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Parasitology Study Notes: Ascaris, Trichuris, Hookworm & More
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Ascaris lumbricoides PARASITE COMMON NAME Ascaris lumbricoides Giant or large intestinal roundworm DIAGNOSTIC STAGE Fertilized or unfertilized egg INFECTIVE STAGE Embryonated egg MOT Ingestion of embryonated egg APPEARANCE White, cream, or pinkish yellow when fresh Ant. End: three lips buccal cavity / Triudate plates ADULT FEMALE Post. End: Straight pointed 22-35 cm by 5 mm Production: 200,000 or 240,000/day 65 million fertilized eggs ADULT MALE EGG Post. End: Curved tail 10-31 cm by 3 mm Fertilized: 45-70 by 35-50 um Ovoidal, golden brown, very thick egg shell, organized germ cell Inner vitelline membrane, glycogen layer, albuminous mammillation Unfertilized/Infertile: 88-94 by 39-44 um Irregularly ovoidal, larger, longer, narrower, thin shell, irregular mamillated coating No vitelline membranes, with lecithin granules, glycogen layer, albuminous mammillation Embryonated egg: no germ layer but has embryo inside Thrives in moist, dark, and cold areas Destroyed by direct sunlight (9-13hrs) Killed at temp above 40C Survive freezing temp Resistant to chemical disinfectant and withstand temporary immersion in chemicals DIAGNOSIS DFS, Kato Katz, FECT TREATMENT Mebendazole, Albendazole, Pyrantel pamoate, Levamisole, Piperazine salts LIFE CYCLE Eggs ingested Adult = 9-11 weeks Fertilized egg Embryonated = trances: 2 weeks, notes: 2months – 2yrs Migration: 14 days Life span: 1 yr OTHER NOTES Toxocara canis – dog Toxocara cati – cat Habitat – small intestine Trichuris trichiura PARASITE COMMON NAME Trichuris trichiura Whipworm DIAGNOSTIC STAGE Unembryonated egg INFECTIVE STAGE Embryonated egg MOT Ingestion of embryonated egg APPEARANCE Flesh-colored or pinkish slender worms Ant. End: colorless, resembles a whip, contains slender esophagus Post. End: digestive and reproductive organs Life span: 1-2yrs ADULT FEMALE Post. End: Straight/blunt 3.5-5 cm by 35-50 mm Production: 3,000 – 10,000/day ADULT MALE Post. End: Coiled or curved through 360; with a single spicule and retractile sheath 3-4.5 cm by 30-45 mm EGG Shape: barrel-shaped with protruding bipolar mucus plug; Japanese lantern, football shaped, lemon-shaped Thick shelled, bile stained Outer: yellowish Inner: transparent shell 50-54 by 22-23 um Discharged in unsegmented stage DIAGNOSIS DFS, Kato Katz, FECT TREATMENT Mebendazole, Albendazole, Pyrantel pamoate, Levamisole, Piperazine salts OTHER NOTES Final habitat: large intestine, specific: cecum TT47-pore forming protein – allows them to embed Hookworm PARASITE COMMON NAME Necator americanus Ancylostoma duodenale Ancylostoma braziliense - cat Ancylostoma caninum - dog Hookworm NA - American, American murderer, New world hookworm AD - Old World hookworm DIAGNOSTIC STAGE Eggs in feces INFECTIVE STAGE Filariform larva MOT Skin penetration APPEARANCE Pinkish, cream yellow, grayish white Small, cylindrical, fusiform Necator – semilunar cutting plates Braziliense – 1 pair Caninum – 3 pairs Duodenale – 2 pairs ADULT FEMALE Post. End: Blunt 9-11 mm by 0.35 mm ADULT MALE Post. End: Bursa copulatrix or membranous caudal bursa or umbrella-like structure with rib like rays 5-9 mm by 0.30 mm RHABDITIFORM L Feeding stage, short and stout, long buccal activity with flaskshaped esophagus, inconspicuous genital primordium FILARIFORM LARVA Longer and slender, pointed posterior end, sheathed EGG Colorless to pale yellow Ovoidal, surrounded by thin, transparent hyaline shell membrane 56-60 um by 34-40 um When passed to the feces, they are in the 2-8 cell stage (Morula ball formation) DIAGNOSIS DFS, Harada-Mori Culture, Kato Katz, FECT TREATMENT Mebendazole, Albendazole (drug of choice) OTHER NOTES Strongyloides stercoralis PARASITE Strongyloides stercoralis COMMON NAME Threadworm DIAGNOSTIC / FEEDING STAGE Rhabditiform larva INFECTIVE STAGE Filariform larva MOT Skin penetration OTHER HOST Dog ADULT FEMALE Parasitic / Filariform: Colorless, small, semi-transparent Ant. End: With esophagus occupying 1/3 of Ant. Part; tapering end Post. End: short conical pointed tail Size: 2.2 by 0.04 mm Buccal Cavity: four indistinct lips Free-living: Shorter but stouter Double bulb muscular esophageal pharynx Size: 1mm by 0.06 mm Intestine: straight cylindrical tube ADULT MALE No parasitic male Free-living: Size: 0.7 by 0.04 mm Broadly fusiform, smaller than FL female Post. End: ventrally curved tail, 2 copulatory spicule, a gubernaculum but no caudal alae RHABDITIFORM Short buccal cavity; Elongated club-shaped esophagus; Conspicuous genital primordium FILARIFORM EGG Unsheathed, alpha-notched tail Shape: Chinese lantern ova Clear thin shell DIAGNOSIS DFS, Harada Mori, Baermann funnel gauze method, Beale’s string test, Duodenal aspiration / small bowl biopsy, and Sputum or Urine TREATMENT Mebendazole, Albendazole (drug of choice) OTHER NOTES Capillaria philipinensis PARASITE COMMON NAME HOST Capillaria philipinensis Pudoc worm Definitive host: fish eating bird Intermediate host: fish (ipon, bagsa, bagsit) Incidental host: human DIAGNOSTIC STAGE Unembryonated egg INFECTIVE STAGE infective larvae MOT Ingestion of raw/undercooked infected fish ADULT FEMALE 2.3-5.3 mm Typical: 8-10 in a single row Atypical: 40-45 in 2-3 rows ADULT MALE 1.5-3.9 mm Chitinized spicule and a long spicule sheath extending beyond the length of the worm Stichocytes – secretory granules found in the esophagus of C. p Stichosomes – entire esophabian structure EGG Typical: pale yellow with moderately thick striated shell and flattened bipolar plus, peanut shaped Atypical: thin-shelled without polar plugs Size: 42 by 20 um DIAGNOSIS DFS, Acid Ether Conc. Technique, Duodenal aspirate, ELISA TREATMENT Mebendazole, Albendazole Patients with electrolyte and protein loss – given electrolyte replacement and high protein diet OTHER NOTES Enterobius vermicularis PARASITE COMMON NAME Enterobius vermicularis Human pinworm, seatworm, society worm DIAGNOSTIC STAGE Embryonated egg INFECTIVE STAGE Embryonated egg MOT Egg is ingested, Inhalation APPEARANCE Small, whitish, brownish Ant End: pair of lateral wings or cephalic alae ADULT FEMALE Size: 8-13 mm by 0.4 mm Post. End: long pointed tail The uteri of gravid is distended with eggs ADULT MALE 2-5 mm by 0.1-0.2 mm Post. End: curved tail and a single spicule Rarely seen, usually dies after copulation RHABDITIFORM LARVA 140-150 μm by 10 μm Has esophageal bulb, but no cuticular expansion on the anterior end. EGG 50-60 μm by 20-30 μm Shape: D-shaped ova, one side flattened and the other side convex. Mechanical protection: Translucent shell; outer triple albuminous covering Chemical protection: inner embryonic lipoidal membrane Inside the egg: a tadpole like embryo, fully mature outside host within 4-6 hrs. DIAGNOSIS Graham’s scotch adhesive tape swab (perianal cellulose tape swab) TREATMENT Mebendazole, Albendazole, Pyrantel pamoate Treatment of the entire household OTHER NOTES Trichinella spiralis PARASITE COMMON NAME Trichinella spiralis Trichina worm, Garbage worm, Tissue roundworm, Muscle worm DIAGNOSTIC STAGE Infective larva INFECTIVE STAGE Infective larva MOT Ingestion of undercooked meat ADULT FEMALE Size: 1.26 – 3.35 mm by 0.029 – 0.038 mm With vulvae opening situated at the ant. 5th of the body with a single ovary found near the caudal end Post. End: blunt rounded Club-shaped uterus Production: 1500 larvae in its life time Life span: 30 days ADULT MALE Size: 0.62 – 1.58 by 0.025 – 0.033 mm With single testis; delicately anteriorly and rounded posteriorly Cloaca at the caudal portion is guarded by 2 conspicuous papillae that holds female during copulation TRICHINELLA LARVA Encysted (infective, pathogenic, and diagnostic stage) Ant. End: Spearlike burrowing tip Size at birth: 80 – 120 um by 10 um Enters a muscle fiber, attains size: 0.65 – 1.45 mm by 0.026 – 0.040 mm Fully developed: may reach up to 1 mm DIAGNOSIS Muscle biopsy, Digestion of muscle samples with pepsin and HCl, Non-specific lab test, Serological test TREATMENT Bed rest and supportive treatment Thiabendazole, Mebendazole, Albendazole OTHER NOTES Filarial worms COMMON NAME Filarial worms DIAGNOSTIC STAGE Microfilaria INFECTIVE STAGE Infective stage to man: Filariform larva / 3rd stage larva Infective stage to vector: Microfilaria HOST Definitive host: Human Intermediate host: Vector MOT Skin penetration Part 1 PARASITE COMMON NAME VECTOR Wuchereria bancrofti Bancrofti’s filarial worm Aedes / Anopheles mosquito / Culex Aedes poecilus – urban type; prevalent in abaca raising areas Anopheles minimus flavirostris – rural type; mountains and hills DIAGNOSTIC STAGE Microfilariae INFECTIVE STAGE L3 larvae HABITAT Lymphatics (lower) SPECIMEN Blood DISEASE Elephantiasis (lower) APPEARANCE / CHARACTERISTICS Long, creamy white, filiform in shape Sheathed (does not stain well with Giemsa) Tail: pointed and free of nuclei Nocturnal Periodicity FEMALE 80 – 100 mm MALE 20 – 40 mm LARVA / MICROFILARIA PARASITE Minute, snakelike organisms Size: 270 – 290 um by 6 – 7 um Enclosed in a hyaline sheath Brugia malayi COMMON NAME Malayan filarial worm OTHER HOST Reservoir host: cat VECTOR Mansonia sp. Mosquito Mansonia bonneae – freshwater swamps Mansonia uniformis – rice field DIAGNOSTIC STAGE Microfilariae in human blood INFECTIVE STAGE L3 larvae HABITAT Lymphatics (upper) SPECIMEN Blood DISEASE Elephantiasis (upper) CHARACTERISTICS Sheathed Two distinct nuclei in the tip of the tail Subperiodic Nocturnal Periodicity Giemsa-stain: pink FEMALE 43 – 55 mm MALE 13 – 23 mm LARVA / MICROFILARIA 111 – 230 um COMBINED DIAGNOSIS Specimen: Capillary blood from skin puncture Wet Preparation – motility Thick blood film – dehemoglobinized Blood collection – between 8:00 pm – 4:00 am Specimen: Venous blood Knott’s technique – isolation of microfilariae Rgt: 1 part of blood + 9 parts of formalin + acetic acid RBC hemolyzed, then stain with Giemsa Detection of circulating filarial antigens (CFA) - Immunochromatographic card test - Sensitive and specific LABORATORY DIAGNOSIS Microfilariae: demonstration of microfilariae in peripheral blood - Thick blood smear – 2-3 drops of free flowing blood from dermal puncture - Membrane filtration method – 1-2 ml intravenous blood through 3um pore size membrane filter - DEC Provocative test (2 mg/kg) – after consuming DEC, mf enters into the peripheral blood in day time within 30-45 mins Adult: biopsy of nodes or lymphatic vessels Immunological test: antibody or circulating filarial antigen (CFA) TREATMENT Diethylcarbamazine citrate, ivermectin with albendazole PART 2 PARASITE Loa loa COMMON NAME Eye worm, African eye worm OTHER HOST Intermediate host: horse fly, deer fly, or Chrysops VECTOR Tabanid / Mango fly / Chrysops specie DIAGNOSTIC STAGE Microfilariae INFECTIVE STAGE Infective juvenile HABITAT Subcutaneous tissue or the conjunctiva of the eye SPECIMEN Blood / eye tissue DISEASE Swelling of the eyes (Calabar or fugitive swelling) LABORATORY DIAGNOSIS Giemsa stain Knott technique Best time to collect: 10:15 AM – 2:15 PM Diurnal TREATMENT DEC – may lead to encephalitis PARASITE Onchocerca volvulus COMMON NAME VECTOR Blinding Filaria Black fly Simulium specie / Simulium blackfly DIAGNOSTIC STAGE