Parasitology OSPE

Y2S2
Giardia duodenalis
 Giardia duodenalis Flagellate in
Giardiasis Small intestine

Cyst: 8-14 m , oval,

4 nuclei,
remnants of flagellae

Trophozoite 8-16 m pear shape 2

nuclei
4 pairs of flagellae
bilaterally symmetrical
Convex dorsally
ventral adhesive disc

3
Giardia duodenalis Giardia duodenalis
trophozoites cyst
4
Cryptosporidium
Cryptosporidium Oocysts
Modified Acid Fast Stain of Faeces

6
Trichomonas vaginalis
 General features of Trichomonas

NO cystic stage
Pear shaped
4-5 anterior flagella
Undulating membrane
Nucleus - single
Axostyle- central rod
Cytostome +/- mouth
8
Entamoeba histolytica
Entamoeba histolytica - causes amoebiasis

2 stages: trophozoite & cyst

Trophozoite: E. histolytica RBCs +

growing & motile stage
Pseudopodia
Inclusions- RBCs (invasive forms)
Nucleus- single

E. dispar
E. dispar identical morphology
but not invasive
NO RBC INCLUSIONS
E. histolytica Cyst -
Nucleii: 1- 4

Inactive, non motile and

infective stage

E. dispar cyst identical morphology

CANNOT DIFFERENTIATE from E.
histolytica cyst
Entamoeba coli cyst – 8 Nucleii

Commensal – NOT a pathogen

 Differentiation of E.hislolytica from other non-pathogenic
intestinal protozoa is very important

Entamoeba coli cyst

Size – larger
>4 nuclei

Entamoeba histolytica cyst = Entamoeba dispar cyst

1- 4 nucleii
Amoebic ulceration
with unaffected mucosa in between
•Trophozoites produce a 'flask-shaped' ulcer int
the submucosa
( typical appearance of intestinal amoebiasis)

Laboratory flask shape

Balantidium coli
Balantidium coli Largest of the parasitic protozoans
Cause balantidiasis
Rare infection Pig main reservoir
Large intestinal - tissue invasive

Clinically similar to amoebic dysentery

but NO extra-intestinal spread
Treatment – tetracycline or metronidazole

Trophozoite Cyst
60-70 m 50-60 m
Toxoplasma gondii
 Morphology – 3 infective forms:
Characteristic form is crescentic shaped Tachyzoite
Toxoplasma

1. Tachyzoites (endozoites) and pseudocysts–

gondii

Tachyzoites - Crescent shape, single nucleus

found in macrophages (pseudocyst) or any
nucleated cell . Multiply rapidly = Tachyzoites
Pseudocysts can cross the placenta
Pseudocyst
Tachyzoites
Cause inflammatory response
and tissue destruction

CLINICAL MANIFESTATIONS
 2. Bradyzoites ( cystozoites) and True cysts – can be
found in any part of the body organs common in
brain, eye, heart.
Cyst wall is formed by the parasite and host.
zoites in true cysts multiply slowly = Bradyzoites
LATENT INFECTION

In immunocompromised patients :-

bradyzoites are released from cysts,

transform back into tachyzoites

cause REACTIVATION of the infection

3.Oocyst – formed in the small intestine of
the cat and passed in cat faeces.

Each sporulated oocyst contains 02 sporocysts

each sporocyst has 04 sporozoites

NOT FOUND IN HUMANS and other intermediate

hosts
Malaria-Plasmodium sp.
23
ERYTHOCYTIC CYCLE - P vivax
Trophozoites
ring
ameoboid

Schizonts rupture - 48h

schizont
RBC: enlarged
)
&
Gametocytes 24
female & male
Pf schizonts rare in peripheral blood 25
P falciparum: FALCIPARUM MALARIA

Erythrocytic stages:
Rings -
multiple infection common
fine, hair –like rings (1/6th rbc)
nucleus single/ fragmented (ear phone)
marginal forms (accole/applique)

