Parasitology revision notes

09-03-2018
 Only3
 Trichomonas
 Entamoeba gingivalis
 Dientamoeba fragilis
Entameba
hystolytica only
pathogenic
intestinal ameba

09-03-2018
 Causative agent of amoebiasis
 More common among adults than in children
 M>>F
 Low socioeconomic status

09-03-2018
Erythrophago
cytosis 
ingested RBC
Immature cyst contains
glycogen mass &
chromatid bodies which
disappears on maturation
Mature cyst is
quadrinucleate
& infective form

09-03-2018
MAN IS THE
MAIN
RESERVOIR
TROPHOZOITES
HARBOUR IN
CAECUM &
APPENDIX
Mature cyst
is the
infective
form

09-03-2018
• Contaminated with mature
quadrinucleate cyst
FECO ORAL ROUTE
• homosexualSEXUAL
TRANSMISSION
• COCKROACHESTRANSMISSION
THROUGH VECTORS
 STRAINS VARY ACCORDING TO ISOENZYME PATTERN  ZYMODEME
 E HISTOLYTICA HAVE 22 ZYMODEME
 10 ARE INVASIVE
 12 NON INVASIVE

09-03-2018
 NON INVASIVE
COLONISATION
 Asymptomatic cyst
passage
 INTESTINAL
 Colitis & dysentery
 Inavsive  flask shaped
ulcer
 EXTRAINTESTINAL
 Amoebic liver abscess
 MC extra intestinal
 Flask shaped ulcer
 Mc in caecum & ascending
colon >> sigmoid >rectum
& appendix

09-03-2018
Mc involves
Posterosuperior
surface of right
lobe of liver
Pleuropulmon
ary abscess is
most frequent
complication of
amoebic liver
abscess

09-03-2018
TONY 2010 KMC
 MOST COMMON TYPE OF ABSCESS IN
LIVER
 REACHES TROPHOZIOTES REACH
LIVER THROUGH PORTAL
CIRCULATION
TONY 2010 KMC

09-03-2018
TONY 2010 KMC
TONY 2010 KMC

09-03-2018
 IN RIGHT LOBE OF LIVER
 CLOSE TO DIAPHRAGM
 SOLITARY
• COMPLICATION
• RUPTURE IN TO
PERITONEUM
PERICARDIAL CAVITY
TONY 2010 KMC
C/F
• IRRITATION OF RIGHT
DIAPHRAGM  RT
SHOULDER TIP PAIN
• JAUNDICE
TONY 2010 KMC

09-03-2018
 M:F = 10 :1
 20-40 YRS OF AGE
 H/O TRAVEL TO ENDEMIC REGION
 H/O INTESTINAL AMEBIASIS MAY NOT BE PRESENT
TONY 2010 KMC
 MILD ABNORMALITY IN LFT
 CT > USG
 SEROLOGICAL TEST FOR ANTI AMEBIC ANTIBODIES
 ENZYME IMMUNOASSAY FRO ANTIBODIES ‘
TONY 2010 KMC

09-03-2018
TONY 2010 KMC
 METRONIDAZOLE  MAINSTAY & CURATIVE IN 90 %
 THERAPEUTIC NEEDLE ASPIRATION
 INDICATION
 FAILURE TO RESPOND TO METRONIDAZOLE IN 3- 5 DAYS
 SECONDARILY INFECTEDWITH PYOGENIC ORGANISM
 HIGH RISK OF RUPTURE
 > 5CM IN DIAMETRE
 LEFT LOBE ABSCESS
 DIAGNOSTIC UNCERTAINITY
 PERGNANCY
TONY 2010 KMC

09-03-2018
Charcot Leyden crystals are hexagonal bipyramidal
structures localised in the primary granules of the
cytoplasm of eosinophils and basophils
 breakdown products of eosinophils and may be seen in the stool or sputum of
patients with parasitic diseases or bronchial asthma

09-03-2018
 Stool Microscopy-done to demonstrate-
 Trophozoites - indicates active infection
 Quadrinucleated cysts- indicates carrier state
 Positive test for heme
 Lack of neutrophils
 Positive test for heme
 Serological test
 Most useful for invasive amoebiasis
 Most commonly used test is IHA
 ELISA  BEST & SPECIFIC
 ASPIRATED PUS  TROPHOZOITES
 ASPIRATES FROM CENTRE SHOWS NO TROPHOZOITE
 ASPIRATE FROM PERIPHERY SHOWS TROPHOZOITE
 PHILIPS MEDIA

09-03-2018
 ASYMPTOMATIC CARRIER
 LUMINAL AGENTS
 ACUTE COLITIS
 METRONIDAZOLE + LUMINAL AGENT
 LIVER ABSCESS
 METRONIDAZOLE /TINIDAZOLE + LUMONAL AGENT

