for chemotherapy, radiation therapy, maybe that
very long time patient has untreated HIV, the immune
• Often asymptomatic system is down and it’s now easy for the
rhabditiform larva to become the filariform
• There could be episodes of vomiting, diarrhea and
larva, thus accelerating autoinfection
constipation
o Exacerbation of gastrointestinal and pulmonary
o These symptoms are non-specific. Sometimes
symptoms
the patient could be misdiagnosed and
▪ Because of the autoinfection, the filariform
mismanaged
larva will always have the larva-lung
• Recurrent asthma is also seen
migration and it will add on to the number of
o Raise the suspicion that the patient could be
females, embedding themselves in the
having infection by Strongyloides stercoralis
mucosa of the GIT organs
o Why is there a recurrent asthma?
o Increased number of larvae in stool samples and
▪ Remember there is autoinfection in
even in sputum
Strongyloides stercoralis infection. The
▪ Because some of the filariform larva will now
filariform larvae that penetrated that intestinal
come out through the sputum
wall will have larval lung migration. Aside
from the GIT symptoms, the patient will have
Loeffler syndrome and recurrent asthma
attacks
o If not diagnosed and managed properly, these
patients could lead to emaciation, loss of
SUMMER 4
PARASITOLOGY
• This are endoscopic pictures showing the increased

number of female worms embedded on the walls on
intestine in hyperinfection
STRONGYLOIDES OVA AND LARVA
• Filariform larvae are slender and long.
• Diagnostic Stage – Rhabditiform larva

o Because the egg hatches inside the human
intestine. But even if it is not seen in the stool, it
is very important to take note that the ova of
Strongyloides stercoralis look similar to
hookworms. Therefore, they also have thin shells, • These are rhabditiform larvae because they are short
cleaved embryos and stout.
• So how can we differentiate Strongyloides to
hookworm if we cannot differentiate them using ther
eggs?
• We can differentiate them using their eggs by looking
at their rhabditiform larvae and filariform larvae.
Rhabditiform larvae are the feeding stages and
filariform larvae are the infective stages.
• These are filariform larvae because they are long and

slender.
• Left photo has a larva that is slender and long, so this

• Rhabditiform larvae are short and stout. is a filariform larva. The larva in the right photo is short
and stout—this is a rhabditiform larva.
SUMMER 5
PARASITOLOGY

STRONGYLOIDES STERCORALIS RHABDITIFORM
LARVA
• Green arrow is showing the short buccal cavity

• Pink arrow is showing the esophageal bulb
• Blue arrow is showing the prominent genital
primordium.
• Therefore, this is the Strongyloides stercoralis
rhabditiform larva.
HOOKWORM RHABDTIFORM LARVA
• On the contrary, the rhabditiform larva of hookworms

• Let us characterize the rhabditiform larva of has a long buccal cavity (shown in the blue arrow in
Strongyloides stercoralis. Take not of the buccal the picture). This is longer than the Strongyloides
cavity of the rhabditiform larva of Strongyloides stercoralis rhabditiform larva.
stercoralis is short. Take a look at the red arrow—that • Looking at its posterior side, the genital primordium is
is the buccal cavity. It is kind of short. However, this not that prominent.
worm has prominent genital primordium.
• This larva is short and stout. It is most likely an

• The genital primordia of this larva are prominent but abducted form larva. Look at the blue arrow, it is
their buccal cavities are very short. These are the pointing to a long buccal cavity. Therefore, this is
rhabditiform larvae of Strongyloides stercoralis. hookworm rhabditiform larva—Necator americanus
or Ancylostoma duodenale.
SUMMER 6
PARASITOLOGY

COMPARISON BETWEEN HOOKWORM AND
STRONGYLOIDES STERCORALIS
HOOKWORM Strongyloides
stercoralis
Rhabditiform Long buccal Short buccal
larvae cavity, small cavity,
(have less prominent
prominent) genital
genital primordium
primordium
Filariform larvae Pointed tail, Notched tail
short long
• This larva is short and stout. Therefore, this is esophagus esophagus
rhabditiform larva. Look at the arrow, you have a long Egg Thin shell, 4-8 Thin shell, 4-8
buccal cavity. cell cleavage cell cleavage
STRONGYLOIDES STERCORALIS FILARIFORM
LARVA
Anterior ends of hookworm and Strongyloides stercoralis

rhabditiform larvae.
• To emphasize the buccal cavity of hookworms is
longer than buccal cavity of Strongyloides stercoralis • This larva is slender and long. Most likely, this is the
rhabditiform larva. filariform larva, particularly from Strongyloides
stercoralis.
• How will you know if the filariform larva is from
Strongyloides stercoralis? They have long
esophageal. The two arrows are showing the length
of the esophagus of this filariform larva. This one is
longer than that of the filariform larva of hookworms.
Additionally, they have notched tails or tails that are
forked or with cleft.
• The larva on the left photo has long buccal cavity.

Therefore, this is the rhabditiform larva of
hookworms—Ancylostoma duodenale and Necator
americanus. The right photo is showing us a
rhabditiform larva with a short buccal cavity.
Therefore, this is the rhabditiform larva of
Strongyloides stercoralis
• The filariform larvae of Strongyloides stercoralis have
•
longer esophagus than that of the hookworms. They
have notched tails or forked tails.
SUMMER 7
PARASITOLOGY

HOOKWORM FILIFORM LARVA
• The filariform larvae of hookworms have shorter • The esophagus of filariform larva are shorter than that
esophagus and their tails are usually pointed. of the filariform larvae of Strongyloides stercoralis.
HOOKWORM Strongyloides
stercoralis
Rhabditiform Long buccal Short buccal
larvae cavity, small cavity,
(have less prominent
prominent) genital
genital primordium
primordium
Filariform larvae Pointed tail, Notched tail
short long
esophagus esophagus
• Left photo = tail is notched or forked (filariform of Egg Thin shell, 4-8 Thin shell, 4-8
Strongyloides stercoralis) cell cleavage cell cleavage
• Right photo = tail is pointed (filariform larva of • The eggs of hookworms and Strongyloides stercoralis
hookworm) are not easily differentiated from each other because
they have description.
DIAGNOSIS
• CBC – will reveal eosinophilia
o However, this is non-specific. You have to
correlate it with the signs and symptoms and your
physical exam of the patient.
• Harada-Mori culture
• Duodenal aspirations
o So, you can get the rhabditiform larva or the adult
worm from the duodenal contents. Again, the
habitat for Strongyloides stercoralis is the small
• Left photo = tail is notched or forked (filariform of
intestine.
Strongyloides stercoralis)
• Sputum can be used in cases of disseminated
• Right photo = tail is pointed (filariform larva of
strongyloidiasis or strongyloidiasis cases with
hookworm)
hyperinfection.
SUMMER 8
PARASITOLOGY
TREATMENT
• These three can be used to treat chronic
strongyloidiasis. But if patient has hyperinfection, you
should choose either Albendazole or Thiabendazole.
o Albendazole
o Thiabendazole
o Ivermectin
• Soil-transmitted
o Ascaris lumbricoides – ingestion of embryonated
ovum
o Trichuris trichiura – same as Ascaris
o Hookworms – skin penetration
o Strongyloides stercoralis – skin penetration
• Food-borne
o Capillaria philippinensis ingestion of encysted
larva in raw fish meat
o Ancylostoma duodenale
• Larval lung migration
o Ascaris lumbricoides
o Hookworms
• Autoinfection
SUMMER 9
PARASITOLOGY
PHYLUM NEMATODA 2 (ENTERIBIUS VERMICULARIS)

ENTEROBIUS VERMICULARIS
INTRODUCTION
BACKGROUND
• Intestinal nematode
• Dioecious: separate sexes
• Common Name: Pinworm, Seatworm
o Pinworm – owing to the morphology of the adult
female vermicularis which has a long-pointed tail
resembling a pin as shown in the picture below
Adult male worm

• Pointed by the black arrow is the curved tail
• Female: 8-13mm x 01.-0.2mm with long pointed tail,
fusiform body
o Bigger than adult male worm
• Host: Humans only