Microfilariae INFECTIVE STAGE L3 larvae HABITAT Subcutaneous tissue SPECIMEN Skin nips / skin shaving DISEASE Blinding filarial worm causing river blindness APPEARANCE / CHARACTERISTICS Thin and wirelike, coil up in knots inside infected skin nodules Unsheathed Nuclei do not extend up to the tip of the tail Non-periodic FEMALE 500 mm MALE 25-50 mm LABORATORY DIAGNOSIS Specimen of choice: skin snips/shaving PARASITE Mansonella ozzardi COMMON NAME New World filaria APPEARANCE Unsheathed Numerous nuclei but do not extend to the tip of tail Non-periodic DIAGNOSTIC STAGE Microfilariae INFECTIVE STAGE L3 larvae FEMALE 65 – 80 mm, ave: 70 mm MALE 32 mm DIAGNOSIS Giemsa stained peripheral blood PARASITE Mansonella perstans COMMON NAME HABITAT APPEARANCE Perstans filaria Peritoneal and pleural cavities, as well as mesentery Unsheathed Numerous extend to the tip of the tail Non-periodic FEMALE 82 mm MALE 43 mm DIAGNOSIS Giemsa stained peripheral blood TREATMENT DEC and mebendazole PARASITE Mansonella streptocerca COMMON NAME HABITAT Skin and subcutaneous tissue SPECIMEN Skin nips DISEASE Non-pathogenic but may cause elephantiasis and cutaneous edema APPEARANCE Nuclei continuous to the tip Relatively straight but strongly bent in “shepherd’s crook curve” Non-periodic PARASITE Dirofilaria immitis COMMON NAME Dog heartworm SYMPTOMS IN MAN Cough, chest pain PARASITE COMMON NAME INTERMEDIATE HOST MOT DISEASE Dracunculus medinensis Medina worm, guinea worm, serpent worm, dragon worm of fiery serpent of the israelites Aquatic crustacean cyclops Accidental ingestion of crustacean with larva Toxemia May cause urticaria, dyspnea, vomiting, pruritus, giddiness due to allergy to toxic substance. LIFE SPAN 1-5 years Angiostrongylus cantonensis PARASITE COMMON NAME HOST Angiostrongylus cantonensis Rat lungworm Definitive host: rats Incidental host: human Intermediate host: snails/slugs DIAGNOSTIC STAGE Infective larva INFECTIVE STAGE Infective stage to humans: 3rd stage larva Infective stage to rodents/rats: 3rd stage larva Infective stage to snails/slugs: 1st stage larva MOT HABITAT Ingestion of raw mollusk Ingestion of leafy vegetables contaminated with mucus secretions of the mollusk Ingestion of paratenic host like prawn or crab Drinking contaminated water Lungs APPEARANCE Pale and filiform ADULT FEMALE Size: 19 – 33 mm and 0.28 – 0.50 mm With uterine tubules (barber’s pole pattern) Post. End: blunt-shaped Production: 15,000/day ADULT MALE EGG Size: 17 – 25 mm and 0.25 – 0.35 mm With well developed caudal bursa (kindey-shaped and singlelobed) Ovoidal with delicate hyaline shell Size: 46 – 48 by 68 – 74 um Unembryonated when deposited LARVAL STAGE 1st stage: With direct small knob near the tip of the tail 3rd stage: 2 well developed chitinous reading below its buccal cavity DIAGNOSIS Presumptive diagnosis: travel, exposure, correlated with symptoms, medical history, lab findings, brain imaging result, serological test Blood examination – high eosino comprising 7-36% is normal CSF examination - Elevated CSF protein level CT Scan – may reveal nonspecific edema and vascular dilation MRI, Dot-blot ELISA – 100% sensitive PCR TREATMENT No antihelminthic treatment although albendazole and mebendazole has treated patients in China, Taiwan, and Thailand. Ocular parastrongylus – requires removal of worms in the eyes PARASITE No. of eggs produced Color Shape Giant intestinal roundworm 200,000 or 240,000 /day Golden brown Ovoidal Whipworm 3,000 - 10,000 /day Yellow, bile stained Barrel-shaped with protruding bipolar plugs Hookworm N. americanus – 6,000-11,000 A. duodenale – 15,000-20,000 Colorless to pale yellow Ovoidal Threadworm Chinese lantern Human pinworm, seatworm, society worm 4,672 – 16,888 /day Ave: 11,105 eggs Pudoc worm