09-03-2018
 NEROPATHOGENIC
 NAEGLERIA FOWLERI
 Acanthameoba
 BALAMUTHIA MANDRILLARIS
 3 MORPHOLOGICAL FORMS
 CYST
 TROPHOZOITE
 FLAGELLATED
 SWIMMING IN CONTAMINATED WATER
 NASAL MUCOSA  OLFACTORY N 
PRIMARY AMEOBIC ENCEPHALITIS
(SIMILAR TO PYOGENIC MENINGITIS )
 POOR PROGNOSIS  DIES WITH IN A
WEEK
 Rx
 AMPHOTERICIN B & RIFAMPICIN

09-03-2018
TROPHOZOITE IS THE
INFECTIVE FORM
• MOTILE
TROPHOZOITE IN
CSF(NO CYST FORM
IN BRAIN)
• CULTURED ON NON
NUTRIED AGR WITH
DEAD E COLI
 IN IMMUNOCOMPROMISED
TROPHOZOITE IS
INFECTIVE FORM
FLAGELALTED
FORM IS
ABSENT

09-03-2018
KERATITIS IN
CONTACT LENS
USERS (CYSTS+)
C/C AMOEBIC
GRANULOMATOUS
ENCEPHALITIS 
SPACE OCCUPYING
LESION IN ct SCAN
 NO SATISFACTORY TREATMENT FOR GRANULPMATOUS ENCEPHALITIS

09-03-2018
 LARGEST PROTOZOAL PARASITE

09-03-2018
TONY 2010 KMC
LUMEN dwelling Hemoflagellates

09-03-2018
 EXIST IN 2 FORMS
 TROPHOZOITE
 CYST
BOTH TROPHOZOITE
& CYST ARE PASSED
IN FAECS
BUT
TROPHOZOITE
DONOT SURVIVE IN
ENVIRONMENT &
CYST IS INFECTIVE
FORM
INFECTIVE
DOSE IS VERY
LOW AS LOW
AS 10 CYSTS
CAN CAUSE
INFECTION

09-03-2018
4 PAIRS OF FLAGELLA

09-03-2018
TROPHOZOITE IS
INFECTIVE FORM
TRANSMITTED BY
SEXUAL
INTERCOURSE

09-03-2018
LYMPHADENOPATHY IN
POSTERIOR TRIANGLE
OF NECK

09-03-2018
REDUVIID BUG
ACTS AS
VECTOR

09-03-2018
U/L EDEMA OF
EYELID D/T
ENTRY IS
THROUGH
CONJUNCTIVA

09-03-2018
TRYPANOSOMA BRUCI TRYPANOSOMA CRUZI
INTERMEDIATE HOST TSE TSE FLY REDUVIID BUG
DEFINITIVE HOST MAN MAN
INFECTIVE FORM METACYCLIC
TRYPOMASTIGOTE
METACYCLIC
TRYPOMASTIGOTE
PORTAL OF ENTRY BY BITE OF FLY SKIN OR CONJUCTIVA
FROM FECES OF BUG
CLINICAL SIGN WINTER BOTTOM SIGN CHAGOMA /ROMANA SIGN
CLINICAL FEATURES SLEEPING SICKNESS
FEVER /INSOMNIA
MEGACOLON
MEGAESOPHAGUS
CARDIOMYOPATHY
 BATMAN HAS NO SLEEP  SLEEPING SICKNESS
 BY BITE OF FLY (BAT)
 BOTTOM SIGN

09-03-2018
• PROMASTIGO
TE
infective stage of
Leishmania,
found in the
insect vector as
well as in
cultures invitro
AMASTIGOTE
INTRACELLULAR
FORM IN
VERTEBRATE HOST

09-03-2018
• RAISED GLOBULIN
CAN BE DETECTED
BY
• ALDEHYDE
TEST OF
NAPIER
• CHOPRAS
ANTIMONY
TEST

09-03-2018
 AFTER COMPLETE TREATMENT
OF VISCERAL LEISHMANIASIS
 DEPIGMENTED MACULE 
EARLIEST LESION
 ERYTHEMATOUS PATCH
 YELLOWISH PINK NODULES

09-03-2018
 DELHI BOIL /ORIENTAL SORE

09-03-2018
TONY 2010 KMC
 Blood sporozoa  plasmodium
 Ttissue sporozoa toxoplasma
 Intestinal sporozoa  isospora cryptosporidium

09-03-2018
ALPHONSE LAVERAN DISCOVERED
PLASMODIUM IN RBC

09-03-2018
 P. vivax,
 P. malariae,
 P. ovale
 P. falciparum
 P. knowelsi
Minimum
Maximm

09-03-2018
 From July to November
 MOSQUITO IS THE DEFINITE HOST
 Sexual cycle occurs in mosquito
 MAN IS INTERMEDIATE HOST
 Asexual cycle takes place

09-03-2018
 Bite of female anopheline mosquitoes:
 Infective forms: Sporozoites
 Injection of blood of a malaria patient containing asexual forms: ‘Trophozoite
induced malaria’
 – Transfusion malaria
 – Congenital malaria
 – Malaria in drug addicts
Extrinscic IP  10-
20 days
Man
harbouring
gametocyte
is the only
reservoir