• Habitat: Large intestine especially cecum (Adult
worm)
• Disease:
o Enterobiasis or Oxyuriasis
▪ Sometimes called oxyuriasis because this
nematode belongs to the family oxyuriade,
Adult female worm
coming from the word oxyuris – sharp tail
o Acute appendicitis • Pointed by the red arrow is the fusiform body and long
▪ Rare pointed tail
BACKGROUND • Note:
• Enterobiasis has a worldwide distribution, occurring o Males are rarely seen because they usually die
in both in temperate and tropical regions after copulation
• High prevalence in both developed and developing
countries
• Affected people in groups
o Household, institutional settings
COMMONLY AFFECTED
• School-aged and pre-school-aged children
• Institutionalized person
• Household members and caretakers of persons with
enterobiasis
RISK FACTOR
• Overcrowding
• Thumb-sucking
• Nail-biting Left: Male E. vermicularis Right: Female E.
• Lack of parental knowledge on pinworms vermicularis
BIOLOGY ANTERIOR END
ADULT • The anterior end of both male and female adult
• Male: 2-5mm x 0.1-0.2mm with curved tail and a Enterovirus vermicularis is quite peculiar. It is tapered
single spicule, resembling number 6
SUMMER 1
PARASITOLOGY

and is flanked on each side by a wing-like cuticular OVA
extensions – Cephalic Alae • 50-60μm x 20-30μm (average 55μm x 60μm)
• Cephalic Alae • D-shaped: Asymmetrical with one side flattened and
o Wing-like cuticular extensions of the head the site convex resembling the letter D
• Slender esophagus terminating in a prominent
posterior esophageal bulb
E. vermicularis ova
• Cephalic Alae – pointed by red arrows
• Posterior esophageal bulb – pointed by green arrows
ARRANGEMENT OF SOMATIC MUSCULATURE
• Arrangement of Somatic Muscles: Meromyarian
o Meromyarian – there are 2 to 5 cells per quadrant
of cross section of the body as shown in the
pictures below
• Translucent shell
o Translucent and colorless. It is not stained with
bile
o Two layers of covering:
▪ Outer triple albuminous covering:
mechanical protection (pointed by red arrow)
▪ Inner embryonic lipoidal membrane:
chemical protection (pointed by green arrow)
▪ These two layers of covering protects the
RHABDITIFORM LARVA tadpole-like embryo (pointed by black arrow)
• 140-150μm x 10μm o Embryo: tadpole-like, matures outside the host
• With characteristics esophageal bulb (pointed by red with 4-6 hours
arrow)
• No cephalic alae LIFE CYCLE
o No cuticular expansion of the anterior end • Gravid female Enterobius vermicularis
o Everything starts when the adult gravid female
Enterobius vermicularis migrate from the colon
down to the anus to deposit already embryonated
eggs on the perianal folds, which usually happens
in the evening hours
o Migrates to perianal region during evening to
deposit eggs
SUMMER 2
PARASITOLOGY

▪ 4,672-16,888 eggs/day (Average 11,105 • Habitat: Large intestine, usually the cecum and its
eggs/day) adjacent parts
o Usually dies after oviposition • Adult and male female Enterobius vermicularis
▪ After eggs deposition, the female Enterobius copulate
vermicularis dies o Male usually dies after copulation
o The female then becomes gravid
o Gravid female migrates down to the anus for
oviposition
▪ Eventually it will crawl down to the anus to
deposit the embryonated eggs in the perianal
folds
▪ Female usually dies after oviposition and the
cycle continues
• Time ingestion of infective egg to oviposition by adult

female: 1 month
o It takes about a month from the time of ingestion
• Embryonated eggs of infective egg to oviposition by adult female
o Fully mature within 4-6 hours • Lifespan of adult parasites: 2 months
▪ The larva containing eggs in the perianal • Airborne Transmission
folds becomes fully mature within 4-6 hours o Rarely, the eggs that are attached on to the
o Infection by ingestion of fully embryonated egg blanket or clothes may become airborne and be
▪ The same host: autoinfection inhaled and swallowed
▪ Other hosts • Retroinfection
▪ Infection occurs when these fully o Embryonated egg hatches to become larva and
embryonated eggs will be ingested by the reenters the large intestine
same host which is a form of autoinfection or o Also in some instances, the embryonated egg in
can be ingested by other hosts, usually close the perianal folds may hatch larva. If this
contact (e.g., other members of the happens, the hatched larva migrates back to the
household through contaminated clothing, large intestine, establish, and mature there as
beddings, etc., which may result to familial adult parasites
outbreaks) o Special type of autoinfection
• Familial parasitic disease o The frequency of retroinfection that is happening
• After ingestion, the embryonated egg containing is yet to be known
third stage larva hatches in the small intestine,
usually duodenum
o The larva then passes down the remaining parts
of the small intestine then ultimately reaches their
habitat, which is the large intestine, usually in the
cecum and its adjacent parts (e.g., ascending
colon, terminal ileum) the larva establishes itself
and matures to become an adult Enterobius
vermicularis
SUMMER 3
PARASITOLOGY

• Therefore, based on the life cycle.. VAGINAL IRRITATION
o Diagnostic Stages • Because of the proximity of the anus to the vagina,
▪ Embryonated egg adult female worm may migrate from the anus to the
▪ Sometimes, adult nematode vagina and possibly depositing eggs there
o Infective Stage • Adult female worm invading the vagina → irritation
▪ Embryonated egg containing third stage larva o The invading worm and eggs themselves cause
o Modes of Transmission vaginal irritation
▪ Ingestion
▪ Inhalation
▪ Autoinfection and retroinfection
o Habitat:
▪ Large intestine especially the cecum
o No larval heart-lung migration
PATHOGENESIS AND CLINICAL MANIFESTATIONS
OF ENTEROBIASIS
PRESENTATION
• Relatively innocuous parasite
• Rarely produces serious medical problem
• Most typical symptom: PRURITUS ANI or itchiness of
the perianal area specially during sleeping at night. • The picture shows a pap smear of a woman
There are possible explanations to this: presenting vaginal itchiness
1. Allergic reaction to the deposited eggs • Her pap smear shows Enterobius vermicularis ova as
2. Movement of migrating worm pointed by the black arrows
3. Pointed tail of gravid female penetrates the ACUTE APPENDICITIS
perianal area during oviposition • The adult Enterobius vermicularis, especially the
o Excoriation and secondary bacterial infection female, may migrate to the appendix causing
▪ The constant scratching of the perianal area obstruction and inflammation of the appendix
in the perinium may cause excoriation and resulting to acute appendicitis
possibly secondary bacterial infection
o Insomnia and restlessness at night
▪ Since migration to the perianal area happens
at night or early morning, intense pruritus ani
may result to insomnia and restlessness at
night
• 1st picture – shows adult Enterobius vermicularis at

the base of the appendix during appendectomy
• 2nd picture – shows adult Enterobius vermicularis at
the base of the appendix
• 3rd picture – biopsy specimen of the appendix. Its
cross section shows two adult Enterobius
vermicularis pointed by black arrows
DIAGNOSIS
CLINICAL DIAGNOSIS
• Enterobiasis should be suspected in children and
adults who show perianal itching, relieved only by
vibrous scratching
• Most typical symptom: Pruritus ani
o Pruritus ani is NOT specific to enterobiasis. There
are other diseases that present with pruritus ani.
SUMMER 4
PARASITOLOGY

To confirm the suspicion for enterobiasis, conduct TREATMENT
a laboratory examination DRUG THERAPY
LABORATORY DIAGNOSIS 1. Mebendazole 100mg
• Microscopic Examination 2. Albendazole 400mg (200mg in children under 2 years
o Identification of eggs old)
• Detection of adult on anal skin or feces 3. Pyrantel pamoate 11mg/kg, maximum dose of 1g
• Tissue biopsy • Radical Cure: Drug therapy should be given again
after 2 weeks to kill any worm that might have
hatched from eggs present during initial killing
o This is to achieve radical cure
• Familial parasitic disease: TREAT THE ENTIRE
HOUSELD
PREVENTION AND CONTROL
REMEMBER!
• The only intestinal infection that cannot be controlled
through sanitary disposal of human feces
o Eggs are deposited in the perianal region instead
of intestinal lumen
▪ These eggs usually contaminate underwear
and beddings and they will be spread and
infect other hosts through feco oral or
GRAHAM SCOTCH TAPE METHOD inhalational routes
• The ova of Enterobius vermicularis may be collected
from the perianal area using this method
• Method of collecting eggs from the perianal area
• Best done in the morning, before defecation and
washing of the anus
HOW TO CONTROL THE INFECTION?

• Personal hygiene
o Fingernails should be cut short
o Hand washing after using the toilet, and before
and after meals
• Infected person is suggested to use showers instead
of bathtubs
• Infected person should sleep alone until adequately
treated.
SUMMER 5
PARASITOLOGY

• Underwear, night clothes, blankets, and bedsheet
should be handled with care and washed in hot soapy
water.
• Drug therapy of the entire household
SUMMER 6
PARASITOLOGY
PHYLUM NEMATODA PART 2 (TRICHINELLA SPIRALIS)

TRICHINELLA SPIRALIS o Most widely distributed species among wild
INTRODUCTION animals; can also infect pigs
BACKGROUND • Trichinella nativa
• AKA Trichina Worm o Infects primarily wild carnivores in the frigid zones
• First described by Tiedemann in 1822 • Other species affecting humans:
• Demonstrated in human cadavers in London by o T. murrelli, T. nelsoni, T. papuae, T.
James Paget and Richard Owen in 1835 zimbabwemsis,T. pseudospiralis
• Before the turn in the century, German investigators BACKGROUND
proved that raw or insufficiently cooked meat like pork
causes human trichinellosis
• Zoonotic infection
• 8 recognized species of Trichinella • The adult female is Viviparous (Larviparous)
o It gives birth to larvae
• Mode of transmission
o Ingestion of raw or undercooked meat of pig and
other animals with encysted larvae
• Infection is maintained in pig-to-pig, or pig-to-rat-to-
pig cycle
EPIDEMIOLOGY
• Cosmopolitan infection
o It is documented in atleast 55 countries worldwide
• 10,000 cases/year
• 0.2% resulting to mortality
BIOLOGY
• Trichinella spiralis
o Most important cause of trichinellosis in humans • Smallest parasitic nematode to humans
o Most adapted to domestic and well pigs • Thread-like
• Trichinella britovi • Ivory white in color when unstained
o Second most common species affecting humans
SUMMER 1
PARASITOLOGY

