KUNWOR, BISHAL SGD: 8 SECTION: A2

PARASITOLOGY OSCE 1

A. ENDOPARASITE/ECTOPARASTIE
1. Ticks (Arachnida) kirna in Nepali
• 4 pair legs, 2 pair mouth parts, no antennae, oval shape, Sexes are
separate.
• Ixodidae (hard ticks), Argasidae (Soft ticks).

AL
• Body cannot be separated into head, thorax & abdomen.
• Anterior Capitulum-dorsal side (Hard ticks) & Ventral side (Soft ticks)

H
• Scutum present in hard ticks, lack in soft ticks.
• Life cycle: Egg, larva, nymph, adult of separate sexes. Range 1-2 yrs.

IS
• Hard ticks: bacterial, viral and rickettsia disease
• primary vector for Borrelia burgdorferi (Lyme disease), and Babesia
sp.
,B
• Clinical symptom at bite site: inflammation, edema, local hyperemia,
R
hemorrhage. Tick paralysis.
• Treatment removal of ticks: few drops of ether/chloroform on head
O

and pulling straight out.

• Prevention: tick repellant, avoid tick infesting area, protective clothing
W

2. Mites (Arachnida) Sulsule in Nepali

• Extremely small, still visible with eyes, oval shape.
N

• Burrow skin, hair follicle, sebaceous gland.

• Egg, larva, nymph, adult (2 weeks from egg to adult)
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• Transfer from one person to another.

• Scabies
• Pimple like lesions, night time pruritis
• Treatment: creams and lotion (permethrin lotion)
• Cleaning clothes, dressing, bedding by hot water and drying in hot
cloth dryer.
 • If clothes cannot be washed right away then put it in plastic, so spread
can be prohibited.
3. Fleas (Insecta) Upiya in Nepali
• 3 pair powerful hairy leg, claw like feet. Rear feet are long for jumping,
mouth for piercing and sucking, comb like structure above mouth
(genal ctenidia) and pronotal ctenidia behind the head.
• Egg deposited on ground-Larva (2-10 days incubation period),3 larva

AL
stage-3rd stage mature larva spin into cocoon, remain in this pupal
stage for 1 year-adult
• Vector for Dipylidium caninum, Hymenolepsis nana, Hymenolepsis

H
dimunita, Yersinia pestis (plaque)

IS
• Clinical symptom: Some are asymptomatic, intense itching,
dermatitis, ulcerations, nodular swelling at bite
• Treatment: Remove the fleas
,B
• Protecting cats and dogs, cleaning the object which are touched by
these animals.
R
4. Flies (Crustacea) Jinga in Nepali
• Two pair wings (one pair small than other), 1 pair eye, 1 pair antenna,
O

3 pair legs
• Metamorphosis
W

• Egg-Larva (multiple stage)-cocoon stage(pupa)-adult

• Tsetse fly- Africa (Trypanosoma)
N

• Sand fly-Asia, S. America, Central America, Mediterranean Mexico

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(Leishmaniasis)
• Black fly- Africa, Mexico, Central and S. America (onchocerca vulvus)
• Deer fly-Tropical Africa (Loa Loa)
• Enteritis and myiasis
• Treatment: topical ointment, Tx for myiasis: complete excision of
lesion.
• Prevention: repellant, protective clothing, hygiene
5. Lice (Insecta) Jumra in Nepali
 • Wingless, 3 pair leg, claw like feet extending from thorax, 1 pair
antenna, Mouth parts for piercing and sucking blood.
• Head louse and body louse are hairless.
• Eggs (nits)- Nymph (3 stage)- Adult (takes 24-27 days) Lives for 30
days.
• Crab lice transmitted via sexual contact. Crab lice has hair on
extremities.

AL
• Pediculosis -infestation of lice, Itching, inflammation at bite site
• Tx- benzene hexachloride lotion (destroys eggs and adult)
• Prevention- Personal hygiene

H
6. Mosquitos (Insecta) Lamkhutte/Maxxad in Nepali
• Head, thorax, abdomen (10 segments), 3 pair legs, 2 pair wings (one

IS
pair small), 1pair antenna
• Egg-Larva (4 larval form)-pupa-Adult
,B
• Anopheles – Worldwide: P. vivax, P. ovale, P. malariae, P. falciparum
• Culex, Ades, Anopheles: Wucheria broncrafti
R
• Anopheles, Mansonia, Armigeres, Ades: Brugia malayi
• S&S: Irritating dermatitis
O

• Tx: lotion and ointments (calamine & Benadryl lotions)

• Prevention: Repellant, insecticide, destroy the stagnant water around
W

your house
N
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B. PROTOZOA
1. AMEBA
a. Pathogenic
i. Entamoeba histolytica
• Infective stage: Cyst Diagnostic stage: Trophozoite and cyst
• Invasive trophozoite and quadrinucleated cyst
• Swallowing food and water contain cyst is mode of transmission

AL
• Extraintestinal and intestinal amebiasis
• Flask shaped Amebic ulcer, liver abscess,
• Amebic dysentery

H
• Direct fecal smear for seeing trophozoite motility, Unidirectional

IS
movement
• Detection of antibodies for the diagnosis of ALA
• Charcot Leyden crystal and RBC ingested trophozoites positive.
,B
• Tx: Metronidazole
• Safe disposal of feces, safe drinking water, food, hygiene.
R
b. Nonpathogenic (Commensal)
i. Entamoeba dispar
O

• Similar to Entamoeba histolytica but DNA and RNA differ.