Red Blood Cell -

NOT ENLARGED
26
P.falciparum – high parasitaemia

Severe complicated disease -

fatal

Falciparum
gametocytes

27
P falciparum- No late stages - amoeboid or schizonts in
peripheral blood

Schizogony in capillaries of internal

organs - SEQUESTRATION

Schizonts rupture – 48h

Gametocytes- late (10 days)

persists- 4 months
Crescent shape
Female & Male
28
 Plasmadium malariae - quartern malaria

Trophozoites: rings
band-form
pigment dark brown

Schizonts rupture - 72 h

Schizont: daisy head

Gametocytes:
Similar to P.vivax but RBC not enlarged 29
Plasmodium ovale- ovale malaria
Confined to Africa. Common in West Africa
(P.vivax absent – Duffy blood gp Ag absent)

Parasitized red cells appear oval

parasite ‘vivax -like’

Imported cases of P. ovale

reported in SL

30
5th Human Malaria Parasite
Plasmodium knowlesi
Rapidly multiply – Quotidian
24h Erythrocytic cycle

Early Trophozoites: Late Trophozoites :

small rings like band-forms like
P.falciparum P.malariae 31
P. knowlesi – late trophozoites
Band forms like P.malariae

32
Anopheles
culicifacies
Rural Malaria Vector
in SL
33
First record A. stephensi,
of Anopheles urban malaria
stephensi in Sri Lanka: vector in India
a potential challenge to
prevent malaria
reintroduction

Dharmasiri et al –
Malaria Journal 2017
16:326

34
35
36
 P. falciparum – thin rings

Thin blood smear Thick blood smear

37
Leishmania
 VECTOR of Leishmania
Sandfly
Lutzomyia sp
Phlebotomus sp

The parasite is found

in its PROMASTIGOTE
form in the sand fly

Extracellular, motile
promastigotes

Vector- adult female sand fly

●39
 Hosts

Man Wild animals

Dog

The parasite is found in

its AMASTIGOTE form
in the vertebrate host :
Host-vertebrates
Intracellular, non-motile • Rodents,
gerbils etc
●40
Typical “dot&dash”
appearance of
amastigotes

Amastigotes seen in a smear from a skin lesion

●41
• Culture

Promastigotes seen in a cluture

●42
www.dpd.cdc.gov
 Fig. X is a lesion in a soldier who served in Kilinochchi.
8 Fig. Y shows a smear from the lesion

A. Name the likely causative organism. (40 marks)

B. How has this patient got infected? State the infective stage
and method of transmission (60 marks)

Fig.X Fig.Y
Trypanosoma
 African
Trypanosomiasis
Vector- Tsetse fly
Glossina spp

• Sexy

Hosts- Vertebrate
animals including man

●45
American trypanosomiasis/ Chaga’s
disease/ Mega disease
Parasite-Trypanosoma cruzi

Vector- Reduvid bug/ Triatomine bug/ Kissing bug

Taking a blood meal through human skin.

Parasite is excreted in feces which is
deposited near bite.
Scratching Breach of skin

Parasitemia

(or can also enter through other sites. e.g

eye)
●46
Tissue Nematodes
 Adults of
Wuchereria bancrofti
are long and threadlike.
MALES (left) measure
up to 40 mm long
and FEMALES (right)
are 80-100 mm long.

Source: www.cdc.gov

48
Worms within lymph vessel

49
Larva developing in the
mosquito thoracic muscle

50
Infective larvae (L3) emerging from proboscis of mosquito

51
Wuchereria bancrofti Brugia malayi

head space

tail nuclei

244-296 (x 7.5-10) m 177-230 (x5-7) m

Lie- graceful curves kinked (acute angles)
head space- short long
nuclei- countable, overlapping,tail nuclei+ 52
 Immunochromatographic
card test

Ag detection
ELISA plate

53
D. repens - mature adult worm
D. repens - immature worm
Definitive host – Dog
Accidental host – Human

54
100x

Cross-sections of Dirofilaria sp. from a subcutaneous nodule

stained with hematoxylin and eosin (H&E).
55
Ascaris lumbricoides
Morphology
Adult

