Parasitology

Faculty : Dr. Abdul Naseer

Compiled by
Rohan Hake
Seth GS Medical college &
KEM hospital, Mumbai
9561983020
 MICROBIOLOGY

Parasites

V V

Protozoans Helminths

Multicellular
V

Trophozoite T Visible to naked eyes

& Worms Never infective form

j I
>

⑧
Cyst
Lay eggs T
Infective to some
Cyst is always infective form
Larva Infective form (Major)

Types Types
Based on locomotory organs Based on Morphology of worms

Cilia : Ciliates Tapeworm : cystodes

Flagella : flagellates Leaf like : flukes : Trematodes

Pseudopodia : amoeba Round worm : Nematodes

Non motile : Sporozoa

Host : >1 host

Definitive host : Sexual life cycle of parasite takes place

Intermediate host : Asexual life cycle of parasite takes place

Habitat :
Protozoans
A. Free living protozoans : freely living in soil and water

·
Inhalation while swimming
V

Cross cribriform plate

Meningitis, encephalitis

CSF sample collected

B. Intestinal protozoans
Ingestion (feco oral) 7
Gastroenteritis 3
Stool sample

C. Vaginal protozoans
Sexual route 7 Vaginitis > Vaginal discharge

D. Blood and tissue protozoans > 2 hosts

Vector bite 3 Blood and tissue sample T Peripheral blood smear

Tissue biopsy
Bone marrow biopsy
Microscopy
Sample T Organisms (Trophozoite or cyst)

Habitats of Helminths

Cestodes : intestinal T 2 hosts

Ingestion
Trematodes : extra intestinal 3 Lung / Liver
3 hosts Stool
v

Nematodes : intestinal 3 1 host

Microscopy
Sample : Stool sample : Organisms 3 Eggs
 Protozoans
Based on locomotory organs

W W W
V

Ciliates Amoeba Flagellate Sporozoa

All are intestinal

- v

Balantidium coli Intestinal Blood and tissue

Giardia Leishmania
Tichomonas Trepanosoma
( vaginal) Man is definitive host
V v

Intestinal Free living W V

Intestinal Blood and tissue

Entamoeba histolytica Naegleria W

Acanthmoeba Cryptosporidium Plasmodium

Balamuthia Cyclosporidium Babesia
Suppinia Cystoisospora Toxoplasma

Man is intermediate host

1. Free living protozoa

Present in Soil and water

Man is host
Amoeba

Morphological form : Trophozoite and cyst

Infective form : Cyst
Route of entry : Inhalational while swimming

Clinical diagnosis : Meningitis / Encephalitis

d W

Neck stiffness Seizures

Kerning’s sign
Brudzunki’s sign

V V
v y

Naegleria Acanthmoeba Balamuthia Sappinia

Meningoencephalitis Encephalitis Encephalitis Encephalitis

PAM GAE GAE E

Primary Granulomatous Granulomatous
Amoebic Amoebic Amoebic
Encephalitis Encephalitis Encephalitis

v V

Granulomatous : Chronic diseases

U

Acute disease Acute disease

Contact lens keratitis

 Lab diagnosis and microscopy

Sample : CSF

2 V

Cyst Trophozoite
i
Non Motile -. Pseudopodia
Motile

o CB C
Naegleria Acanthmoeba Balamuthia Sappinia
Lobe like Pseudopodia Thorn like Pseudopodia Branching Pseudopodia Bilobed nucleus
Normal Pseudopodia

Multiple cyst wall is characteristic of free living protozoa

&I Co ⑰
Naegleria Acanthmoeba Balamuthia Sappinia
2 walls 2 walls 3 walls 2 walls
Smooth Outer : Irregular Smooth
Inner : Polyhedral Bilobed nucleus

Not seen in CSF

Treatment
Doc for Naegleria : Amp B
For others : No specific treatment; only supportive treatment
IV fluids, Oxygen, corticosteroids

2. Intestinal protozoan

Intestinal habitat
1 host
Ciliates, amoeba, flagellates, sporozoa

Morphological forms : Trophozoite and cyst

Route of entry : Ingestion
Clinical features : Abdominal pain, vomiting, diarrhoea / dysentery