09-03-2018
 Anopheles culifacies  rural malaria
 Anopheles stephensi urban malaria
 Most important vector in india
• Vector control is one of
the primary weapon to
control malaria in
endemic area
• Eliminating breeding
places most important
step in eliminating
mosquito
 Extrinscic IP 10-20 days
 Mosquito should live for 10-12 days to become infective
 Strategy in malaria eradication  shorten lifespan of mosquito to less than 10 days

09-03-2018
 Against vivax  duffy negative RBC
 Against falciparum  newborn sickle cell trait
 G6PD DEFICIENCY
 HLA B 53
 SEVERE MALNUTRITION
 IDA
 HbF
 AS LONG AS INFECTED  IMMUNE TO REINFECTION

09-03-2018
 in liver parenchyma
 Liberated merozoites are called as ‘Cryptozoites’
 No clinical manifestation; No pathological change
 Blood is sterile
 Parasite resides inside RBCs;
 passes through stages of Trophozoite, Schizont, Merozoite
 Except gametocyte all other stages are killed in RBC
 Parasitic multiplication brings clinical attack of malaria

09-03-2018
P knowlesi 24 hr
P.vivax P ovale P falciparum 48 hr
P malaria 72 hr Quartan malaria
Tertian malaria

09-03-2018
 Some merozoites develop in RBCs of spleen and bone marrow to form
‘Gametocytes
 Individual who harbours gametocyte  CARRIERS
 In p vivax gametocytes in blood after 4-5 days after appearance of asexual
parasite
 In p falciparum it appears after 10-12 days
 Gametocytes are most numerous during early stage of infection when their
density may exceed 1000 per mm3 of blood
 If gametocyte > 12/mm3 transmit infection
 Persistence of late tissue phase in liver
 Seen in P.vivax and P. ovale & absent in P falciparum
 Cause relapses in Vivax and Ovale malaria
 Liberated merozoites are known as ‘Phanerozoites’

09-03-2018
 Completion of gametogony:
 Exﬂagellation of microgamete and maturation of
gametes
 Fusion of gametes form ‘Zygote’; zygote matures to
‘Ookinite’
 Sporogony:
 ookinite develops into ‘Oocyst’
 On 10th day of infection, oocyst ruptures, releasing
sporozoites; sporozo ites reach salivary glands
Mosquito at this stage is capable of transmitting
infection
Recruidescnece
 Persistence of erythrocytic forms
 p falciparum & p malariae
Relapse
 d/t hypnozoite (exoerythrocyrtic
cycle)
 P vivax p ovale

09-03-2018
Pre eradication era
 Clinically diagnosed malaria cases
 Magnitude of malaria was
determined on the basis of
diagnosed cases
Eradication era
 Microscopic diagnosis
 The microscopic diagnosis of malaria
cases became the main method of
diagnosis.
 The parameters used for the
measurement of malaria were
mostly parasitological in nature
 Spleen rate:
 Percentage children 2–10 years age showing enlargement of spleen
 – Index used for measuring endemicity of malaria in a community
 Average enlarged spleen
 Parasite rate: Percentage children 2–10 years age showing parasites in blood flms
 Parasite density index
 Infant parasite rate:
 Percentage infants showing parasites in blood flms
 Is ‘most sensitive index of recent malaria transmission’ in a locality
 If IFR is zero for 3 consecutive years, it is regarded as absence of malaria transmission (even
though anopheline may remain)
 Proportional case rate: Is no. of clinical malaria cases diagnosed per 100 patients at
tending hospitals and dispensaries

09-03-2018
 Annual parasitic incidence (API)
 Annual blood examination rate
 Annual falciparum index
 Slide positivity rate
 Slide falciparum rate
 Annual parasite incidence.[API]
API =confirmed cases during 1 year x 1000
population under surveillance
 Annual blood examination rate [ABER]
ABER= nos of slides examined x100
population
Sophisticated measure
of malaria incidence in
a community
Index of operational
efficiency

09-03-2018
 annual falciparum incidence
since the emergence of P. falciparum problem in
India data are collected separately for total malaria
cases and P. falciparum cases.
 slide positivity rate
% of slides found positive for malarial parasite
irrespective of the type of species.
Slide falciparum rate
% of slides positive for P. falciparum parasite.

09-03-2018
THICK SMEAR
 MORE SENSITIVE
THIN SMEAR
 IDENTIFICATION OF SPECIES
CHARACTERISTICS

09-03-2018
 QUANTITATIVE BUFFY COAT TEST
 PRESTAINED WITH ACRIDINE ORANGE
 USED FOR MASS SCREENING
 PARASITE F TEST
  DETECTS HISTINE RICH PROTEIN
(HRP 2)  SPECIFIC FOR
PLASMODIUM FALCIPARUM

09-03-2018
 DETECTION OF PARASITE LDH
 DETECTION OF PARASITE ALDOLASE

09-03-2018
RELAPSE
RECRUIDESCENCE

09-03-2018
 ONLY RING FORMS & GAMETOCYTES
MULTIPLE RING
FORMS & ACCOLE
SICKLE SHAPED
CRESCENTIC OR
BANANA SHAPED

09-03-2018
• EARLY TROPHOZOITES
ARE RING FORMS
• LATE TROPHOZOITES
ARE TROPHOZOITES
SICKLE
SHAPED IN
FALCIPARUM
BAND
TROPHOZOITE IN
PLASMODIUM
MALARIAE