• Very large worm

• Adult females: 20 to 35 cm
• Adult males: 15 to 30 cm, curved
tail
• A female may lay approximately
200,000 eggs per day
• Anterior end has three lips
• Live in the lumen of the small
intestine
57
 Morphology – fertilized egg

Shape Round to oval

Size 50-70um x 40-50um

Surrounded by a thick smooth transleucent shell consisting of three layers:

- The outer coarsely mamillated albuminoid coat
Covering - A thick transparent middle layer
- Inner lipoidal vitelline membrane (Some eggs are found in feces without the outer
mamillated albuminous coat. These are called decorticated eggs)

Ovum Contains a large unsegmented ovum of granular mass with clear space at both the end
58
Source: http://laboratorytests.org/ascaris-lumbricoides-roundworm-egg/
 Shape Round to oval.

Morphology – unfertilized egg

Shape elongate than fertilized eggs

Size 90µm x 45µm
Covering Albuminous coat is thin, distorted and scanty.
Contains an unsegmented small atrophied ovum with a
Ovum
mass of disorganized highly refractile granules.
59
Source: http://laboratorytests.org/ascaris-lumbricoides-roundworm-egg/
Hookworms
Morphology
Necator americanus - 1 cm in length, head sharply bent backwards.
Buccal capsule has a pair of ventral cutting plates.

61
Morphology
A. duodenale - slightly larger, head bent backwards in a smooth curve.
Buccal capsule has two pairs of teeth

62
Males have expanded tails to form the
copulatory bursa in both species

63
Egg Morphology
• Ovoid, 60 x 40 um with a thin glass like shell. Embryo usually
segmented when pass out with the faeces

64
Trichuris trichiura
 Trichuris trichiura
Whip worm

Anterior

Posterior
 Trichuris trichiura

Morphology - 3 - 5 cm long
Anterior end: Thin and is threaded into
the mucosa of the large intestine.
Posterior end: Thick (whip handle).

Posterior end of male is curved.

 Whip worms embedded into LI mucosa
(by anterior ends)

Posterior ends of Posterior ends of

males females
Egg - Paddy seed shape with
two polar plugs
Enterobius vermicularis
Enterobius vermicularis
Pin worm
 Enterobius
vermicularis

Morphology -
creamy white,
1cm, spindle
shaped
Eggs - Plano-convex (50 x 25 um)
Double walled.
Developing embryo inside.
 Diagnosis
Demonstration of eggs:
Graham’s Scotch Tape method
A simple ‘cello-tape’
Cotton wool swab
Adults
Larva migrans
Cutaneous larva
migrans - CLM /
Creeping eruptions
Cestodes
Common features of cestodes
• Shape: Flat ribbon like parasites
• Location: Adults are living in the small intestine
of vertebrates.
• Size: A few mm to almost 10 m!
• No body cavity or alimentary canal
• Hermaphrodite

82
83
Scolex (Head)
Equipped with a variety of
holdfast organs
- hooks
- acetabula (suckers)
- rosetellum

Neck (growth region)

- contains stem cells that are
responsible for giving rise to new
proglottids.

Strobilation – differentiation of new

proglottids
near the anterior end.
84
 Strobila (Body)
• Immature proglottids
• Youngest proglottids (prepuberty proglottids).
• Mature proglottids
• Locate between immature and gravid proglottids
• Contain male and female reproductive organs
which are completely matured and capable of
reproduction.
• Gravid proglottids (old/aged)
• Filled up with eggs, just before detachment.
Taenia solium
Pork tapeworm
 Taenia solium
(Pork tape worm)
General features
• The adult is 3-5 m in length.
• The scolex bears a rostellum.
• Has four suckers with a double row of hooks.
• Rostellum armed with two rows of hooks.
• Location: Adults in the SI of
man