Ciliates Amoeba Flagellates Sporozoa

Balantidium coli Entamoeba histolytica Giardia Crypto

Cyclo Acid fast protozoa
v
Iso
Large intestinal = Dysentry
V v

Flask shaped ulcer Small intestinal : Diarrhoea

Opportunistic protozoa
V

Malabsorption
 Lab diagnosis

Microscopy : Wet mount of stool sample

Trophozoite
Giardia
1 Axostyle

to
2 suckers

Go
8 flagella
- 2 front
- 2 behind
- 4 side
Balantidium coli Entamoeba histolytica Falling leaf motility
Hair like cilia Pseudopodia +
RBC in cytoplasm : Not always

Cysts
Intestinal protozoa : Single cyst wall and multiple nuclei

Acid fast : Sporozoits

888 ⑧
⑧
Cryptospora
Round
O
B coli Entamoeba Giardia 4-5 um
Round Round Oval shaped
2 nuclei 4 nuclei Axostyle at centre Cyclospora
⑧
4 nuclei Round
⑧ 8-10 um

Isospora
⑱ Oval
25-30 um

Treatment
DOC for all motile intestinal protozoa : Metronidazole
Asymptomatic E. histolytica infection : carriers : Paramomycin > Iodoquonol > Diloxanide furouate

Nitazoxan DOC for Cryptosporidium

Cotrimaxazole
Cotrimaxazole
: DOC for Cyclospora
DOC for Isospora

3. Vaginal protozoa

1 host
Flagellates
Trichomonas vaginalis

Morphology : Only Trophozoite (No cyst)

Infective form : Trophozoite form
Route in entry : Sexual

Clinical manifestations : Vaginal discharge

Vaginitis : vaginal itching

Trichimonas Gardnella vaginalis Candida albicans

Itching + — +++

Discharge Green White White

Consistency and smell Thin ; Fishy smell Fishy smell Thick curdy white
 Microscopy : Vaginal discharge

V V
V

Wet mount Gram stain KOH Mount

*
* Giardia
Clue cells
Trichomonas vaginalis
C
⑧
Candida albicans
Pseudohyphae

5 flagella
1 Axostyle Whiff test + Whiff test —
Badminton shaped
Jerky motility

Treatment : Metronidazole Rx : Metronidazole Rx : Fluconazole

4. Blood and tissue protozoa > 2 hosts Y Transmitted by vector bite

W
V

Flagellates Sporozoa

Leishmania Plasmodium
Trypanosoma Babesia - Purely tissue protozoa No haemolytic anemia
>

Toxoplasma - No vector Feco oral

T

Definitive host cat

>

Morphological forms : Mastigote form Morphological form : Sporozoite form

Transmitted by vector bite Transmitted by vector bite

Definitive host : Man Definitive form : Vector (Toxoplasma : Cat)

Intermediate form : Vector Intermediate host : Man

A. Blood and tissue Flagellates

Leishmania
Morphological forms : Mastigote form > 2 forms

W v

Amastigote form Promastigote form

Round in shape Spindle in shape
No flagella -I

Flagella is in front
Always intracellular

Infective form : Promastigote form

Route of entry : Vector bite : Sandfly (Phlebotomus argentepes)

Clinical manifestations : Leishmaniasis (mc in Bihar)

Cutaneous leishmaniasis 3 Oriental sore / Delhi boil Y L. tropica

Mucocutaneous leishmaniasis > Espundia 3

L. bruzilensis

Visceral leishmaniasis > Kala Azar >

L. donovani

T
PKDL : Post Kala Azar disease leishmaniasis

Involves RES Y Hepatosplenomegaly

 Lab diagnosis

Microscopy : Peripheral blood smear

↓
Amastigote with macrophage T LD bodies

Leishmania Donovan body

Immunological method : ELISA

Rapid Ag test
W V

Ag Ab Special test : Napier’s aldehyde test

d d Rapid Test : rk 39 Ag
High specificity High sensitivity

Treatment : Amp B

Trypanosoma

Morphological form : Trypomastigote

Infective form : Trypanomastigote

Route of entry : Vector

V V

T. cruzi T. bruci
W W

Reduvig bug Tse Tse fly

v V

Chagas disease Sleeping sickness 7 Night time restlessness

> Day time sleepiness

Clinical manifestations Clinical manifestations

W v

Unilateral conjuctivital/ eyelid edema Lymphadenopathy in posterior triangle of neck