• Infective stage: Mature cyst
W

• Diagnostic stage: Cysts and trophozoites in feces

ii. E. moshkovshii
N

• Similar to E. histolytica and E. dispar but differ biochemically

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and genetically
• Infective stage: Mature cyst
• Diagnostic stage: Cysts and trophozoites in feces
iii. E. hartmanni
• Similar to E. histolytica but small.
• Doesn’t ingest RBC.
• Infective stage: Mature cyst
• Diagnostic stage: Cysts and trophozoites in feces
 iv. E. coli
• Trophozoite blunted pseudopodia, sluggish movement, no
RBC ingested instead of RBC bacteria is ingested, more
granular vacuoles.
• Cyst larger size, more nuclei (8)
• Infective stage: Mature cyst
• Diagnostic stage: Cysts and trophozoites in feces

AL
v. E. polecki
• Found in pigs and monkeys
• Sluggish trophozoite motility

H
• Uninucleate cysts
• Infective stage: Mature cyst

IS
• Diagnostic stage: Cysts and trophozoites in feces
vi. E. gingivalis
,B
• Can be found in mouth
• Trophozoite with blunted pseudopodia
R
• Food vacuole contains leukocytes
• No cyst stages
O

• Can be transmitted via kissing, sharing utensil

• Infective and diagnosis: Trophozoite
W

vii. E. nana
• Blunt hyaline pseudopodia, food vacuole with bacteria.
N

• Quadrinucleated cyst and same size as trophozoite

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viii. Iodamoeba butschlii

• Trophozoite-large vesicular nucleus
• Uninucleate cyst
• Large glycogen bodies-stained dark brown with iodine

Diagnosis: Commensal

• Stool examination, Cysts recovered from formed stool, trophozoites from

watery stool
• Use of FECT and zinc sulfate flotation for cyst recovery
• Trophozoites by direct fecal smear.
• For diagnosis of E. gingivalis swab between gums and teeth is examined for
trophozoites.
• TX: not necessary Prevention: Good hygiene and proper disposal of human
waste.
c. Free living pathogenic

AL
i. Acanthamoeba species
• Active trophozoite with thorn like appendages
• Cyst (1 nuclei) stage formed when environment condition is

H
not favorable
• Can survive in contact lens solution.

IS
• Infective Stage: trophozoites
• Diagnostic stage: Cyst and trophozoite in tissue
,B
• Acanthoma keratitis, Granulomatous amebic encephalitis
• Diagnosed by epithelia biopsy or corneal scraping
R
• Diagnosis of GAE is usually in postmortem
• Tx. Medical treatment in not met yet
O

• Prevention: Contact lens hygiene Robust immune system

ii. Naegleria fowleri
W

• Trophozoite, flagellate and cyst form are present

• Infective stage: Trophozoite
N

• Diagnostic stage: Trophozoite form in CSF and brain tissue

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and flagellate form occasionally in CSF

• Clinical: Primary amebic meningocephalitis
• Diagnosis: blunt, lobose pseudopodia, directional motility
• Tx: Amphoterin B + clotrimazole
2. CILIATES AND FLAGELLATES
a. Pathogenic
i. Balantidium coli
• Causative agent for balantidiasis
• Only ciliate to cause human infection
• Normal host: pig
• Trophozoite (macro and micro nucleus, 2 contractile vacuole)

AL
and cyst (2 nuclei)
• Ingestion of contaminated water and food containing cyst
result in infection

H
• Infective Stage: Cyst
• Diagnostic

IS
stage: Cyst and trophozoites
(sedimentation/floatation techniques)
• Attack intestinal epithelium, round base wide neck ulcer
,B
• Can spread to mesenteric nodes, appendix, liver, pleura,
lungs, genitourinary sites.
R
• Tx: tetracycline/ metronidazole
• Prevention: Sanitation, pig feces fertilizer should be avoided
O

ii. G. Lamblia
• Giardiasis
W

• Flagellate lives in duodenum, jejunum, upper ileum

• Quadrinucleated cyst stage (4 nuclei, and trophozoites (pear
N

shaped, 2 nuclei, 4 pair flagella)

KU

• Infective stage: Cyst

• Diagnostic stage: Trophozoite and cyst
• Attach to intestine by sucking disc, decrease maltase and
sucrase activity, malabsorption, maldigestion
• Steatorrhea, low grade fever, failure to thrive
• Diagnosis: Cyst or trophozoite in stool specimen. Trophozoite
floating leaf like motility
• Tx: metronidazole, tinidazole, furazolidone, albendazole
 • Prevention: Sanitation
iii. Trichomonas vaginalis
• Trichomoniasis
• Only trophozoite stage (pyriform shape)
• Four free anterior flagella, 5ht embedded in undulating
membrane
• One nucleus

AL
• Mode of transmission: Sexual intercourse
• Inflammation of vagina, prostatitis in male, other areas
affected are urethra also.