• Egg: Striated wall. Embryo

inside called onchosphere

• Larval stage: Cysticercus

Found in skeletal/cardiac
muscle of pigs
Taenia saginata
Beef tapeworm
Taenia saginata (Beef tape worm)
General features
• Usually 3-5 m in length.
(can grow up to 20 m in length)
• The scolex does not have a rostellum.
• Four suckers in the scolex.
• T. saginata is the largest of the genus Taenia.
• Can survive in many years.
 Diagnosis of T. solium and T. saginata
1. Identification of gravid segments in
feces.
Segments after injecting dye show lateral
branches of uterus

>13 uterine branches in T.

saginata
<13 uterine branches
in T. solium

91
Diagnosis contd…
2. Identification of scolex (if passed in
feces)

T. saginata T. solium
92
3. Eggs- all taenid eggs are similar

• Note-
• Keratin blocks forming
the egg wall
• Embryo with 6 larval
hooklets.

4. Serology-to detect
Antibodies/ Antigen- only
in invasive infections
93
Dog Tapeworm
Echinococcus granulosus

94
Echinococcus granulosus

Scolex
Immature segment

Mature segment

Gravid segment

95
 Hydatidosis
• Larval stage of E.
granulosus: Hydatid cyst.
Cyst at removal
• Ingestion of the egg by
accidental intermediate
host, onchosphere enters
circulation carried to
many organs – liver, lungs,
kidney, bone.
• Parasite forms a slow
growing cyst in organ.
Large hydatid cyst
opened to expose
numerous daughter cysts

96
Histology of a hydatid cyst Brood capsules
with
protoscolices

Germinal
layer
(envoys)
Hyaline layer
(ectocyst)

Fibrous layer
(pericyst)
97
Hydatid Cyst

98
 Multi-organ hydatidosis with extensive involvement of the hemi-pelvis and ipsilateral
femur

Kapoor et al., 2013 (Parasitology International) 99

 Diagnosis
• Radiology - lung cysts
‘water lily’ sign
• Ultrasound
• Intradermal test - CASONI
test , use cyst fluid as
antigen; hypersensitivity
reaction
• Serology- IFAT, ELISA,
Immunoelectrophoresis Treatment – Albendazole may reduce size of a
cyst, may even cure
(IEP) Surgical intervention

100
Hymenolepis diminuta
Rat tapeworm
Hymenolepis diminuta

Mature segments
of Hymenolepis sp

Egg
102
Hymenolepis nana
Dwarf tapeworm
Morphology-H. nana

Egg
Scolex
104
Trematodes
Flukes
Schistosomes
Blood flukes
 General morphology of
adults
• Flat, elongated and leaf shaped worms (except schistosomes which
are round and worm-like)
• Suckers for attachment to host.
• Hermaphrodites (except schistosomes)
• Size varies: 1mm to several centimeters

107
Schistosomes –
Blood flukes

108
Life cycle of
schistosomes MAN-Definitive Host
Adult fluke

Eggs passed in urine/

faeces

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
Water/ Moisture
Cercaria

SNAIL-Intermediate Host Miracidium

Redia<-Sporocyst (ciliated larva) 109
Schistosome eggs

110
Fasciola hepatica
Sheep liver fluke
Fasciola hepatica

Flat and leaf like. Body

surface has spines.

112
Fasciola hepatica- Diagnosis

1. Direct method- eggs in feces

(but scanty)
2. Indirect method- detection
of antigen/ antibody using
ELISA, IF methods.

113
Clonorchis sinesis
Chinese liver fluke
Clonorchis sinensis
Chinese liver fluke

Flat and elongated.

Narrow pointed
anterior end.
Adults found in bile
ducts and pancreatic
ducts.

115
 Clinical features and Diagnosis
Depends on the worm load Diagnosis:
• Fever • Demonstration of
• R/hypochondriac pain eggs in feces.
• Jaundice
• Cholecystitis, hepatitis,
pancreatitis etc.
• Malignancy in liver and bile
duct

116
Fasciolopsis buski
Intestinal flukes
 Intestinal flukes
Fasciolopsis buski
Largest human trematode (2cm
x 7cm)
Common in SE Asia.
No local cases.
Common parasite of man and
pig
Adult in small intestine.