V
W

Clinical diagnostic sign Winter bottle sign

Romana’s sign

Lab diagnosis Lab diagnosis

Microscopy : PBS Microscopy : PBS

Treatment Treatment
DOC : Benznidazole DOC : Suramin

B. Blood and tissue Sporozoa

All Blood and tissue Sporozoa : Morphological form and infective form : Sporozoites
Habitat : Blood and tissue
Host : 2 hosts

Plasmodium

Morphological form : Sporozoites T Trophozoite T Schizoites

W

Contains merozoites inside

v

Burst open to release Merozoites

V

Merozoites become Gametocytes

Infective form : Sporozoite form

Route of entry : Female anopheles mosquito

 Clinical manifestations
Malaria Malaria 7 Quotidian T P. knowlesi
Fever - Tertian > Rest all species
Chills Y Quartan > P. malaria
Hepatosplenomegaly

Complications of malaria
• Cerebral malaria x Due to occlusion of cerebral blood vessels

• Algid malaria >

Hypotension and shock

• Black water fever Y Malaria patient treated with quinine

2

Intra vascular hemolysis

• Renal complications 7 ATN : Acute tubular necrosis - A/w : P. falciparum

3 Nephrotic syndrome - A/w : malariae

Species : P. ovale, P. Malariae, P. knowlesi, P. vivax, P. falciparum

Lab diagnosis

Microscopy : PBS 7 Trophozoite Schizoites Gametocytes

P. vivax ⑧ O O
Single ring form Seen

888 E
Not seen
P. falciparum

Single or multiple Attached to capillary Banana shaped

ring forms endothelium

Immunological method
Rapid Test : Ag pLDH : all species of Plasmodium
-

>
HRP2 Ag : +ve for P. falciparum

Treatment
P. Vivax Quinine
T

P. falciparum Artemether
>

Babesia

Morphological forms : Sporozoites -> Trophozoite - Gametocytes

Infective form : Sporozoites
Route of entry : Vector : Hard tick : Ixodid tick

Clinical manifestations
Babesiosis Fever
>

Chills
>

Hepatosplenomegaly
>

Lab diagnosis
Microscopy : PBS Trophozoite Gametocytes

88 Maltese cross
Treatment
Atorvaquone
Toxoplasma
Purely tissue protozoa No haemolytic anemia
>

No vector Feco oral

T

Definitive host cat

>

Morphological forms : Sporulated oocyst containing Sporozoites

8
Enter via feco oral route

·
Reach stomach and intestines

Tachyzoites Blood

Tissue cyst

Become bradyzoites
· Bradyzoites

Intermediate host : Sheep

Tissue
Accidental intermediate host : Man
W v v V

Muscle Eye Brain Dead end

Toxoplasmosis

Infective form : Sporulated oocyst containing Sporozoites

Route of entry : Feco oral

Clinical manifestations
Toxoplasmosis T Cervical lymphadenopathy
Muscle : Myalgia
Eye : Diplopia
Brain : Seizures

Congenital toxoplasmosis : Only parasite to cross placenta

8

Chorio retinitis
Hydrocephalus 7 Due to blockage of CSF
Calcification in brain

Lab diagnosis
Microscopy PBS T Tachyzoites
Y Tissue biopsy Bradyzoites
>

Immunological method
Special test : Sabin fieldmann dye test > Gold standard test
ELISA
IgG avidity test
V

Avidity increases with time

V

Low avidity : Recent infection : Acute disease

Very high avidity : Chronic disease

Diagnosis of congenital infection T

TORCH infections
W

Risk of transmission : 25-30%

V

Indirect test : Ab detection

V

IgM > IgA

For congenital Toxoplasma, IgA > IgM

DOC for Toxoplasmosis : Pyremethamine + Sulfadinizine

DOC for Toxoplasmosis in pregnancy : Spiramycin
DOC in immunocomprosed : Cotrimoxazole
 Helminths

Multicellular
V

Visible to naked eyes

Worms Never infective form

8. Lay eggs

Larva
Infective to some

Infective form (Major)

Helminths
Based on Morphology of worms

g y
r

Cystodes Trematodes Nematodes

Tapeworm Flukes Round worm
Intestinal Extra intestinal Intestinal
2 hosts 3 hosts 1 host