ADULT shows how claspers of the male worm hold the female
MALE worm.
• 0.62-1.58mm by 0.025-0.033mm LARVA
• Single testis near the posterior end of the body, • Measurement
joined by genital tube in the mid-body, extends back o At birth: 80-120um x 5.6um
to the cloaca o Encysted: 0.65-1.45mm x 0.026-0.040mm
• No spicule • Anterior end (tip): spear-like for burrowing
• The posteriorly located Cloaca: evertible and o Possible to penetrate tissues of the host
equipped by 2 conspicuous conical papillae • The adult larva encysted in the muscle fiber has a
(claspers) which clasp the female during copulation Digestive tract similar with adult
• Reproductive organ not fully developed already
possible to identify the sex
FEMALE
• It is bigger than the male.
• 1.26-3.35mm by 0.029-0.038mm ENCYSTED LARVA
• Single ovary, oviduct, seminal receptable, coiled • Trichinella spiralis: the only intracellular parasitic
uterus, vagina, and vulva nematode
• Vulva for copulation located at the anterior fifth,
ventral side
It shows a Trichinella spiralis larva encysted to a skeletal

muscle. The larva gets its nourishment through the
nurse cell. The encircled one is the encysted larva that
is coiled spirally. Stichosome is made up of stichocytes
which is like the esophagus of the parasites. Appreciate
that the larva is located inside the skeletal muscle which
is the nurse cell.
LIFE CYCLE
• In the life cycle of the Trichinella spiralis, the host,
including humans, pigs, rats, dogs, bears, foxes,
walruses, and other omnivores and carnivores serve
The picture shows the adult male and female Trichinella as the definitive hosts, final hosts, and intermediate
spiralis in copula. The bigger worm is the female, and hosts.
the smaller worm is the male. The encircled portion • Humans:
o Definitive host
SUMMER 2
PARASITOLOGY

o Final host muscles. If the pig is not eaten with humans,
o Intermediate host – harboring both the adult and the pig becomes the final host. It is a dead-
larval stages end then there would be no transmission. The
• Transmission starts by ingestion of raw or encysted larva will die when the pig dies. If
undercooked meat containing encysted larvae the pig with encysted larvae is eaten by
• Encysted larvae are released once exposed to gastric humans, raw or undercooked, the parasite is
acid and pepsin (EXCYSTATION) transmitted to humans. In that regard, pig
o The larvae are released from the cyst, a process acts as an intermediate host. This principle
called excystation. applies in the life cycle of Trichinella spiralis
• Newly released larvae invade the small intestine in humans, in the domestic cycle, and in the
mucosa and undergo 4 molting before they adult sylvatic cycle.
Trichinella spiralis • Humans and other animals act as (depending on the
o → develop to become adult (2 days). Maturation circumstances)
takes up 2 days. o Definitive host
• Adult male and female worms copulate 5-7 days post o Final host
infection o Intermediate host
o → After 1 week: female gives birth larvae • Encysted Larvae
(LARVIPAROUS) o Both diagnostic stage and infective stage
• The role of human is DEFINITIVE HOST.
• The newborn larvae burrow the intestinal wall
o → enter the circulation after they go to striated
muscles, like skeletal muscle and cardiac muscle.
o → where they start to go ENCYSTATION in the
striated muscles
▪ Start of encystation: 3 weeks
▪ Complete encapsulation: 4-5 weeks
▪ Life span of encysted larva: 5-40 years and
the capsule become uncalcified.
• Life span of adult worm in the small intestine: 4 weeks
after which they die. What is left in the human host is
the encysted larvae.
• Transmission of encysted larvae in humans if
(humans can be an INTERMEDIATE HOST)
o Cannibalism is being practiced
o Human being eaten by an animal
• In the absence of a human with encysted larvae being
eaten by a wild animal or practicing cannibalism,
humans become the FINAL HOST. PATHOGENESIS AND CLINICAL MANIFESTATIONS
• No transmission of encysted larvae from human to SEVERITY OF SYMPTOMS DEPENDS ON THE
other human/animal INTENSITY OF INFECTION
• Being classified as definitive host, intermediate host, • Light infection (10 larvae): usually asymptomatic
and final host is applicable to animals. Therefore, to • Moderate infection (50-500 larvae): symptomatic
complete the life cycle of Trichinella spiralis, there o Shows gastroenteritis, diarrhea, abdominal pain
should be: • Severe infection (> 1,000-3000 larvae): severe
o Alternations of different hosts in order to disease
complete the life cycle of Trichinella spiralis. PHASES OF INFECTION
▪ For example, a pig is a definitive host, • Enteric Phase
harboring adult Trichinella spiralis that o Corresponds to stage of incubation and
copulate—sexual reproduction, producing intestinal invasion
larvae. This larva is encysted to striated • Invasion Phase
SUMMER 3
PARASITOLOGY

o Corresponds to stage of larval migration and
muscle invasion
• Convalescent Phase
o Corresponds to stage of encystment and
encapsulation
ENTERIC PHASE
• Resembles of an attack of acute food-poisoning
• Diarrhea, constipation, vomiting, abdominal cramps,
malaise, nausea
INVASION PHASE
• Migrating larvae and resulting metabolites → • Neurological manifestations:
immunological, pathological, and metabolic reactions o Small subacute cortical infarcts
• Marked Eosinophilia o Meningitis, meningoencephalitis
o → increase histamine o Heavy Infection: ocular disturbances, diplegia,
o Histamine, serotonin, bradykinin, and deafness, seizure, and coma
prostaglandin → increase vascular permeability
→ tissue edema
• Cardinal signs and symptoms:
o Severe myalgia, periorbital edema, eosinophilia
• Other symptoms:
o High remittent fever and chills, headache,
dyspnea, dysphagia, difficulty in chewing •
• Occasionally,
o Extremity paralysis, splenomegaly, gastric and
intestinal hemorrhages (severe cases)
CONVALESCENT PHASE
• Symptoms like fever, weakness, pain, and other
symptoms start to abate
• Abatement of symptoms
• Full recovery: self-limited (this is expected because
Trichinellosis is a self-limiting disease)
• Protean neurologic signs from brain damage may
persist
PROGNOSIS
• Good prognosis especially in mild infections
• Death may occur in cases of heart failure,
• Larval migration into the heart muscle can result encephalitis, and other end organ complications
Cardiac manifestations: • Absent eosinophilia is a poor prognostic indicator
o Pericardial pain, tachycardia, ECG abnormalities
o Pericardial effusion, heart failure
SUMMER 4
PARASITOLOGY

DIAGNOSIS NON-SPECIFIC LABORATORY TEST
DEFINITIVE DIAGNOSIS
• Complete blood count: to detect Eosinophilia

• The most definitive examination is the • Muscle enzymes
demonstration of encysted larva through muscle o Creatine phosphokinase, lactate dehydrogenase,
biopsy like the grastrocnemius muscle (as shown in myokinase
the picture) • Determination of Total serum IgE
• Digestion of muscle samples with pepsin and ALGORITHM FOR THE DIAGNOSIS OF THE
hydrochloric acid PROBABILITY OF ACUTE TRICHINELLOSIS IN
o To determine larvae per gram of muscle HUMANS
o To isolate larvae for molecular characterization • Not all institutions can do tissue biopsy or it is too risky
o The digestion technique is limited to muscle or difficult to reach. In order to establish the diagnosis,
larvae, atleast 10-12 days old or about 2-3 weeks the algorithm for the diagnosis of the probability of
post-infection. Since younger larvae may be acute Trichinellosis in humans was made.
destroyed by the digestion process. • The table shows the group of letters from A-D and its
• During the larval migration, the larvae may be corresponding symptoms.
demonstrated using venous blood as a sample
GROUP SYMPTOM
through:
A Fever, eyelid and/or facial edema,
o Knott concentration technique
myalgia
B Diarrhea, neurological signs, cardiac
signs, conjunctivitis, subungual
hemorrhages, cutaneous rash
C Eosinophilia (>1,000 eosinophilis/ml)
and/or increased total IgE levels,
increased levels of muscular enzymes
D Positive serology (with a highly specific
test), seroconversion, positive muscular
biopsy
• This is the corresponding criteria for every
o Membrane filtration technique interpretation.
INTERPRETATION SYMPTOM
Very unlikely One A, or One B, or One C
Suspected One A or two B PLUS One C
Probable Three A PLUS One C
Highly Probable Three A PLUS Two C
Confirmed Three A PLUS Two C PLUS
One D, or Any of A or B PLUS
One C PLUS One D
SUMMER 5
PARASITOLOGY