118
Clinical features and diagnosis
• Generally asymptomatic.

Diagnosis: Demonstration of
eggs in stools. Occasionally,
adult flukes are passed out.

119
Paragonimus westermani
Lung flukes
Lung flukes
Paragonimus westermani

Common in Far East.

In Sri Lanka, found in
wild animals. No
human cases.
Fluke is thick & fleshy.
Similar to coffee
seeds.
Adults found in lungs,
encysted in pairs
121
Infected crabs

122
 Clinical features and Diagnosis
 Fever ⚫ Eggs in stool or sputum.
 Cough
 Pleural pain,
 Haemoptysis
(symptoms and
signs similar toTB)

123
Arthropods
Arachnida ; Insecta:
• Two main body division
• Fused Head & thorax • Body divided in to three
• Abdomen parts :
Head, thorax and abdomen
• Adult has FOUR pairs
• Adults have THREE pairs of
of legs legs
• Wingless With or without wings
Eg: Ticks, mites
Mosquitoes
Eggs: Eggs:
laid singly in clusters
with floats

Larvae: Larvae:
parallel to siphon tube +
surface
no siphon
tube

Adult: rests
Adult: rests @
parallel to
45º angle to
surface
surface
 Malarial vector
Anopheles culicifacies
Adult: Size: small- medium
wings & female palps - banding
resting position: culicine-like
 Culex quin..
Culex quinquefasciatus
Very common urban domestic mosquito
throughout South/SE Asia- vector of
bancroftian filariasis

Small, brown, absence of markings

 Small, delicate, black & white
Aedes spp. banding on legs.
wings clear

Ae. aegypti Ae. albopictus

Most important to know how

to identify
Mansonia spp.

Vector of
Brugian filariasis

Brown, speckled wings (light/dark scales)-

not important to identify

Breeding: eggs laid on undersurface of

leaves of water plants
Larvae/pupae attached to plant roots
Armigeres sp
Very common dusk/night biter
Pest & vector of Dirofilaria repens
Breeding: polluted water

Dirofilariasis
Dirofilaria repens: common Causes subcutaneous
parasite of dogs nodules in humans

Transmitted by Aedes,
Armigeres,
Mansonia
Ticks
 Hard tick
family Ixodidae

1. scutum/ dorsal shield on its

back
2. Mouth parts visible
 Soft tick

1. Without scutum/ dorsal shield

2. Mouth parts are

ventral and not visible
Mites
 Sarcoptes scabeii
Causes scabies

Maculo-papular itchy
rash on specific
areas of the body.
Transmitted from
person to person.
Highly contagious
Small , flattened, disc-shaped mite
Just visible to the naked eye

Adult: 4 pairs of short stumpy legs

vector of Orientia tsutsugamushi
cause of SCRUB TYPHUS
Lice
LICE

Man - sucking lice (suck blood)

•Head Lice - Pediculus humanus capitis
•Body Lice - P.h. corporis
•Pubic Lice (or Crab Lice ) - Pthirus pubis
Fleas
General features of fleas
• Wingless, blood sucking ectoparasites of
vertebrate animals
Vectors of -
• Bubonic plague due to Yersinia pestis

• Endemic typhus due to Rickettsiae sp

• Cestode infections eg. Cysticercoid stage

of
Hymenolepis diminuta-in Rat flea &
Dipylidium caninum – in Dog flea
Flies
 Housefly ( Musca domestica)
• Light or dark gray colour
• Has – head , thorax and abdomen
• Thorax has 4 longitudinal black
stripes

Myiasis

Invasion of living tissues of man and

animals by the larvae of certain species
of Dipterous flies
Dermotobia hominis
The larvae of this fly lay eggs
ind living tissuent

Larvae may be found on skin, wounds and eyes

65-year-old man presented with skin lesions on his chest and left
arm and shoulder.
Myiasis
Dermatobia hominis
in eyelid
 Sand fly

Identification: Smaller than a mosquito

Hairy body
Long legs
Snakes