T. solium (pork) Schistosoma (Blood fluke) Strongyloids (Parthenogenic)

Small intestinal 2 hosts Small intestinal
Man is definitive Host Man is definitive Host Ovoviviparous
Pig is intermediate host Snail is 1st intermediate host

T saginata (Beef) P westermani (lung) Acylostoma (hookworm)

Small intestinal Man is definitive Host Small intestinal
Man is definitive Host Snail is 1st intermediate host
Cattle is intermediate host Crab is 2nd intermediate host

E granulosus (Dog) F hepatica (Liver) Ascaris (Roundworm)

Small intestinal Man is definitive Host Small intestinal
Dog is definitive host Snail is 1st intermediate host
Man is intermediate Host Aquatic plants is 2nd intermediate host

H nana (Dwarf) F buski (small intestinal) Enterobius vermicularis (pin/threadworm)

Small intestinal Man is definitive Host Large intestinal
1 host : man Snail is 1st intermediate host No dysentery / No diarrhoea
Aquatic plants is 2nd intermediate host Perianal itching Perianal NIH swab
7

Appendicitis
Clonarchis (Liver)
D Latum (cyclops and fish) Man is definitive Host Trichuris trichura (whipworm)
Small intestinal Snail is 1st intermediate host Large intestinal
3 hosts Fish is 2nd intermediate host Chronic dysentry Iron deficiency anemia
T

Man is definitive Host Rectal prolapse

Cyclops and fish are inter. host Opisthorchis (Liver)
Man is definitive Host Filarial worm
Snail is 1st intermediate host Subcutaneous tissue
v
Fish is 2nd intermediate host Culex
Doc : Praziquantel No eggs
W
Lays larva : Viviparous
Doc : Praziquantel
Trichinella spiralis (Spiral worm)
Muscle 3Myocarditis
Oviparous : lays eggs : diagnosed by stool in eggs 3 Remaining Pig
Viviparous : Larva : diagnosed by larva in tissue biopsy > F, T, D Lays larva : Viviparous
Ovoviviparous : diagnosed by larva in stool sample T Strongyloids

Dracunculus medinensis (Guinea Worm)

Egg is infective form in : 5 Helminths Subcutaneous tissue
2 cestodes : Dog tapeworm and Dwarf tapeworm Cyclops
3 nematodes : Ascaris, E Vermicularis, T trichura Lays larva : Viviparous

Route of infection : 3 Skin Penetration Trematodes Schistosoma

? Nematodes
T
v

7 Strongyloids, Acylostoma Doc : Albendazole

4 vector bite T Filarial worm
Clinical diagnosis

Opportunistic infection : immunocompromised : Strongyloids

Acute infection T 2 cestodes - T solium

>
H nana

3
2 nematodes -
Strongyloids
3
E vermicularis

Anemia > Cestode Y Megaloblastic anemia > D latum

T Nematode > Iron deficiency anemia 7 Trichuris trichura

> Hookworm > Ancylostoma
T
Necator

Carcinoma > Trematodes > Schistosoma hematobium >Bladder Ca

> Schistosoma japanicum T Colon Ca

Chlonarchis HCC & Cholangiocarcinoma

Opisthorchis

Larva migrans (Migrating larva) is due to

Animal nematodes > human nematodes (Only small intestinal)

• Cutaneous Strongyloids
T

Ancylostoma Necator
>

mc : Ancylostoma caninum & Ancylostoma brazilensis

• Visceral T Ascaris

mc : Toxocara canis

Loeffler’s pulmonary eosinophilia

v V

Cough Urticaria

Hypersensitivity reaction of lungs against Larva migrans

V

Visceral larva migrants > Cutaneous Larva migran

Toxocara canis is mcc of Loeffler’s syndrome

Q. Patient on steroids presented with nocturnal cough with chief complaints of urticaria. BAL sample was collected - Multiple larva
Ans : Strongyloids stercolaris

Specific disease
Appendicitis T Enterobius vermicularis
Rectal prolapse T T trichura
Myocarditis T T spiralis

Lab diagnosis
Skin tests
Montenegro test 3 Leishmania
Casoni’s test T E granulosus
Bachman test > T spiralis

Non bile stained eggs

N Necator
E E vermicularis
H H nana
A Ancylostoma
 Eggs floating on saturated salt solution
N Necator
E E vermicularis
H H nana
A Ancylostoma