H
• Trophozoite infect the surface but doesn’t invade.
• Infective and diagnostic stage: trophozoites

IS
• Saline preparation of vaginal fluid
• Tx: metronidazole/tinidazole
,B
• Prevention: limiting sexual partner, use protective device for
sex.
R
b. Non pathogenic
i. T. hominis
O

• Only trophozoite (pyriform shape)

• 5 anterior flagella, 1 posterior flagella
W

• 1 nucleus
• Cecal area of large intestine is habitat
N

ii. T. tenax
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• Only trophozoite (pyriform shape)

• Smaller and slenderer than T. vaginalis
• Four equal flagella and 5th on margin of undulating membrane
which don’t reach posterior end.
• Single nucleus
• Transmission from droplet spraying, kissing, common
utensil/glasses to drink.
• Living in tartar of teeth
 • Diagnosis by swabbing of tartar between teeth
iii. Chilomastix mesnili
• Lives in cecal region of large intestine.
• Trophozoite and cyst stage
• Trophozoite is asymmetrically pear shaped
• 3 anterior, one posterior flagella
• Cyst- pear or lemon shaped

AL
• Transmission-ingestion of cyst in food and drink.
• Diagnostic stage: Cyst or trophozoites in feces.
• Tx: N/A Prevention: Personal hygiene and sanitation

H
3. COCCIDIAN

IS
i. Cryptosporidium hominis
• Sexual or sporogony producing oocyst-asexual cycle or
schizogony (merogony) producing merozoites-gametogony
,B
producing male(micro) and female(macro) gametocytes.
• One Oocyst four sporozoites) – Trophozoite (becomes
R
intracellular but extra cytoplasmic, attached to brush border)
• Two types of oocyst – thin walled (infect other enterocyte)
O

and thick walled (passed in feces)

• Infective stage: Thick-walled oocyst
W

• Diagnostic stage: Thick-walled oocyst

• In immunocompromised person diarrhea becomes severe
N

• Acid fast staining is fastest and cheapest method for

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diagnosis.
• Tx: no acceptable treatment
• Prevention: Contamination of water by human feces should
be reduced.
ii. Cyclospora cayetanensis
• Infective stage: Sporulated cyst
• Diagnostic stage: Unsporulated cyst
• 1 oocyst (2 sporocyst each containing 2 sporozoite)
 • D-xylose malabsorption
• Chronic and acute diarrhea with alternating constipation
• Direct microscopic examination of fecal smears under high
magnification
• Tx: Self-limiting disease.
• Prevention: Fruits and vegetable should be washed before
eating.

AL
iii. Cystoisopora belli
• Causes cystoisporiasis
• Sporulated Oocyst contains 2 sporocyst with each having 4

H
sporozoites
• Transmission: Ingestion of contaminated food or water

IS
containing sporulated oocyst.
• Infective stage: Mature oocyst with sporozoites
,B
• Diagnostic stage: Oocyst in feces
• Self-limiting diarrhea to severe diarrhea illness in
R
immunocompromised person.
• Flattened mucosa and damaged villi.
O

• Tx: Symptomatic patient with trimethoprim +

sulfamethoxazole
W

• Prevention: Good sanitary practices.

iv. Toxoplasma gondii
N

• Infective stage: bradyzoite, tachyzoite and oocyst

KU

• Extraintestinal (bradyzoite, tachyzoite)

• Mature oocyst contains 2 sporocyst (each having 2
sporozoites)
• In immunocompromised people: encephalitis, myocarditis,
focal pneumonia
• Diagnosis: analyzing blood sample using serologic test
methods.
v. Sarcocystis species
 • Simplest form is zoite (banana shaped)
• Infective stage: Cyst with bradyzoite ingested in undercooked
meat.
• Diagnosis: Identification of sporocyst in feces.
• Tx: Treatment is rarely required.
• Prevention: cooking or freezing meat to kill bradyzoites in
sarcocysts.

AL
4. OTHER PROTOZOAN
i. Blastocyst hominis
• Glistening appearance in wet mount, absence of organelle of

H
locomotion
• Four forms: vacuolated, ameba like, granular, multiple fission

IS
• Vacuolated form is predominant in fecal specimen which
causes diarrhea.
,B
• Granular forms are multinucleated and found in old culture
• Causes blastocystosis
R
• Tx: Metronidazole
• Prevention: Consuming safe drinking water.
O

ii. Dientamoeba fragilis

• Flagellate with only trophozoite stage known.
W

• One/two rosette shaped nuclei (rarely 3/4)

• Lives in mucosal crypts of the appendix, cecum and upper
N

colon.
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• Clinical: doesn’t invade the tissue, irritate mucosa,

hypersecretion, hypermotility of bowel
• Infective and diagnostic form: trophozoites
• Diagnosis: binucleated trophozoites in stool.
• Tx: Iodoquinol
• Prevention: Proper sanitation, disposal of human waste