09-03-2018
 PLASMODIUM VIVAX (plasmodium ovale is also treated as vivax)
 3DAYS CHLOROQUINE + 14 DAYS PRIMAQUINE

09-03-2018
 PLASMODIUM FALCIPARUM (plasmodium
malriae is treated as plasmodium
falciparum
 Treated as plasmodium
falciparum
 In addition 14 days of
primaquine

09-03-2018
Patient at high risk area for Pf
(TfR>1% & Pf >30 %)
Patient not at high
risk area for vivax
• Wait for slide results
• Give CQ for 3 days
Treat according to slide
results
RDT for falciparum 
+ve
Rx as Pf
RDT for Pf –
ve 
slide,CQ for
3 days
+ve for Pf
Rx
accordingly
+ve for
vivax
PQ *14
DAYD
CHLOROQUINE
CQ SENSITIVITY Pf AREAS)
IF SENSITIVE IF RESISTANT
MEFLOQUINE
OR
HYDROXYCHLOROQUINE
IF RESISTANT
• ATOVAQUINONE
• PROGUANIL
• DOXYCYCLINE

09-03-2018
 NEPHROTIC SYNDROME  PLASMODIUM MALARIAE
 ACUTE TUBULAR NECROSIS (RENAL FAILURE )IS CAUSED BY PLASMODIUM
FALCIPARUM (MALIGNANT TERTIAN FEVER)
 PERNICIOUS MALARIA
 CEREBRAL MALARIA
 DIFFUESE SYMMETRICAL ENCEPHALOPATHY
 NO FNL
 MULTIPLE FALCIPARUM INVADING SAME RBC
 SPLENIC RUPTURE
 ACUTE TUBULAR NECROSIS (RENAL FAILURE)
 BLACK WATER FEVER
 INTRAVASCULAR HEMOLYSIS  HEMOGLOBINEMIA  HEMOGLOBINURIA

09-03-2018
 MALARIAL PARASITE ABSENT IN P/S
 ANTIMALRIAL Ab +
 D/T REPEATED SUBCLINICAL INFECTION
 LAUNCHED BY WHO UNICEF & WORLD
BANK IN 1998

09-03-2018
 STRENGTHEN HEALTH SYSTEM
 ENSURE THE PROPER & EXPANDED USE OF INSECTICIDE TREATED MOSQUIT O
NETS
 ENSURE ADEQUATE ACCESS TO BASIC HEALTH CARE & TRAINING OF HEALTH
CARE WORKERS
 ENCOURAGE DEVELOPMENT OF MORE EFFECTIVE & NEW ANTIMALARIA
DRUGS & VACCINE

09-03-2018
 RESISTANCE TO INSECTICIDE IN VECTOR
 MULTIPLE DRUG RESISTANCE
 INSTABILITY OF POPULAION
 ANTIGENIC VARIATION IN PARASITE
 DETERIORATION OF PUBLIC HEALTH SYSTEM

09-03-2018
 2 species of protozoa
 Babesia microti
 Babesia divergans
 Ioxdid ticks
 Babesia is a tick-borne organism transmitted by I. scaputaris, the same tick that transmits
Lyme disease.
 Intraerythrocytic tetrads  maltese cross appearance
 Patients become anemic and develop hepatosplenomegaly, but patients who are
asplenic are at a much greater risk.

09-03-2018
 Obligate intracellular parasite
 Cat is definite host
 Intermediate host  human sheep mouse and pig

09-03-2018
NONFELINE STAGE
 IN THIS STAGE TISSUE CYST OR
SPORULATED OOCYST IS INGESTED
BY INTERMEDIATE HOST  CYST IS
DIGESTED RAPIDLY IN STOMACH
pH--> release bradyzoites or
sporozoites in SI epithelium
transform into tachyzoites 
replicate in all cell except RBC (but
mainly in CNS & muscle)
FELINE STAGE
 IN DEFINITIVE HOST (CAT)
 A/W FORMATION OF OOCYST
EXCRETED IN FAECES
 MATURE OOCYST CONTAIN 2
SPOROCYST  EACH WITH 4
SPOROZOITES
FRESHLY PASSED
SPORULATED
OOCYST IS NOT
INFECTIOUS
BECOMES
INFECTIOUS IN SOIL
ONLY AFTER
DEVELOPMENT

09-03-2018
SPORULATED CYST
TISSUE CYST
CONTAINING
BRADYZOITES
BOTH ARE INFECTIVE
 INGESTION OF SPORULATED CYST OR TISSUE CYST CONTAINING BRADYZOITES
(MOST COMMON)
 BLOOD TRANSFUSION
 KIDNEY OR HEART TRANSPLANTATION
 TRANSPLACENTAL TRANSMISSION