A Ascaris
T Trichuris trichura

Operculated eggs
3 host Helminths
D latum + All Trematodes except Schistosoma

Identification of eggs

Cestodes

- I
C
Embryophore
-
↑ 3 pairs of hooklets
j

Embryo

T solium / T saginata
W

Acid fast staining

r W

0 0
O

T solium T saginata

- Larva is Infective form - Larva is Infective form

- Definitive host : Man - Definitive host : Man
- Causes : Taeniasis (Gastroenteritis) - Causes : Taeniasis (Gastroenteritis)
- Intermediate host : Pig or man - Intermediate host : Cattle

- V

Tissue cyst
Tissue cyst W
Cysticercosis
Accidental intermediate host
Cysticercosis

<M
Muscular Ocular Neuro
MC Most important

Neurocysticerosis
Clinical manifestations
Asymptomatic : mc
Mc symptom : seizures

Diagnosis : MRI brain

W

Multiple small cyst

Treatment
Albendazole + Steroids
Start steroids first then start Albendazole
Steroids : keeps check on inflammation
Albendazole : Kills T solium
E granulosus
Eggs are not seen in stools of human as man is not definitive host

Tissue cyst >

Hydatid cystic disease or Echinococcosis

<M
Liver Lung Brain
mc

When tissue cyst are formed : Man act as Accidental Intermediate host

&
o
3 layers
Hydatid fluid
Brood capsule
Protoscolex
Larva in cyst

H nana

B
3 pairs of hooklet
Polar filaments

D latum

D
Operculated egg
Trematodes

Schistosoma
1 intermediate host > Non operculated eggs
W

Infective form : Cercaria larva

V

Enters via skin penetration

Schistosoma

W V

Bladder infection Intestinal infection

v W

Cystitis Interitis
V v
S hematobium S mansoni
Chronic : Bladder cancer S japanicum
Chronic : Colon cancer

Eggs
Eggs have spine

D B
Lateral spine : S mansoni
⑧
Lateral knob : S japanicum
Terminal spine : S hematobium

All other Trematodes

2 intermediate host > Operculated eggs
q

Infective form : Metacercaria larva

V

Enters via ingestion

Eggs are Operculated

Nematodes

SS
Strongyloids
Larva in stool
Ovoviviparous

Ancylostoma duodenale
Embryo

8
Inner membrane : irregular
Small intestinal

Ascaris

⑨
Semilunar chitin sheath
Outer irregular albuminous coat

E vermicularis
Plano convex

Large intestinal
Trichuris trichura

⑧
Mucous plugs at both the ends

Extra intestinal nematodes

Viviparous
2 hosts

Filarial worm

Subcutaneous : Subcutaneous nodules

Lymphatics : Swelling due to lymphatic blocks

Commonly seen in North East India

Vector : Culex mosquito

Diagnosis by Peripheral blood smear
W

Microfilaria larva
V
Only larva seen in Blood smear

Wucheria bancrofti Brugiya malayi

B B Lymphatic filariasis

No nuclei in tail tip 2 large nuclei in tail tip

Sheath present outside Sheath present outside

Onchocerca volvulus Loa loa

B B Subcutaneous filariasis

No nuclei in tail tip Multiple small nuclei in tail tip

No sheath present outside Sheath present outside
 T spiralis

Mc : Ocular muscle > Cardiac muscle

W V

Diplopia Myocarditis

Diagnosis
Muscle biopsy

Spiral larva
⑨
Skin : Bachman test

D medinensis

Clinical manifestations
Skin blisters Only parasite to form skin blisters
>

Rupture
V

Place that area into water

V

Larva comes out

Adult worm
T solium T saginata
Tapeworm

EE Rostellum present Rostellum absent

F
-

T solium T saginata

F hepatica F buski
Leaf like

* A
Triangular projection present Triangular projection absent

F hepatica F buski
Life cycle

Organism T Morphological forms

Helminths

Operculated eggs Y 2 intermediate hosts

If 1st intermediate host is

V
Snail T 100% Trematodes

W V

No 2nd intermediate host 2nd intermediate host

V

Schistosoma v V 2

Crab Aquatic Fish

V v V

P westermani Faschiola hepatica Clonarchis

Adult worms Opisthorchis

Cyclops 7 No 2nd intermediate host > D medinensis

>
Fish as 2nd intermediate host >
D latum

For others >

Identify by eggs