Micro Parasitology CBA 4 Hamza Mumtaz
PROTOZOA CAUSING INTESTINAL AND UROGENITAL INFECTIONS
ENTAMOEBA HISTOLYTICA
• Diseases: amebic dysentery and liver abscess
• Characteristics: intestinal protozoan; motile ameba (trophozoite); forms cysts with 4 nuclei. Life
cycle: human ingest cysts à form trophozoites in small intestines à pass to colon and multiply
à cysts form in colon à passed through feces
• Transmission: fecal-oral transmission of cysts; human reservoir
• Pathogenesis: trophozoites invade colon epithelium and produce flask-shaped ulcer à can
spread to liver and cause abscess
• Lab diagnosis: trophozoites and cysts visible in stool
• Treatment: metronidazole or tinidazole for symptomatic patients; iodoquinol or paromomycin for
carriers
• Prevention: proper disposal of human waste + water purification + handwashing
GIARDIA LAMBLIA
• Diseases: Giardiasis, especially diarrhea
• Characteristics: intestinal protozoan; pear-shaped, flagellated trophozoite, form cyst with 4
nuclei. Life cycle: humans ingest cysts à form trophozoites in duodenum à form cysts à passed
in feces
• Transmission: fecal-oral transmission; human and animal reservoir
• Pathogenesis: trophozoites attach to wall but not absorbed; interfere with absorption of fats and
protein
• Lab diagnosis: visible in stool
• Treatment: metronidazole
• Prevention: water purification + hand washing
TRICHOMONAS VAGINALIS
• Diseases: trichomoniasis
• Characteristics: urogenital protozoan; pear-shaped, flagellated trophozoites; no cysts
• Transmission: transmitted sexually; human reservoir
• Pathogenesis: trophozoites attach to wall of vagina and cause inflammation and greenish
discharge
• Lab diagnosis: trophozoites visible in secretions
• Treatment: metronidazole
• Prevention: condoms
PROTOZOA CAUSING BLOOD+TISSUE INFECTIONS
PLASMODIUM SPECIES
Plasmodium vivax, ovale, malariae and falciparum
• Disease: malaria
Micro Parasitology CBA 4 Hamza Mumtaz
• Characteristics: protozoans that infects RBCs and tissue (liver, kidney, brain). Life cycle: sexual
cycle à production of gametes in humans and spores in mosquitoes; asexual cycle: (schizogony)
only in humans. Sporozoites in saliva of female Anopheles mosquito enter human blood à invade
hepatocytes à multiply and form merozoites (vivax and ovale form hypnozoites) à merozoites
leave hepatocytes and infect RBCs à form schizonts that release more merozoites à some
merozoites become male and female gametocytes à gametes à unite to form oocyst containing
many sporozoites à released and migrate to salivary glands
• Transmission: via female Anopheles mosquitoes
• Pathogenesis: merozoites destroy RBCs à anemia. Cyclic fever pattern due to periodic release of
merozoites. Plasmodium falciparum effects RBCs à occlude capillaries à anoxia in brain or
kidney
• Treatment: Chloroquine (Malarone, if resistant) + Primaquine for vivax and ovale
• Prevention: chloroquine (doxycycline or Malarone incase of resistance)
TOXOPLASMA GONDII
• Diseases: toxoplasmosis
• Characteristics: tissue protozoan. Life cycle: cyst in cat feces is ingested à differentiate in gut,
invade gut wall à infect macrophages and form trophozoites à rapidly multiply and kill cells à
cysts containing bradyzoites form
• Transmission: ingestion of cysts in raw meat and in food contaminated by cat feces; also, from
mother to fetus trans-placentally. Cat is definitive host; humans are intermediate
• Pathogenesis: trophozoites infect brain, eyes and liver. Cysts persist in tissues à enlarge à cause
symptoms
• Lab diagnosis: serologic test for IgM and IgG antibodies; trophozoites also visible in tissue
• Treatment: sulfadiazine plus pyrimethamine
• Prevention: properly cook meat; stay away from cats. Trimethoprim-sulfamethoxazole used to
prevent toxoplasma encephalitis in AIDS patients
TRYPANOSOMA CRUZI
• Diseases: Chagas’ disease
• Characteristics: blood and tissue protozoan. Life cycle: trypomastigotes in blood of reservoir host
are ingested by reduviid bug and form epimastigotes and then trypomastigotes in the gut à