OTHER TESTS
• ELISA: recommended for screening test
• Western Blot: confirmatory test
o Confirmation of ELISA positive sample
• Bentonite Flocculation Test
o Primarily used to diagnose Trichinella spiralis
infection and is performed by coating particles of
Bentonite with the test antigen and observing
flocculation on addition of the serum. Titration is
achieved by serial dilution of the serum
o However, this test has ;ow reactivity, not a
favored test
TREATMENT
TREATMENT CYCLE
• Albendazole 15mg/kg x 10-15 days per cycle
o Children: 10mg/kg x 10-15 days
• Mebendazole 5mg/kg OD x 10-15 days
• In severe infection, another treatment cycle is
repeated after the initial cycle to achieve radical cure
SUPPORTIVE TREATMENT
• Analgesics to address pain like muscle pain
• Anti-pyretics to address fever
• Steroids: control hypersensitivity reactions to larvae
PREVENTION AND CONTROL
MEASURES TO DO
• Health education is important for the prevention and
control of this parasitic infection
• Proper cooking of food
o Minimum of 77C (170F) to kill the larvae
• Freezing of meat
o (-)15C for 20 days, or
o (-)30C for 6 days
• Regular animal monitoring, keeping pigs rat-free,
proper disposal of carcasses
o Meat inspection or detection of circulating
antibodies
SUMMER 6
PARASITOLOGY
DRACUNCULUS, ANGIOSTRONGYLUS, ANISAKIS, TOXACARA

DRACUNCULUS MEDINENSIS ● Genetial primordium
COMMON NAME ● Strongyloides is kinkier compared to
● Guinea worm hookworm
● Fiery serpent LIFE CYCLE
● Medina worm
IMPORTANT PARASITE IN:
● Middle East (SA, Iran, Yemen)
● Central India
● Pakistan
● Africa
● North America-parasites of dogs and other
● Philippines
Note: history of travel to these countries with interactions
with dogs and carnivores can be a clue to suspect
dracunculus medinensis
DISEASE
● Dracunculiasis
Note:
● DM a parasite frequently found in the
subcutaneous tissue and muscles of humans,
dogs, and sometimes cattle and horses
● Most striking lesions of DM causes cutaneous ● Indirect life cycle
nodules and subsequent ulcers o Needs an intermediate host
o Due to nature and life cycle of the adult PHASES
worms especially female adult worms 1. Human drinks unfiltered water containing
MORPHOLOGY copepods with L3 larvae
● Males are smaller (1.2-2.9 cm long)
o males are smaller which is the general 2. Larvae would be released when the copepods
rule in nematodes die inside the body
● Females measures 60 cm in length o Larvae released in the stomach
● Larvae measures between 500-700 micrometer penetrates the stomach and matures
o Can live for 6 days in clear water into adult worms
o 2-3 weeks in muddy water 3. Fertilized female worm migrates to surface of
● Can’t be identified microscopically specially the skin in subcutaneous tissue also in the muscles
larva because they usually reside in their causing blisters
intermediate host, copepods.
4. The moment the patient's feet are submerged in
Case: Patient went swimming in a muddy river in Africa. water (muddy or clean), it would trigger the
The patient exhibits ulceration nodules. release of the L1 larva from the emerging female
● Dracunculus medinensis caused ulceration. worm
o L1 larvae released in the water
5. L1 are ingested by copepods and undergoes

molting from L1 - L3
Note:
● Infective stage
● 3rd stage larva
● Definitive host
● Humans
● Dogs
● Horses
● Intermediate host
● cyclops/copepods that ingested the L3
● Larva found in the copepod larva
● Looks like rhabditiform and filariform of
hookworm and strongyloides but differ in:
● Buccal cavity
● Esophagus
SUMMER 1
PARASITOLOGY

● Result of popping the blister
● Adult female gets out and deposits L1 larvae in
water
● Image shows the intermediate host - copepod or

cyclops
Note: mode of transmission
● DM = ingestion of contaminated water TREATMENT
o No skin penetration
● Surgical removal of worm
o Skin penetration only occurs during the
o Female worm must not be cut
release of L1 by adult female
● Metronidazole/Thiabendazole
PATHOLOGY CAUSED BY DM
o Does not kill but facilitates removal
o Pampalipong
● Mebendazole
o Kills adult DM
● Filtering water source
o Stop the chain of infection by removing
contaminated water with copepods that
ingested L3 larvae
● Avoid contact with contaminated water
● Blister
● Water inside
● Blister that became ulcerated after popping

● Technique for removal
o Foot is submerged in water to signal the
female adult worm to deposit L1
o Tip of the worm comes out and would be
tied to a stick then proceeds to rolling
the stick until the whole female adult
worm comes out
SUMMER 2
PARASITOLOGY

ANGIOSTRONGYLUS CANTONENSIS
New name is Parastrongylus cantonensis.
● “Rat lungworm - zoonotic disease
● Was first discovered in pulmonary arteries and
the heart of domestic rats in Canton, China in
1935 (Chen).
● The worm normally lives in the lungs of rats but
can cause eosinophilic meningoencephalitis
in man.
MORPHOLOGY
Male adult worm Female adult Ova
worm
-16-19mm x -21-25mm x -46-48um x

0.26mm in 0.30-0.36mm in 68um
diameter diameter ● Tingnan niyo ito, they have well-developed
-thin-shelled copulatory bursa (right), and a long specule (left)
-pale, filiform -has uterine - for copulation.
(slender), tubules w/c is unembryonate
delicate worm intertwined d when
-they have a well around the oviposited
develop caudal intestines giving (laid)
bursa (kidney- it a barber-pole
shaped, single appearance
lobed) -can lay 15,000
-they have long eggs daily
spicule
● For the morphology, unique ito siya na parasite
kasi wala talaga siyang kamukha.
○ For the male adult worm, it is pale,
filiform (slender), delicate worm and they
have developed caudal bursa similar to
your other parasites with copulatory
bursa for copulation and they have very
long spicule. In the world of parasite,
kailangan well-developed yung
● Diba sa atin na discuss wala pa nag exhibit na
reporductive system kasi the only goal is
ganitong pattern (barber’s pole) ng female adult
to reproduce.
intestine. It has uterine tubules which are round
○ For the female adult worm, uterine
spirally around the intestine. Naka intercoil
tubules w/c are intertwined around the
parang DNA.
intestines giving a barber-pole
ADULT WORM
appearance. It can lay 15,000 eggs
daily. A. Adut female worm with characteristic barber-
○ For the ova, hindi masyado siya distinct pole appearance (anterior end of worm is to the
kasi kamukha niya yung ova ng top)
hookworm, Strongyloides, and other B. Tail of adult male, showing copulatory bursa and
thin-shelled worm. long spicules (arrows).
SUMMER 3
PARASITOLOGY

● Again, barber-pole. Alam niyo na na ganito yung
female kasi ang male di naman sinabi na barber-
pole yung uterus. And males do not have uterus.
● Distinguishing feature for the adult male would
be the copulatory bursa which they termed as
kidney-shaped and long spicule.
OVA
• Ito yung intermediate host nila, these are found sa

mga canal.
● For the ova, ito yung appearance niya. They

have delicate hyaline shells and usually
unembryonated when oviposited.
REVIEW
• This is a snail compared to a ballpen, malaki talaga

sila.
LIFE CYCLE
● Infective stage - 3rd stage larva (L3)

● Definitive host - rats
● Incidental host - humans
● Intermediate host - snails, slugs (Achantina
fulica)
● Paratenic host - fresh water shrimps, land
crabs, frogs
Rat Lungworm kasi ang gusto nila na site is lungs and
heart of the rats first discovered in Canton, China.
Definitive host is rats kasi zoonoti, nasa animals siya
mainly. Role of humans in the life cycle is incidental
lang. Kung damak tayo, dun lang tayo makakuha ng
ganitong disease. ● Indirect life cycle kasi meron siyang intermediate
host w/c is the Acahntina fulica.
● For example, first number. Eggs hatch in the lungs
or in the heart and L1 are passed to the feces of the
SUMMER 4
PARASITOLOGY

rodent. For the Angiostongylus, the L1, shed from blood vessels of diagnose Proper cooking
the definitive host, are ingested by your gastropod Ingestion of the brain and of meat and
IH/PH meninges and History of fish – (never
intermediate host (Achantina fulica in w/c mag stay
infected free wandering travel to eat raw and
yung L3). with 3rd worm in the brain endemic areas/ insufficiently
● So yung L3, syempre ang rat kahit ano lang stage larva tissue food habits- cooked meat
kinakain, so kainin niya yung snail so magbalik presumptive and fish)
nanaman sakanya. And the adult male and female Severe headache, diagnosis
nandun sa pulmonary arteries w/c is located in the fever, paralysis of Elimination of
the lower CSF exam – IH
lungs.
extremities, stiff increased
● If yung tao nagkain ng accidental ingestion of neck, coma, and number of Wash
gastropod/larvae in contaminated fruits, the larva death eosinophil and vegetables
will migrate to the brain, eyes and to the lungs and lymphocytes. properly
do not reach reproductive maturity. Kaya hindi tayo Destruction of the Identification of
considered as definitive host kasi wala saatin yung brain and spinal immature
adult male and female. Ang nasa atin lang is yung cord cells by worms
trauma and
L3 which can migrate to the brain and can cause
immune response CT scan
eosinophilic meningoencephalitis. Nasa meninges due to dead
yung infection. worms result in ELISA
vague symptoms
Eosinophil counts
are high in
peripheral blood
and CSF as well
as lymphocytosis
in CSF.
DISEASE & DIAGNOSIS
Disease:
• Angiostrongyliasis
• Eosinophilic meningoencephalitis
Diagnosis:
• Relatively difficult
• Presumptive diagnosis is made by travel history and
exposure
• CSF (10% eosinophilia in proportion to the WBC)
• CT scan
• ELISA
PATHOLOGY
Clinical
Disease Features DX Test T/P/C
(S&S)
Eosinophilic Presence of Relatively No tx available
meningitis worms in the difficult to
SUMMER 5
PARASITOLOGY