09-03-2018
 Chorioretinitis
 Intracerebral calcification
 Hydrocephalus

09-03-2018
 Microcephaly
 Microphthalmia
 Mental retardation
 Deafness
 Blindness

 IgG presence of IgG in infants blood does not confirm the diagnosis (igG can
cross placenta  therefore can be maternal Ab)
 PERSISTENCE OF IgG BEYOND 6-10MONTHS  TOXOPLASMOSIS
 IgM
 Test of choice for detection of congenital toxoplasmosis
 IgA
 IgA has Greater sensitivity for neonate compared to IgM
 Double sandwich IgA ELISA better than IgM double sandwich ELISA

09-03-2018
Immunocompromised
 Cns manifestation
 Encephalopathy
 Meningoencephalitis
Immunocompetent
 Asymptomatic (90%)
 CF  mc cervical lymphadenopathy
 Less commonmanifestation
 Encephalitis
 Myocarditis
 Pneumonia
 TESTS FOR IgG
 Sabin fieldman dye test (most preferred IgG test & gold standard)
 AVIDITY TEST
 IgG ELISA
 TESTS FOR IgM
 DOUBLE SANDWICH ELISA
 IgM IFA
 IMMUNOSORBENT AGGLUTINATION ASSAY

09-03-2018
 PYRIMETHAMINE + SULFADIAZINE  TREATMENT OF CHOICE
 SPIRAMYCIN  DOC IN PERGANNCY
 PREVENT VERTICAL TRANSMISSION
 FOR PROPHYLAXIS IN AIDS PATIENT WITH CD4 COUNT <100/ML  TMP –SMX

09-03-2018
 CRYPTOSPORIDIUM PARVUM

09-03-2018
• THICK WALLED 
EXIT FORMS
• INFECT NEW HOST
THIN WALLED
 AUTO
INFECTION
DIAGNOSIS BY
DEMONSATRTION OF
ACID FAST BACILLI IN
STOOL

09-03-2018
 IN SI INGESTED OOCYST
LIBERATES SPOROZOITES
WHICH INFECT INTESTINAL
EPITHELIAL CELLS &
MULTIPLY IN VACOULE
 INTRACELLULAR BUT
EXTRACYTOPLASMIC
IN IMMUNOCOMPETEENT HOST
 SELF LIMITING DIARRHEA
IMMUNOCOMPROMISED
 COMMON CAUSE OF DIARHHEA
 PROFUSE & WATERY

09-03-2018
 INFECTIVE FORM IS
SPORULATED OOCYST
 FRESHLY PASSED OOCYST
IN FECES ARE NOT
INFECTIVE
 AFTER MATURATION IN
SOIL THEY BECOME
INFECTIVE
 C/F SIMILAR TO
CRYPTOSPORIDIA
 DIAGNOSIS 
DEMONSTARTION OF ACID
FAST OOCYST IN FECES
 RX  COTRIMOXASOLE

09-03-2018
 CAUSES DIARRHEA IN IMMUNOCOMPROMISED
 DIAGNOSIS BY ACID FAST OOCYST IN FECES
 RX  CO TRIMOXAZOLE
TONY 2010 KMC

09-03-2018
 NECATOR
 ENTEROBIUS
 HYMENOLEPIS
 ANKYLOSTOMA

09-03-2018
 Doc for nematodes is albendazole except
 enterobius (DOC is mebendazole)
 Filariasis (DOC is DEC)
 Onchocerca & strongyloides (DOC is ivermectin)
 Dracuncullus (DOC is metronidazole)
 Angiostrongylus cantonensis (DOC is thiobendazole)
 LARGEST NEMATODE

09-03-2018
HABITAT OF ADULT
WORM IS IN JEJUNUM
INFECTIVE FORM
IS EMBRYONATED
EGG WITH
RHABDITIFORM
LAARVA
D/T MIGRATING LARVA
 LOEFFLERS
SYNDROME

09-03-2018
 D/T ADULT WORM
 MALNUTRITION
 INTESTINAL BLOCK
 APPENDICITIS
 OBSTRUCTIVE JAUNDICE
 INTESTINAL PERFORATION
 DEMONSTRATION OF EGG IN FAECES

09-03-2018
 FERTILISED EGG FLOATS IN SATURATED SOLUTION OF SODIUM CHLORIDE
 UNFERTILISED EGG SINKS TO BOTTOM

09-03-2018
BIPOLAR
CRESCENIC
SPACES
BILE STAINED
IRREGULAR
SURFACE
 D/T MIGRATING LARVA IN LUNG

09-03-2018
 DEMONSTRATION OF BILE DUCT
 LARVAE IN SPUTUM  LOEFLLERS SYNDROME

09-03-2018
 OVOVIVIPAROUS
 OPPORTUNISTIC INFECTION IN IMMUNOCOMPROMISED
HABITAT 
DUODENUM &
JEJUNUM
FILARIFORM
LARVAE ENTERS
BY PENETRATION
OF SKIN
EGG HATCH IN
INTESTINE
(OVOVIVIPAROUS )
& PRODUCE
RHABDITIFORM
LARVE
 MAY ALSO CAUSE
AUTOINFECTION