when bug bites, it defecates and feces containing the trypomastigotes contaminate the wound à
organisms enter the blood and form amastigotes within the cells à become trypomastigotes
• Transmission: by reduviid bugs
• Pathogenesis: amastigotes kill cells, especially cardiac muscle à myocarditis + neuronal damage
• Lab diagnosis: trypomastigotes visible in blood
• Treatment: nifurtimox or benznidazole
TRYPANOSOMA GAMBIENSE + RHODESIENSE
• Disease: sleeping sickness
• Characteristic: blood and tissue protozoan. Life cycle: trypomastigotes in blood of human or
animal reservoir are ingested by the tsetse fly à differentiate in the gut to form epimastigotes
and then metacyclic trypomastigotes in salivary glands à fly bites à trypomastigotes enter the
blood
• Transmission: transmitted by tsetse fly; Gambiense à human reservoir; rhodesiense à animal
reservoir
Micro Parasitology CBA 4 Hamza Mumtaz
• Pathogenesis: trypomastigotes infect brain à encephalitis
• Lab diagnosis: trypomastigotes visible in blood + CSF in late stages
• Treatment: suramin
LEISHMANIA DONOVANI
• Disease: Kala-azar
• Characteristics: blood and tissue protozoan; Life cycle: human macrophages with amastigotes are
ingested by sand fly à amastigotes differentiate in fly gut to promastigotes à migrate to pharynx
à sand fly bites human à promastigotes enter blood macrophages à form amastigotes à
these affect reticuloendothelial cells in spleen and liver
• Transmission: via sandflies; animal reservoirs (dogs), and humans (India)
• Pathogenesis: amastigotes kill reticuloendothelial cells à liver, spleen and bone marrow
• Lab diagnosis: amastigotes visible in bone marrow smear
• Treatment: sodium stibogluconate
CESTODES
SCHISTOSOMAS
Schistosoma mansoni, japonicum, haematobium
• Diseases: schistosomiasis
• Characteristics: trematode (blood fluke); adults exist as 2 sexes but are attached to each other;
eggs are differentiated by spines. Mansoni à large lateral spine; japonicum à small lateral spine;
haematobium à terminal spine. Life cycle: humans infected by cercariae penetrating skin à
form larvae that penetrate blood vessels à carried to liver à become adults à migrate in the
portal vein to reach mesenteric venules (mansoni, japonicum) or urinary bladder venules
(haematobium) à eggs penetrate gut or bladder wall à excreted à hatch in fresh water à
ciliated larvae penetrate snails and multiply to form free swimming cercariae
• Transmission: transmitted by penetration of skin by cercariae. Humans are definitive host; snails
are intermediate hosts
• Pathogenesis: eggs in tissue induce inflammation, fibrosis and obstruction, especially in liver and
spleen. S. mansoni damages colon, S. japonicum damages small intestine, and S. haematobium
damages bladder à predisposes carcinoma
• Lab diagnosis: eggs visible in feces or urine à eosinophilia occurs
• Treatment: Praziquantel
NEMATODES
ANCYLOSTOMA DUODENALE & NECATOR AMERICANUS
• Diseases: hookworm
• Characteristics: intestinal nematode. Life cycle: filariform larvae penetrate skin à enter blood à
migrate to lungs à enter alveoli à pass up trachea à swallowed à become adults in small
intestine à attach to walls via teeth (anclystoma) or cutting plates (necator) à eggs passed in
feces à form noninfectious rhabditiform larvae and then infectious filariform larvae in soil
• Transmission: filariform larvae in soil penetrate skin of feet; humans are only host
Micro Parasitology CBA 4 Hamza Mumtaz
• Pathogenesis: anemia due to blood loss from GIT
• Lab diagnosis: eggs visible in feces; eosinophilia occurs
• Treatment: mebendazole
• Prevention: use foot wear
ASCARIS LUMBRICOIDES
• Diseases: ascariasis
• Characteristics: intestinal nematode. Life cycle: humans ingest cells à form larvae in gut à
migrate via blood to lungs à alveoli à trachea à swallowed à become adults in gut à lay eggs
that are passed in feces à embryonate in soil
• Transmission: food contaminated with soil; humans are only host