• So ito yun siya, mga larvae natin. So diba nag • IN DOGS:
encyst sila, nandoon sila embedded in the brain o Found in the intestines when they ingested eggs
tissues or in the lung tissues. o Transplacenta infection (infection from mom to
TREATMENT puppy during pregnancy)
• No anthelmintic treatment is recommended o Transmammary infection (infection from mom to
(patibayan ng guardian angel haha) puppy through breast feeding)
• Usually self-limiting; administration of anthelminthic o Puppies less than 5 weeks can have this.
drugs is not necessary. • IN HUMANS:
• Killing worms found in the brain would cause greater ▪ Can be found in the liver, lung, brain, heart,
inflammatory reaction. muscle, or eye
o Pagnamatay na ang larvae sa brain the MORPHOLOGY
more our bodies react or create an • Adult Female
inflammatory reaction thus, we (the o 5 to 18 cm long
patient) may develop eosinophilic • . Adult Male
meningoencephalitis. o 4 to 10 cm long
• Management:
o Symptomatic treatment with analgesics
o Frequent removal of about 10mL spinal fluid
(CSF) at intervals relieves headaches (invasive)
▪ Because they are invasive, they can block
the flow of CSF (may cause hydrocephalus
etc.)
• Thiabenazole, Mebendazole, Albendazole,
Ivermectin (these are only effective in experimental
animals)
PREVENTION/CONTROL ▪ Wala mashadong distinguishing features
• Proper eating habits ganito sa mga gross or malayong picture but
• Safe food preparation if i-zoom in natin ang picture, tingnan niyo
• Elimination of Intermediate Host (impossible haha) TOXOCARA SPP.
• Adult Toxocara spp. Measure approximately 4 – 6
• Washing of leafy vegetables
cm long (males) and 6 – 10 cm long (females).
NOTE • Like all ascarids, Toxocara have three “lips” on the
• In Infective stage of Angiostrongylus cantonensis in anterior end of the worm.
o Kamukha siya ng Ascaris, they also have 3 lips
the INTERMEDIATE HOST?
o Answer would be L1 o the anterior end. Diba meron yung silang lips
yung ganyan na parang suckers niya pero di sila
• But if the question is What is the infective stage to
suckers, lips sila.
humans or to the Definitive Host?
o It should be L3
TOXOCARA CANIS/CATI
• Toxocara canis: parasite on dogs
• Toxocara cati: parasite on cats
• Another name of Toxocara canis is Dog Round
Worm
• It is a Zoonotic Disease (disease mainly on animals) • They also possess large, spear-shaped cervical
INFECTION alae, which are broader in T. cati than T. Canis.
• Geographic range: Worldwide
• Definitive: Hosts
• Intermediate Host: NONE (direct life cycle)
• Accidental Host: Humans and other mammals
o Children are more susceptible than adults
SUMMER 6
PARASITOLOGY

MORPHOLOGY
• Adult
o Female: 6.5 – 15 cm
o Male: 4 – 6 cm long
o Three lips
o Prominent Cervical Alae
• Egg
o Brownish color and almost spherical (85um x
75um)
• Ito makita natin na probably this is your Toxocara
• Close-up of the anterior end of Toxocara canis Canis kasi di siya mashadong broad
(Adult), showing the three lips.
• But in this one, ito nasa ibaba, diba mashado siyang

malapad. Parang imagine niyo na cobra siya so yun
▪ Diba meron ding ganito ang ascaris, meron yung Cati
silang lips na tatlo containing papilla, yung
mga receptors nila
• Broad alae with striations, characteristic of T. cati..
• For the egg, para siyang Ascaris Ova pero tignan

natin closer look mamaya, iba siya
• So for the adult ha tandan niyo nalang to na image.

▪ Pag nakakita kayo ng ganito, it’s enough na Oh diba meron siyang sabi cephalic alae/anterior.
sabihin na Toxocara spp. Lang or pwede din Parang cobra itong toxocara canis natin, broader
lagay niyo cati or canis pero lahat yun than toxocara cati.
pwede ko ilagay sa answer key, its either
Toxocara Cati, Toxocara Cani, or Toxocara
Species. But pag nakalagay doon,
nakaindicate na san mas pronounced yung
broad alae or cephalic alae, ang sagot ninyo
is yung Toxocara Cati kasi sinabi naman sa
powerpoint natin na this is much broader
and pronounced in Toxocara Cati than
Toxocara Canis.
SUMMER 7
PARASITOLOGY

• Eggs • From pitted appearance then differentiated into 4 cell
o 85um x 75um stage and eventually into your larva stage
o Have thick brown shell
o T. cati eggs look identical
• Wag niyo ito siya iconfuse with your Ascaris kasi iba • So pag nag putok na siya, ayan na mag labas ang
talaga ang mukha nila larva.
TOXOCARA SPP. o Infective stage to the accidental and definitive
• Toxocara eggs are golden in color, spherical to host
slightly pear shaped, thick-shelled, and have a pitted
surface. The size range for different species varies
slightly; T. canis is slightly larger (80—85 µm) than
T. cati (65—75 µm).
LIFE CYCLE
• Eggs must be present in external environment for 2
weeks to be infective
• Ingestion by dog
o Makapal ang kanilang egg pero hindi 3 ang • Eggs hatch and larvae penetrate the gut wall
layers compared to Ascaris Lumbricoides na • Migrate into various tissues; encyst if dog older than
tatlo yung layers, tignan niyo parang 2 lang. 5 weeks
o TIgnan niyo parang may butas-butas siya, kung • Younger dogs larvae migrate through lungs,
sa ascaris parang bulutong- bronchial tree, esophagus, and move back into the
bulutong(cortication), dito parang lubak-lubak - small intestine
pitted siya • Older dogs
o The size varies o Encysted Stages reactivate during pregnancy
• This one is a very good image of your Toxocara spp. ▪ During pregnancy pwede nila matransfer
Eggs. Very thick shell with embryo sa loob and yung toxocara infection sa kanilang babies
tignan niyo ang egg parang may nagalubak-lubak kasi yung “encysted” meaning maging
parang golf ball. Others (white) ito siya nagadevelop dormant muna sila. For example, itong larva
na ito siya, nagadivide na ang cells papunta larva mag migrate sa muscle tapos mag encyst
sila, pahinga muna ako/matulog muna ako,
parang maghibernate muna sila. Then pag
buntis nanaman ang aso mag reactivate
sila, mag excyst sila meaning exit to the cyst
stage, mabuhay nanaman sila.
o Infection spread by transplacental and
transmammary routes
▪ Transplacental – crossing the placenta
▪ Transmammary routes – during breast
feeding
o Infective eggs spread through lactating bitches
(dogs).
SUMMER 8
PARASITOLOGY

SYMPTOMS
• In dogs usually asymptomatic
• Heavy infections can result in death
• In humans
o abdominal pain
o decreased appetite
o restlessness
o fever
o hive
o other symptoms vary with site larvae infections
▪ in lungs, bronchial tree, esophagus, or
muscles
• They should be present muna approx. 2 weeks in TOXOCARIASIS
the external environment so this is the egg pass • Pathology
through the feces and divide na sila into 2 cell • 3 Clinical Forms:
stage, 16 cell stage then the embryonated egg with o Visceral larva migrants (VLM)
the larvae will be ingested by the dogs in less than o Ocular larva migrants (OLM)
five weeks na dogs and the larvae will be released o Covert toxocariasis (cotox)
into the intestines and then go to the circulation, OCULAR LARVAE MIGRATIONS (OLM)
lungs, bronchial tree and the esophagus and • Caused by larva migration to the retina
eventually into the lumen of the small intestine and o Retina
then life cycle continues o Scar formation
• (red arrow) direct life cycle of the dogs because o Retinal detachment
they are the definitive hosts o Partial to full vision loss
• Humans are the accidental or incidental hosts so ▪ 10.000 infections per year
embryonated egg with the larva, if we don’t wash ▪ 700 permanent vision loss
and to dogs greater than 5 weeks and non- Ocular Larva Migrants (OLM)
pregnant, the larvae will go to intestine and • Expressed with signs and symptoms manifested in
eventually to circulation but nagadevelop tayo ng the eyes, and occurs usually in children 5 to 10
adult but we are accidental hosts years old
• Humans – larva arrested and don’t develop adult
dogs – larva into adults • Cotton ball appearance
• Hindi ditto makikita ang larva kasi if mamatay and
larvae, inflammatory infections will start
• Another example of life cycle mainly less than 5

weeks old yung gusto ng mga toxocara canis and
cati na mga definitive hosts
SUMMER 9
PARASITOLOGY

NEUROLOGICAL TOXOCARIASIS
• Larvae may migrate to the brain, meninges, and
may be found present in the cerebrospinal fluid
(CSF).
VISCERAL LARVAE MIGRATIONS (VLM)