09-03-2018
 MIGRATING FILARIFORM LARVA OF STRONGYLOIDES MOVES RAPIDLY IN A
SHORT SPAN OF TIME @ RATE OF 3-4 CM /HR
SKIN LESION
• URTICARIA
• PRURITUS
PULMONARY LESION
• HEMORRHAGE IN
ALVEOLI
• BRONCHOPNEUMONIA
INTESTINAL LESIONS
• NECROTISING BOWEL
DISEASE
• MILD CHRONIC
COLITIS
HYPERINFECTION
• PARALYTIC ILEUS
• GI BLEED

09-03-2018
 IDENTIFICATION OF RHABDITIFORM LARVAE IN STOOL
 GENITAL PRIMORDIA
 SHORT BUCCAL CAVITY
 BULB LIKE ESOPHAGUS (HOUR GLASS SHAPED)

09-03-2018
 IVERMECTIN (200 UG /KG DAILY FOR 2 DAYS
 ALBENDAZOLE 400MG DAILY FOR 3 DAYS

09-03-2018
 OLD WORLD HOOK WORM  ANCYCLOSTOMA DUODENALE
 NEW WORLD HOOK WORM NECTOR AMERICANUS

HABITAT IS SI(JEJUNUM
>DUODENUM > ILEUM)
RESERVOIR
OF
INFECTION IS
MAN
FILARIFORM LARVAE
PENETRATES SKIN

09-03-2018
 PLASMA IS MAIN SOURCE OF NOURISHMENT
 RBC PASS WITH OUT ANY CHANGE IN LUMEN OF SI OF HOOK WORM
 Average blood loss by the host per worm per day is 0.03 mL with N. americans and
0.2 mL with A. duodenale
  IRON DEFICIENCY ANEMIA
 CF
 D/T LARVAE  GROUND ITCH
 D/T ADULT WORM IRON DEFICIENCY ANEMIA

09-03-2018
 NOT BILE STAINED
 SEGMENTED
 CONTAIN BLASTOMERES

09-03-2018
 SEAT WORM
 Disease of developed countries
INFECTIVE FORM
IS EMBRYONATED
EGG
CAECUM
APPENDIX
ADJACENT
PART OF
ASCENDING
COLON

09-03-2018
 Perianal pruritus
 Worse at night
 Heavy infections  abdominal pain & weight loss
 Appendix Appendicitis

09-03-2018
 MODE OF INFECTION
 INGESTION OF EGG
 AUTOINFECTION
 RETROGRADE IFECTION

09-03-2018
 Pyrantel palmote
 Mebendazole
TONY 2010 KMC

09-03-2018
LYMPHATIC
• WUCHERERIA
BENCROFTI
• BRUGIA
MALAYI
• BRUGIA TIMORI
SUBCUTANEOUS
• LOA LOA
• ONCHOCERCA
VOLVULUS
SEROUS
• MANSONELLA
OZZARDI
• MANSONELLA
PERSTANS

09-03-2018
 MAINLY CAUSED BY
 WAUCHERERIA BANCROFTI (MOST COMMONLY)
 BRUGIA MALAYI BRUGIA TIMORI

09-03-2018
ADULT
WORM IN
LYMPHATICS
MAN IS THE
DEFINITIVE HOST
MICROFILARIA
IN BLOOD
EXTRINSIC IP 
10 -14 DAYS

09-03-2018
MANSONIA IS THE
MAIN VECTOR

09-03-2018
PREPATENT
PERIOD
• TIME INTERVAL B/W INOCULATION OF
INFECTIVE LARVAE & FIRST APPEARANCE
OF DETECTABLE LARAVE
CLINICAL
INCIBATION
PERIOD
• INVASION OF INFECTIVE LARVAE
TO DEVELOPMENT OF CLINICAL
MANIFESTATIONS
ASYMPTOMATIC
AMICROFILARIAE
• NO
MICROFILAIN
BLOOD
ASYMPTOMATIC
MICROFILARIAE
• MICROFILARIA
IN PERIPHERAL
BLOOD
ACUTE
MANIFESTATION
• FEVER
• LYMPHANGITIS
• LYMPHADENITIS
• EPIDIDYMO
ORCHITIS
C/C
OBSTRUCTIVE
LESION
• HYDROCELE
• ELEPHANTIASIS
• CHYLURIA

09-03-2018
 D/T HYPERSENSITIVITY REACTION TO FILARIAL ANTIGENS
 RAISEDD TITRE OF FIALRIAL Ab
 MICROFILARIA NOT DETECTABLE IN BLOOD
 MICRFILARIAE PRESENT IN TISSUES
 TROPICAL PULMONARY EOSINOPHILIA
 PROMPT RESPONSE TO DEC

09-03-2018
 MAXIMUM DENSITY OF MICROFILARIAE IN PERIPHERAL BLOOD IS REPORTED
B/W 10 PM TO 2AM

09-03-2018
 DEC
 DOC
 1-4 G/KG FOR 6-9 MONTHS
 PARASITE DOESN’T MULTIPLY IN INSECT VECTOR
 INFECTIVE LARVAE DONOT MULTIPLY IN HUMAN NHOST
 LIFE CYCLE OF PARASITE IS RELATIVELY LONG  15 YRS