• Pathogenesis: larvae in lung cause pneumonia; heavy worm burden can cause intestinal
obstruction
• Lab diagnosis: eggs visible in feces; eosinophilia occurs
• Treatment: mebendazole
ENTEROBIUS VERMICULARIS
• Diseases: pinworm infection
• Characteristics: intestinal nematode. Life cycle: humans ingest eggs à develop in the gut à at
night, females migrate from the anus and lay eggs on skin and in environment
• Transmission: transmitted by ingesting eggs
• Pathogenesis: worms and eggs cause perianal pruritus
• Lab diagnosis: eggs visible by scotch-tape technique
• Treatment: mebendazole
STRONGLYOIDES STERCORALIS
• Diseases: strongyloidiasis
• Characteristics: intestinal nematode. Life cycle: Filariform larvae penetrate skin à enter blood à
go to lungs à alveoli à trachea à swallowed à become adults and enter mucosa à females
produce eggs that hatch in the colon à noninfectious rhabditiform larvae à passed in feces à
form infectious filariform larvae in soil
• Transmission: filariform larvae in soil penetrates skin
• Lab diagnosis: larvae visible in stool; eosinophilia occurs
• Treatment: ivermectin
TRICHINELLA SPIRALIS
• Diseases: trichinosis
• Characteristics: intestinal nematode. Life cycle: humans ingest undercooked meat containing
encysted larvae à mature in small intestine à female worms release larvae that enters blood à
migrate to skeletal muscle or brain à where they encyst
• Transmission: ingestion of raw/undercooked meat. Reservoir: pigs and rats. Humans are dead-
end hosts
• Pathogenesis: larvae encyst within striated muscle cells called “nurse cells” à inflammation
• Lab diagnosis: encysted larvae visible in muscle biopsy
• Treatment: thiabendazole (mebendazole in extreme cases)
Micro Parasitology CBA 4 Hamza Mumtaz
TRICHURIS TRICHIURA
• Diseases: whipworm infection
• Characteristics: intestinal nematode. Life cycle: humans ingest cells à develop in gut à eggs
passed in feces to soil à they embryonate in soil
• Transmission: transmitted by food or water contaminated by eggs in soil; humans are only host
• Pathogenesis: worm in gut usually causes little damage
• Lab diagnosis: eggs visible in feces
• Treatment: mebendazole
LOA LOA
• Diseases: loiasis
• Characteristics: tissue nematode. Life cycle: bite of deer fly (mango fly) à deposits infective
larvae à develop into adults and migrate subcutaneously à females produce microfilariae à
enter blood à ingested by deer flies à infective larvae are formed
• Transmission: via deer/mango flies; humans are only definitive host
• Pathogenesis: hypersensitivity to adult worms causes swelling in skin à adult worm seen
crawling across conjunctiva
• Lab diagnosis: microfilariae visible on blood smear
• Treatment: diethylcarbamazine
ONCHOCERCA VOLVULUS
• Diseases: onchocerciasis (river blindness)
• Characteristics: tissue nematodes. Life cycle: bite of female blackfly deposits larvae in
subcutaneous tissue à mature into adult worms à females produce microfilariae à migrate
into interstitial fluids à ingested by blackflies à infective larvae formed
• Transmission: transmitted by female blackflies; humans are only definitive host
• Pathogenesis: microfilariae in eye can cause blindness à adult worms induce inflammation in
nodules of skin à scaly “lizard” skin à loss of subcutaneous tissue is called “hanging groin”
• Lab diagnosis: microfilariae visible in skin biopsy
• Treatment: ivermectin for microfilaria; suramin for adult worms
WUCHERERIA BANCROFTI
• Diseases: filariasis
• Characteristics: tissue nematodes. Life cycle: bite of female mosquito deposits infective larvae
that penetrate bite wound à form adults à produce microfilariae à circulate in blood à
ingested by mosquitos à infective larvae are formed
• Transmission: via female mosquitos (Anopheles or Culex); humans are only definitive host
• Pathogenesis: adult worms cause inflammation that blocks lymphatic vessels (elephantiasis)
• Lab diagnosis: microfilariae visible on blood smear
• Treatment: diethylcarbamazine