• Caused by movement of worm larvae throughout
various organs of the body
o Dependent on organ infected
▪ Fever
▪ Coughing (Granuloma formation)
▪ Asthma A. It has liver sinusoids, hepatocytes
B. HEPATOMEGALY: the larvae is in the liver
▪ Pneumonia
▪ Wheezing
▪ Hepatosplenmegaly
Visceral larva migrants (VLM)
• Result of migration and subsequent death of the
larvae in the different tissues and organs, producing
an intense inflammatory response manifested as
eosinophilic granulomas
• If buhay pa ang larva, di pa masyado naga induce
ng inflammation but once they are dead and ma
release na ang kanilang mga laman then the DIAGNOSIS
intense inflammatory response will occur • Dogs
• Granuloma if sa parasite mayroong mga monocyte, o fecal float
lymphocyte, and mononuclear, usually comprise the • Humans
granuloma o monitor for symptoms
o ELISA
o Anti-Toxocara Antigen IgE level
o CT scans or Ultrasound can allow for
visualization
TREATMENT
• Use anti-parasitic drugs in combination with anti-
inflammatory medications.
o Kasi diba they induces granuloma formation,
that’s why we give the patient anti-inflammatory
medications.
o Albendazole
▪ Preferred Choice
▪ Remember this, if there are cutaneous
manifestations or involvement of muscles,
albendazole should be the first to come in
mind.
o Mebendazole
SUMMER 10
PARASITOLOGY

o Thiabendazole LIFE CYCLE
• Ocular Larvae Migrations require surgery
o Especially your retinal detachment.
ANISAKIS
• So marine mammals excrete unembryonated eggs.

Kasi diba sa deep sea mammals, ito sila – mga
• Kung sino yung mahilig diyan sa mga sashimi sa
dolphins, whales.
mga fresh na isda, ito yung pwede niyo makuha.
• And the eggs will embryonate in the water
• Disease: Anisakiasis or Anisakidosis
(saltwater) and L2 larva form in the eggs
• Epidemiology: In, Asia, the majority of reports have
• After the L2 larvae hatch from eggs, then it will be
come from Japan and Korea
ingested by your crustaceans (shrimps). Then they
• Parasites of whales,
will mature to L3.
dolphins, porpoises,
• The infected crustaceans are eaten by the fish and
walruses, seals, sea
squid. Upon the host’s death, larvae migrate to the
lions, and deep marine
muscle, so mag encyst sila sa muscle, through
mammals
predation. So yung shrimp, which is the intermediate
• Elongated vermiform bodies without segmentation
host, makain daw siya ng malalaking isda.
• Humans: GI infections, allergic reactions with the
• Then the fish and squid maintain larvae that are
consumption of raw and undercooked squid and fish
infective to human. So ang role ng malaking isda
containing the 3rd stage larvae of the parasite
dito is your paratenic host, because they are not
• Anisakis simplex and Pseudoterranova decipiens
involve in the life cycle of the parasite.
• Contracaecum sp. and Hysterothylacium sp.
• Then it will be ingestion by the big fishes (dolphins,
ANISAKIS SIMPLEX
etc.) and the life cycle continues.
MORPHOLOGY
• For example, humans eat raw fish meat, so ang
• rd
3 Stage Larva
mapunta sa atin ay yung 3rd stage encysted larvae.
• Milky white in color Yun yung makain natin. That’s our infective stage.
• Measuring 19 to 36 mm in length PATHOLOGY
o Long stomach, and a blunt tail with mucron, and • Gastric pathology: hemorrhage and inflammation,
are referred to as Type 1 larvae severe abdominal pain accompanied by nausea and
o Tandaan niyo lang ang long stomach and blunt vomiting
tail with mucron.
• Intestinal pathology
• Allergic reactions
DIAGNOSIS
• Recent history of eating raw or improperly cooked
fish or squid
o This is usually the mechanism on how we can
acquire the parasite.
• Gastroscopic/endoscopic examination
SUMMER 11
PARASITOLOGY