09-03-2018
 AFRICAN EYE WORM
OFTEN IN SC
TISSUE OF MAN
(MOST
COMMONLY IN
SUBCONJUNCTIV
AL TISSUE OF
MAN)
CHRYSOPS

INTERMEDI
ATE HOST

09-03-2018
 D/T
HYPERSENSITIVITY
REACTION TO ADULT
WORM 
CHARACTERISTIC SC
SWELLING
 RX
 DEC
 CORTICOSTEROIDS

09-03-2018
 RIVER BLINDNESS
 MANIFESTATIONS
 ONCOCERCOMATA  SUBCUTANEOUS ITCHY NODULE
 OVER SACRUM COCCYX & ILIAC CREST
 FIRM & NONTENDER
 SKIN  PRURITUS & RASH
 VISUAL IMPAIREMENT  MOST SERIOUS COMPLICATION

09-03-2018
BLACK FLY OR SIMULIUM IS
VECTOR

09-03-2018
 DIAGNOSIS OF ONCHOCERCIASIS
 SETECTION OF ADULT WORM ON BIOPSY
 RX
 IVERMECTIN
 Mazzotti reactions can be life-threatening, and are characterized by fever, urticaria,
swollen and tender lymph nodes, tachycardia, hypotension, arthralgias, oedema,
and abdominal pain that occur within seven days of treatment of microfilariasis

09-03-2018
MAN IS THE
DEFINITIVE
HOST
INTERMEDIATE
HOST IS CYCLOPS

09-03-2018
 EXTRACTION OF FEMALE WORM
 LARVAE DEMONSTRATION ON CONTACT WITH WATER
 ANTIHISTAMINES STEROIDS
 NITROTHIAZOLE COMPOUND

09-03-2018
ADULT LARVA
RESIDES IN
CAECUM
SMOOTH EGGS WITH
BIPOLAR PROTRUDING
MUCUS PLUG

09-03-2018
 ABDOMINAL PAIN
 ANOREXIA
 BLOODY DIARRHEA
 RECTAL PROLAPSE  IN CHILDREN
 MEBENDAZOLE
 ALBENDAZOLE

09-03-2018
 MAN IS AN INCIDENTAL HOST

09-03-2018
TRANSMITTED BY
ENCYSTED 1ST
STAGE LARVAE IN
UNDERCOOKED
MEAT
MOST
OMMONLY
EXTRAOCC
ULAR
MUSCLE
ARE
INVOLVED

09-03-2018
 DIAGNOSIS
 MUSCLE BIOPSY
 PX
 PROPERCOOKING OF MEAT
 Rx
 THIOBENDAZOLE

09-03-2018
 invasion of the nematode larvae of animal origin in the visceral organs and skin of
man.
 Man  accidental host.
 The helminths do not complete their normal cycle of development and their movement is
arrested at some level in the human body
 The larva migrans is distinctly of two types:
 a.Visceral larva migrans
 b. Cutaneous larva migrans

09-03-2018
 It is a syndrome caused by migration or persistence of larval nematodes of animal
origin in the deeper parts of the human body.
 The condition is caused by:
 1. Angiostrongylus cantonensis.
 2. Angiostrongylus costaricensis.
 3.Toxocara canis.
 4.Toxocara cati
 5. Anisakine species
 6. Gnathostoma spinigerum.
 creeping eruption.
 intense pruritic reaction of the skin caused by prolonged migration of dog and cat
hookworms in man.
 The causative agents are:
 1. Ancylostoma braziliense.
 2. Ancylostoma caninum.
 3. Strongyloides stercoralis.
 4. Necator Americanus.
 5. Ancylostoma duodenale.
 6. Bunostomum phlebotomus.
 7. Uncinaria stenocephala
 8. Gnathostoma spinigerum
MOST COMMON

09-03-2018
 ABDOMINAL PAIN
 ANOREXIA
 BLOODY DIARRHEA
 RECTAL PROLAPSE

09-03-2018
 Cestodes & trematodes lay operculated
eggs
 Except schistosome  nonoperculated
eggs

09-03-2018
 Flat segmented tape like
 Divided in to
 Intestinal sps
 Tissue sps
 Cestodes are hermaphrodites
 All are oviparous

09-03-2018
Taenia saginata
is the largest
helminth &
largest worm
DEFINITIVE
HOST IS MAN
HABITAT IS
JEJUNUM

09-03-2018
CYSTICERCUS CELLULOSAE CYSTICERCUS BOVIS

09-03-2018
Man act as
intermediate as well
as definite host
Eggs can also cause
infection as the same way
as pig
CYSTICERCOSIS IN ANY
ORGAN  MOST COMMON
IN SC TISSUE & MUSCLES ,EYE
BRAIN(NEUROCYSTICERCOSI
S)