• Serological test – Enzyme-linked immunosorbent
assay (ELISA), and radioallergosorbent test (RAST).
CONTROL AND PREVENTION
• Marine fish, squid, and shellfish must be thoroughly
cooked prior to consumption
• For raw or undercooked preparations, fish and
shellfish must undergo blast freezing at -35°C for at
least 15 hours.
• Freezing at -20°C for 7 days has also been found to
be effective.
SUMMER 12
PARASITOLOGY
FILARIASIS, MANSONELLA
BLOOD AND TISSUE-DWELLING NEMATODES o Wuchereriasis
● Called as Microfilariae group o Elephantiasis
o Diagnostic stage is the microfilariae MORPHOLOGY
● Requires arthropod as an intermediate host Male-adult Female-adult Microfilariae –
o Unique feature of blood and tissue nematodes worm worm Dx stage
● Diagnosis is made by examining thick and thin • 20-40 um x • 80-100 um x • Minute snake-
0.1 mm in 0.24-0.3 mm in like organism
Giemsa stained blood smears diameter diameter constantly
o Giemsa stain used in haematology to stain moving among
blood smear • Copulatory • Vulva is the RBC
o Onchocerca volvulus spicules cervical in
are position (near • 270-290 um
▪ not stained by Giemsa stain distinctly the level of the enclosed in a
▪ skin scrapings are used from nodular unequal middle of the hyaline sheath
lesions to detect O. volvulus and esophagus) w/c is much
● Exhibit periodicity dissimilar longer than its
• Posterior end body
o Only detected at a certain time similar to is narrow and
malaria • Gubernacu abruptly • Contains
● The microfilariae of the following causes pathology: lums is pointed nuclei along
crescent – the axis of its
o Wuchereria bancrofti
shaped • Found tightly body
o Brugia malayi • Caudal end coiled in
o Loa loa is curved nodular • Conspicuously
o Onchocerca volvulus ventranlly dilations in arrange in2-3
lymph vessels rows and do
• Found and sinuses of not extend to
● Long, threadlike nematodes tightly lymph glands the tip
● Various species inhabit the human lymphatic ccoiled in
system nodular
dilations in
● Inhabits subcutaneous and deep connective tissue
lymph
or nodules (Onchocerca volvulus) vessels
● Adults of all species of filariae are parasites of and
vertebrate host – hosts with vertebrae sinuses of
lymph
● Adult female worm produce eggs that during their glands
development become elongate and wormlike in MICROFILARIAE – DIAGNOSTIC STAGE
appearance “microfilariae” • Minute snake-like organism
● ovoviviparous - deposit egg and larvae • Constantly moving among the RBC
GENERAL MECHANISMS o Traveling through the blood vessels
● Mf migrate within the vascular system through the • Microfilariae is enclosed in hyaline sheath which
tissue is much longer than its body
● Mf can live a long time in the body of the vertebrate
• Contains nuclei along the axis of its body
host but will not undergo further development
o Only microfilariae
● Developing further only when ingested by
Intermediate Host and vector (arthropod/insect).
o To transform into infective larvae
● Disease:
o Lymphatic filariasis
WUCHERERIA BANCROFTI
● Distributed in tropics and sub-tropics region
● Originated in SE Asia in early civilization
o Parasitizing Indonesian leaf monkeys
● Recent prevalence rate is 120 million cases globally
● Diseases
o Bancroftian filariasis • Picture above is an adult male Wuchereria bancrofti
SUMMER 1
PARASITOLOGY
o Only microfilariae are detected not the adult
worms
• (3) Adult produce sheathed microfilariae that
migrate into the lymph and blood channels
o Nucleus extends to the tip of the tail
o Sheath is longer than the body of WB
• (4) Blood meal of the mosquito then ingests
microfilariae
• (5) Microfilariae shed sheaths, penetrate mosquito’s
midgut and migrate to thoracic muscle
o From L1 to L3 larva
Note:
• Picture above is an adult female Wuchereria
bancrofti
• Proboscis
o Pang inject or pang suyop of blood
o Microfilariae stays at proboscis before being
transferred to the host again during blood meal
PATHOLOGY
Clinical
• Microfilariae image Disease Features Dx test T/P/C
• Nucleus is found until the tip of the tail (S&S)
• Condom like structure is the sheath found at the tail
Bancroftian Asymptomatic- Blood smear DEC -
LIFE CYCLE fariasis “endemic (Thick & Thin diethylcar
individuals”- preparation) bamizine
Wucheriasis tolerance of the stained w/
immune system Giemsa
Elephantiasis w/c does not stain- identify
Ivermectin
recognize the microfilariae-
worms as sheathed w/
Mosquito foreign no nuclei at Eradicate
bite- “microfilaremia”. the tip of the breeding
Anopheles & tail. areas of
Culex- Some will mosquitos
nocturnal develop Renal Serologic
periodic (hematoria/prote test- ELISA Pest
strain inuria) & employing
Lymphatic dse. - monoclonal
control
Aedes- Hydrocele abs to detect
subperiodic circulating Mosquito
Pacific strain Inflammatory Ag. nets
• (1) A mosquito takes a blood meal (acute)- fever
o Infective stage is the L3 larva (high 1-2 days ICT- whole Tx of
and gradually blood Ag infected
o The saliva of the mosquito contains subsides after 2- card test. individuals
anticoagulant and the L3 larva of WB 5 days).
• (2) WB L3 larva then enters the skin eventually Lymphangitis-
inflammation of
develop into adult in the lymphatics the lymphatic
SUMMER 2
PARASITOLOGY
● Again, pwede natin gamiting Serologic test and
vessels.
Lymphadenitis- Immuno Card Test.
inflammation of ● For the treatment, diethylcarbamazine and
lymph nodes. Ivermectin.
Affects the ● We cannot eradicate mosquitos, so the best way is
limbs, breast, to eradicate their breeding areas (similar to dengue)
scrotum
(orchitis) Clinical features (S&S)
epididymitis
(spermatic cord) Obstructive phase-blockage Nocturnal periodicity-9pm-
or elsewhere. of the lymph vessels-dilating 2am is their greatest conc in
Chyluria-lymph it and the accumulation of the blood
in the urine chyle- Milky urine
Subperiodic-exhibit
● So for the pathology for Wuchereria bancrofti, we Elephantiasis- the microfilaremia at all times
have Bancroftian filariasis, Wucheriasis or enlargement of one or more but most between noon and
Elephantiasis. So it is a mosquito bite, the vectors limbs, scrotum, breast, or 8pm.
are Anopheles & Culex. For this one (Anopheles & vulva w/ dermal hypertrophy
and varicose changes.
Culex) we have nocturnal periodic strain meaning
sa gabi sila, and Aedes we have subperiodic Pacific Adult worms are found in the
strain. So vectors are Anopheles, Aedes, and lymph vessel throughout the
Culex. body. -Axillary, epitrochlear,
● For the clinical manifestation they are usually inguinal, pelvic nodes, testis,
epididymis, spermatic cord.
Asymptomatic, they have no symptoms presented
Worms die and tend to
lalo na sa mga endemic areas, normal lang sa calcify.
kanila. For example in Palawan, endemic yung
kanilang malaria. Then we have tolerance of the ELEPHANTIASIS
immune system w/c does not recognize the worm
as foreign “microfilaremia” kasi parang nasanay na
yung body nila na normal nalang and microfilaria sa
blood.
● Some will develop renal and lymphatic disease.
Hydrocele due to the deposition of the dead adult
male and female worms.
● They develop inflammatory reactions kasi for
example they have Lymphangitis-inflammation of
lymphatic vessels due to obstruction. Then
Lymphadenitis- inflammation of the lymph nodes. ● Every part of our body has a lymphatic vessel. If ma
● Tandaan niyo pag Lymphangitis, it’s for the obstruct sila, ganito ang kalabasan.
lymphatic vessels. If Lymphadenitis, it’s the lymph LOA LOA
nodes which are inflamed. LIFE CYCLE
● It could affect the limbs because all of our body
have lymphatics especially the limbs mahirapan sila
because of the gravity and weight of the body.
Mahirapan mag balik yung mga lymph from the
lymphatic system to our thoracic lymph. For the
breast also because the breast tissue has many
lymphatic vessels. Also for the scrotum, pag mag
obstruct, it will cause orchitis and epididymitis and
elsewhere na may lymphatic vessels.
● Makita natin na chyluric yung urine, means may
taba yung urine.
● For the diagnostic stage, generalities for this group
it blood, thin and thick smear stained with Giemsa.
To identify the diagnostic stage w/c is the
microfilaria which has a characteristic feature of
sheathed w/ no nuclei at the tip of the tail but naga ● Similar life cycle with Wuchereria bancrofti but
extend sila doon. difference now is diba ang vectors for Wuchereria is
SUMMER 3
PARASITOLOGY
Anopheles, Culex, and Aedes. Dito, it’s the fly. The • Localize pain lungs
Chrysops fly takes a blood meal. L3 larva parin and pruritus
yung ibigay niya saatin. (Infective stage) • Appearance
● Now in the Adults in the subcutaneous tissue. As of the worm
compared to your Wuchereria, the adults are in the in the
conjunctivae
lymphatic vessels. Si loa loa, nasa subcutaneous
• Migration of
tissue. adult worm
● The adult produce sheathed (sheated parin cos ang through the
only unsheathed natin is the oncosarcavolvulus). tissues
They can be found on the spinal fluid, urine, PATHOGENESIS
sputum, but most commonly in the peripheral blood
• Calabar swelling
in the lungs. So this would be the diagnostic
stage. 1. A transient subcutaneous swelling marking the
● Infective stage - L3 larva migratory course through the tissues of the adult
● Diagnostic stage - microfilariae (sheathed) filarial eye worm of the genus Loa (L.loa).
● Same parin, pag mag blood meal yung Chrysops 2. The most common display of infection is the
fly, it will get the microfilariae. Inside the Chrysops,it localized allergic inflammations called Calabar
will develop L3 larva which is the infective stage to swellings that signify the migration of the adult
man.
worm in the tissues away from the injection site
LOA-LOA
by the vector.
• Also known as: African Eye Worm
• Eye worm:
• Found in the rain forest of Sudan, Congo, and West
1. Visible movement of the adult worm across the
Africa
surface of the eye cause congestion, itching,
• The scientific name is a native term for the worm
pain, and light sensitivity but little damage (kay
(loa-loa means worm-worm haha); discovered during
naa lang sila sa conjunctiva
the slave trade.
• Migrates into the conjunctival tissue (puti sa mata
natin) across the eyeball
• Exhibit diurnal periodicity (Mf is shed in the
bloodstream day or night) 10:00am-2:00pm • Generalized Pruritus
• Microfilarae – 275um in length. Sheathed, nuclei 1. In the absence of Calabar swelling
extends to the tip of the tail. • Lungs (parasite may cause):
LIFE CYCLE OF LOA LOA 1. Fluid collection/Pleural effusion
• Vector: Chrysops fly (Deer fly, Horse fly, Mango fly) 2. Lung inflammation
3. Rare
• Infective Stage: Third stage larvae (L3)
4. Unknown mechanism
• Diagnostic Stage: Microfilaria in spinal fluid, urine, DIAGNOSIS
CSF, PBS, Lungs • Diurnal Periodicity of Loa loa microfilaria
• Habitat: Subcutaneous tissue; affects conjunctive 1. Daytime (10am to 2pm): Peripheral blood
of the eye (AFRICAN EYE WORM) 2. Non-circulation phase: Lungs (most of the
PATHOLOGY time)
Clinical Diagnostic • Also, we could identify the adult worm in the eye or
Disease T/P/C
features test under the skin
Loasis • Calabar • Blood • Diethylcarbamazi 1. Gusto nila [L. loa] ang conjunctiva ng eyes so
swelling: smear: (thin ne (DEC)
Bites from allergic and thick) • Ivermectin either use Peripheral Blood Smear (PBS) if
Mangofly- reaction to collect • Surgical removal wala pa nag manifest sa conjunctiva or
genus the between of the worm in Visualization of the adult worm in the
Chrysops metabolic 10am-2pm. the eye conjunctiva
products of • Giemsa stain
the worm or or H&E stain • Pest control • Antibody test for Loa loa
dead worms • Worm can • Control bleeding MICROFILARIA OF LOA LOA
when they be found in areas of the • Sheath stains lightly or not at all
appear in spinal fluid, insect vectors
one area urine, • Nucleus in its body are coarse and crowded
(Wrist & sputum, and (compared to Wuchereria which is organized)
ankle).
SUMMER 4
PARASITOLOGY
• The body has irregular curves and can take on a loa but meron siyang dalawang sobra which
corkscrew appearance differentiate it from the loa loa.
• Nuclei extend to tip of tail
• Coarsely arranged nucleus extending at the tip plus

may sheath and then may nucleus sa end which is
BRUGIA MALAYI termed as the terminal yung pinakadulo ang the
• Malayan form of lymphatic filariasis – “Malayan subterminal
filariasis” o Wuchereria: does not extend up to the tip but
• Common in the Fae east. 30% occur in South longer sheath
Chuna, 20% in India. While the rest occur in o Loa loa: It extends up to the teeth
Thailand, Vietnam, Indonesia, Malaysia, Philippines, o Brugia: Additional two nucleus
and South Korea.
• Exhibit nocturnal periodicity in the blood stream
• Pathology is similar to W. bancrofti but confined to
lower extremities
• Mosquito vector belongs to genus Mansonia and
some Anopheles
1. Wuchereria bancrofti: Anopheles, Aedes, Culex
2. Loa loa: Chrysops, horse & deer fly
• Diagnosis- Blood smear (Thin & Thick)
• T/P/C- same with bancrofti
1. Diethylcarbamazine and Ivermectin
• Microfilariae- 177-230 um in length. Sheathed,
body nuclei extends almost to the tip of the tail. 2 • Meron siyang distinct terminal and subterminal
terminal nuclei are distinctly separate from the nucleus that’s unique for B.M. Ito yung sheath niya
others in the tail. parang supot ng ice candy
• Magandang arrangement ng nuclei but they are

crowded and ito yung striking may dalawa siyang
separate nucleus extending at the tip kagaya ng loa • Up to the tip only, wala na siyang dalawang extra
SUMMER 5
PARASITOLOGY
2. Onchocercosis
3. River blindness
• Microfilariae
1. Only pathogenic tissue nematode which is not
sheathed
2. No nuclei at the tip of the tail
3. Found in nodules under skin, not in peripheral
blood
• This is your Brugia Malayi kasi may dalawa siyang

extra na nucleus sa tip ng kanyang tail and
sheathed din siya.
4. The head is twice longer than broad.