09-03-2018
 MOST COMMONLY INVOLVES BRAIN
PARENCHYMA
 MOST COMMON PARASITIC DISEASE OF
CNS WORLD WIDE
 IN INDIA NEUROCYSTICERCOSIS IS
REGARDED AS SECOND MOST IMPORTANT
CAUSE OF ICSOL FOLLOWING
TUBERCULOSIS & THE MOST COMMON
CAUS EOF EPILEPSY

09-03-2018
INTERMEDIATE
HOST IS SHEEP
PIG CATTLE
GOAT MAN
DEFINITIVE HOST IS DOG
WOLF FOX

09-03-2018
DEFINITE HOST
INTERMEDIATE
ACCIDENTAL
HOST

09-03-2018
DEFINITE
HOST
INTERMEDIATE
HOST
ACCIDENTAL HOST
 NO HUMAN TO HUMAN TRANSMISSION

09-03-2018
 LIVER  MC
 LUNG  2ND MC
 ABDOMINAL CAVITY
 SPLEEN
 KIDNEY
 BRAIN
 BONE
• USUALLY SINGLE
• INVOLVES RIGHT
LOBE OF LIVER
CAUSED BY
ECCHINOCOCCUS GRANULOSUS
ECHINOCOCCUS MULTILOCULARIS

09-03-2018
 ASYMPTOMATIC MOST COMMONLY
 ABDOMINAL PIAN
 DYSPEPSIA
 VOMITING
 MOST COMMON SIGN  HEPATOMEGALY
 USG & CT
 CALCIFICATION OF WALL
 HYPERECHOGENC HYDATID SAND
 DAUGHTER CYSTS WITH IN LARGE SAND
 SERODIAGNOSTIC ASSAY  HELPFUL IN 85 % CASES
 ARC 5 TEST
 ELISA
 IHA
 CASONIS INTRADERMAL TEST

09-03-2018
CE 1  CONCENTRIC
HYPERECHOGENIC HALO
AROUND CYST WITH FREE
FLOATING
HYPERECHOGENIC FOCI
CE2
MULTIVESICUAL
CYST
• ROSETTE
• CLUSTER
CE3  WATER LILY
SIGN/WWATER
SNAKE SIGN
ACTIVE FERTILE
CYST

09-03-2018
 P.A.I.R  FOR ANTOMICALLY & SURGICALLY APPROPROPRIATE LESIONS
 PUNCTURE
 ASPIRATION USG GUIDED
 INJECTION OF SCOLICIDAL AGENT
 15 % HYPERTONIC SLAINE
 95 % ALCOHOL
 MEBENDAZOLE
 0.5 % SILVER NITRTAE
 REASPIRATION
 SX
 FOR E MULTILOCULARIS

09-03-2018
 SUPERFICIAL CYST  SPILLAGE
 CYST IN SPINE BRAIN HEART LUNG
 INACTIVE OR CALCIFIED CYST
 CYST COMMUNICATING WITH BILIARY TREE
 CYST OPENING INTO URINARY TRACT ABDOMINAL CAVITY OR URINARY TRACT

09-03-2018
AFULT WORM RESIDES
IN ILEUM 
CONSUMES B12 
MEGALOBLASTIC
ANEMIA
SECOND
INTERMEDIATE
HOST IS FISH
1ST
INTERME
DIATE
HOST IS
FISH
3 HOSTS

09-03-2018
BOTH
CYSTICERCOI
D & EGG CAN
CAUSE
INFECTION

09-03-2018
CERCARIA IN
SNAILS IS
INFECTIVE
SCHISTOSOMES
ARE
TRANSMITTED
BY SNAILS

09-03-2018
 SHISTOSOMA HAEMATOBIUM 
BILHARZIASIS
 TERMINAL PAINLESS HEMATURIA (IN
VESICAL PLEXUS)
 TERMINAL SPINE IN EGGS OF
SCHISTOSOMA HEMATOBIUM
TERMINAL SPINE

09-03-2018
 ORIENTAL BLOOD FLUKE
 A/W KATAYAMA FEVER (D/T IMMUNE
COMPLEXES)

09-03-2018
TERMINAL SPINE
 SCHISTOSOMA
HAEMATOBIUM
LATERAL SPINE 
SHISTOSOMA
MANSONI
LATERAL ROUND KNOB
 SCHISTOMSOMA
JAPONICUM
URINE FECES

09-03-2018
 CHINESE LIVER FLUKE
 ORIENTAL LIVER FLUKE

09-03-2018
EXCYST IN
DUODENUM 
THROUGH AMPULLA
OF VATER 
MATURE IN TO
ADULT WORM IN
BILIARY CANALICULI
INGESTION OF
METACERCARIA IN
INADEQUATELY
COOKED FISH

09-03-2018
INTERMEDIATE HOST IS
SNAIL
HUMANS & SHEEP 
DEFINITIVE HOST

09-03-2018
TRANSMITT
ED BY
INGESTION
OF CRAB
(2ND
INTERMEDI
ATE HOST)
1ST
INTERMEDIA
TE HOST IS
SNAIL

Parasitology revision notes

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