5. Ang tail andyan lang, No sheath
6. No Nucleus at the tip
CLINICAL SIGNIFICANCE/DISEASE:
• Severe dermatitis
• Microfilaria in ocular structure may result in
blindness (trachoma)
• This is the differentiation of the first 3 parasites that • Leading cause of blindness in Africa
we’ve discussed. • T/P/C- similar to other filariasis
o W.B: Does not extend up to the tip 1. Diethylcarbamazine and Ivermectin
o Loa loa: Extend up to the tip
o B.M: Extend up to the tip but with terminal and
subterminal nucleus
TREATMENT
• Diethylcarbamazine (DEC)
1. Effective against microfilariae and adult worms
• Albendazole
1. May be given if DEC is not effective after
repeated treatment
• Surgical removal of adult worm
• Sometimes, treatment is not indicated.
PREVENTION
• May take weekly Diethylcarbamazine if visiting
endemic area
• Use insect repellant
2. Wala nagachange ang life cycle ng filarial worms
• Use clothing that covers most of the skin
except for the vector, this one is Simulium or
ONCHOCERCA VOLCULUS P.294
Blackfly- fly nila nagakagat parin ha di pabebe
• Also known as the “Blinding Worm” na nagalipad sa tae
• Disease: 3. L3 parin ang infective stage
1. Onchocerciasis 4. Nasa subcutaneous nodule ang adults
SUMMER 6
PARASITOLOGY
5. Microfilaria is typically found in the skin and in • (E) Mansonella perstans
the lymphatic but unsheathed • (F) Mansonella streptocerca
Summary: • (G) Mansonella ozzardi
• Found in Africa, and Central and South America
• Vector: Female Simulium Blackflies
• Infective Stage: Third Stage Larva (L3)
• Diagnostic Stage: Microfilaria in skin, lymphatics,
occasionally in blood, urine, sputum;
• Habitat: Subcutaneous tissues, lymphatic
• Simulium black fly
• Onchocerca volvulus
• Twice broader and nucleus s not too long and it
has no sheath
• Trachoma
• Just like Loa loa, it can cause blindness “River

Blindness”
• If they stay in nodules, they can also cause nodules
SUMMARY
• Onchocerciasis is characterized by cutaneous (mga
nodules) and ocular pathology (river blindness) that
occurs after the invasion and death of microfilariae
in the skin and eye.
• While adult worms are enclosed in nodules
(onchocercomas) in the subcutaneous and deeper
tissues
• (A) Wuchereria - nucleus arranged and does not PATHOGENESIS
extend up to the tip Onchocerciasis
• (B) Brugia malayi – may dalawang sobra, the • An eye and skin disease
terminal and subterminal • Symptoms are caused by the microfilariae, which
• (C) Loa loa – extending up to the tip move around the human body in the subcutaneous
• (D) Onchocerca volvulus tissue and induce intense inflammatory responses
when they die
SUMMER 7
PARASITOLOGY
NOTE! • The large adult female worms are contained
• Wolbachia specifies have been found to within fibrous nodules or onchocercomas in
endosymbionts of O. volvulus adults and subcutaneous or deeper tissues
microfilariae and are thought to be the driving force • ONCHOCERCOMA: subcutaneous nodules
behind most of O. volvulus morbidity. (nandyan ang adult female)
• Pruritus, dermatitis = allergic reaction to the

migrating microfilaria
o The more common generalized form
presents with subclinical or intermittent
dermatitis that may progress to skin
hyperpigmetation or depigmentation
(lizard skin) and atrophy with the loss of
• For the microfilaria once they are dead, they will
elasticity (hanging groin)
release the Wolbachia and it will cause
inflammation, migration of the neutrophils and
macrophages that causes pacification meaning
cloudiness of the eye.
• Skin thickening is a symptom of Onchocerciasis

DIAGNOSIS
• Skin Snips: Microfilaria (anytime)
o Wet mount
o Stained with Giemsa or Hematoxylin
• Biopsy of skin nodules: Adult worm with
Wolbachia
• Demonstrates from skin snips/tissue scrapings
unsheathed microfilariae with no nuclei in tail
• River blindness: most serious manifestation

• Simulium sp, black flies, intermediate hosts that
require fast-flowing water for their breeding and
development; the disease is thus restricted to areas
adjacent to river systems • Nodules- encapsulation of adult worm in a
fibrous tissue tumor-like mass
SUMMER 8
PARASITOLOGY
PREVENTION
● Insect repellant
o Avoid endemic areas
● Wearing clothes covering the skin
SUMMARY
● This is the summary of your filarial worms.

● We have Wuchereria bancrofti:
o Sheathed, no nuclei in the tip of the tail
● Brugia malayi:
o Sheathed, 2 terminal nuclei
● Loa loa:
o Sheathed, nuclei up to the tip of the tail
● Onchocerca volvulus (skin)
o No, sheath, no nucleus at the tip of the tail
o This is the only parasite which is usually not
diagnose using thick and blood smear stained
by Giemsa.
TREATMENT
● Ivermectin plus Doxycycline:
o Ivermectin: kills larvae
o Doxycycline: kills Wolbachia
● Old drugs but no more recommended: ● Another summary for the disease, vector and
o Diethylcarbamazine (DEC): Kills adult → diagnostic stage specimens.
accelerates river blindness LIFE CYCLE OF MANSONELLA
▪ This is the exception when using
diethylcarbamazine. It will exacerbate river
blindness in your Onchocerca volvulus.
MAZZOTTI REACTION
● Hypersensitivity reaction due to lysis of worms
● Death of the microfilaria can trigger allergic reaction
which may cause pruritus and shock
o When they die, they release the contents of
Wolbachia and then they will induce
inflammatory reaction. It will trigger allergic
reaction causing pruritus or even shock which
can cause death.
SUMMER 9
PARASITOLOGY
● Now, for the Mansonella, midges or midge LIFE CYCLE OF MANSONELLA OZZARDI
(culicoides) is its vector. It has similar life cycle.
● This is the midges they have hairy wings (right pic).

On the left pic is the mosquito with plain wings with
no hair.
LIFE CYCLE OF MANSONELLA PERSTANS
● This is the midge. When we compare to the

mosquito and fly, it is very small.
● This will be discussed in your entomology. You will

learn their complex mouth parts. They have
epipharynx, maxille, mandible, hypopharynx, and
labium.
● Mansonella perstans
● This is the appearance of a midge under a

microscope. ● Mansonella streptocerca. They have hook-like
appearance of its tail
SUMMER 10
PARASITOLOGY
SUMMARY MANAGEMENT
Location of Location of ● Treatment
Parasite Vector o NO optimal treatment
adult microfilaria
Culicoides Dermis of the Most of the o Ivermectin
midge skin (less than time in the o Diethylcarbamazine plus Mebendazole
Mansonella 1mm from skin. o Albendazole or Mebendazole plus anti-
streptocerca skin) inflammatory drug (Steroids)
Sometimes ● Prevention:
in blood.
o Insect repellant
Culicoides Subcutaneous Blood
midge tissues o Wearing clothes that cover most of the skin
Mansonella
ozzardi Simulium
blackfly
Mansonella Culicoides Peritoneal Blood
midge and pleura
perstans
Infective Stage: Third Stage Larva (L3)
● Diagnostic Stage:
o Microfilaria in the blood stream (M. ozzardi,
M. perstans)
o Microfilaria in skin snips (M. streptocerca)
Note:
● The clinical presentation of most Mansonella
infections generally appears to be mild; many
infections are asymptomatic, particularly among
individuals living in endemic regions.
● Mansonella perstans:
o No sheath but extends up to the tip of the tail
● Mansonella ozzardi:
o No sheath, no nuclei at the tip of the tail
● Mansonella streptocerca (skin):
o No sheath, nuclei extending to the top of the
hooked tail
PARTHOGENESIS
● M. ozzardi
o Non-specific arthralgia, headaches, fever,
lymphadenopathy, pruritus
o Suspect this parasite id the patient is in
endemic are
● M. streptocerca
o Pruritus, papular eruptions and pigmentation
changes
● M. perstans
o Often asymptomatic
o When symptoms occur, they appear related to
migration of adult worms and include transient
subcutaneous swellings (similar to those
caused by Loa loa), pericarditis and pleuritis,
and ocular symptoms (e.g., impaired visual
acuity) if microfilariae enter the eye.
SUMMER 11

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PARASITOLOGY

MLS 409 | LECTURE | MIDTERM

• This is an example of Ascaris lumbricoides. (Oh diba

• Female Ixodes tick with a male Ixodes attached to its

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• This is an example of a paratenic host.

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1. cuticle and hypodermis

● This is the appearance of intestinal obstruction

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3-3.5 cm in length 3.5-5.5 cm in 5-54um x 22-23um in

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Disease Clinical DX test T/P/C

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• For example, si Mark infected siya ng Capillariasis.

INTESTINAL NEMATODES: HOOKWORMS

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• The photo above will show you how small hookworms

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PHYLUM NEMATODA PART 2 (STRONGYLOIDES STERCOLARIS)

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