Eggs in utero T: 8-10, single row A: 40-45, 2-3 rows Trichina worm, garbage worm, tissue roundworm, muscle worm 1,500 LARVAE/LIFETIME Rat lungworm 15,000 /daily D-shaped eggs, or one side flattened, the other convex Pale yellow T: Peanutshaped with flattened bipolar plugs A: thin shelled w/o polar plugs Ovoidal PARASITE Diagnostic stage Infective stage MOT H to L Final habitat Giant intestinal roundworm LS: 1 yr Fertilized or unfertilized egg Embryonated egg Ingestion Yes Small intestine Whipworm LS: 1-2yrs Unembryonate d egg Embryonated egg Ingestion No Large intestine Hookworm Eggs in feces LS: (NA) 4-20yrs, (AD) 1yr Filariform larva Skin penetration Yes Small intestine Threadwor m Rhabditiform larva Filariform larva Skin penetration Yes Small intestine Human pinworm, seatworm, society worm Embryonated egg Embryonated egg Ingestion, Inhalation, Hand to mouth, Soiled night clothes, Sleeping in bed with carriers, contaminate objects No Large intestine Pudoc worm Unembryonate d egg Infective larva Ingestion of raw or undercooked infected fish No Small intestine Trichina worm, garbage worm, tissue roundworm, muscle worm LS: 30 days Encysted larva Encysted larva Ingestion of undercooked meat No Larva: Striated muscle Bancrofti’s filarial worm LS: 2-3 months Microfilaria Rat lungworm Infective larva Adult: small intestine Microfilaria Man: 3rd stage larva To humans: 3rd stage larva Snail to rats: 3rd stage larva Vector: Aedes poecilus & Anopheles minimus flavirostris No Lower Lymphati cs Ingestion Yes Brain, lungs, eyes Rat to snails: 1st stage larva PARASITE DISEASE Ascaris l. Ascariasis Trichuris t. Trichuriasis Necator a. Ancylostomiasis Strongyloides s. Strongyloidiasis Enterobius v. Enterobiasis Capillaria p. PUDOC Disease / Mystery disease Capillariasis Trichinella s. Trichinellosis Wuchereria b. Bancrofitian filariasis Elephantiasis PARASITE Diagnosing, organs involved Giant intestinal roundworm Lungs, absorption ng nutrients, intestine, Whipworm Intestine, bloody stool, hypo albumin, IDA, rectal prolapse, petechial hemorrhage Hookworm Skin, lung, small intestine A braziliense and A caninum – creeping eruptions or cutaneous larva migrans Threadworm Borborygmi Human pinworm, seatworm, society worm Intense itching, intestine, poor appetite, grinding of teeth Pudoc worm Borborygmi Trichina worm, garbage worm, tissue roundworm, muscle worm Muscle, edema, paralysis of extremities, meningitis, meningoencephalitis, ocular disturbance Wuchereria bancrofti Lymph related Brugia malayi Epitrochlear, inguinal, axillary lymph nodes (arm, groin, armpit) Scrotum Loa loa Eyes, bridge of nose, calabar swelling Onchocerca volvulus Eyes, allergy Mansonella ozzardi hives, lymphadenitis, skin itching, pain in joints Mansonella perstans Allergy, calabar swelling, joint and bone pain, liver, edema Mansonella streptocerca Skin, subcutaneous tissue Dirofilaria immitis Cough and chest pain Drancunculus medinensis Hives, shortness of breath, vomiting, itching, pagkahilo/giddiness Rat lungworm Brain, eyes, lungs PARASITE Appearance Giant intestinal roundworm Adult: White, cream, pinkish yellow when fresh Ant. End: triudate plate / 3 lips buccal cavity Fem: straight pointed posterior end, bigger Male: curved tail Whipworm Ant. End: colorless, whip, slender esophagus Post. End: organs Fem: straight or blunt posterior end, slightly larger Male: coiled or curved through 360, single spicule, retractile sheath Hookworm Pinkish, cream yellow, or grayish white Small, cylindrical, fusiform Fem: blunt posterior end, longer Male: bursa copulatrix or membranous caudal bursa, shorter Threadworm Parasitic F: colorless, small, semi-transparent Ant: esophagus 1/3 Ant end: tapering Post end: short conical pointed tail Buccal cavity: 4 lips FL Fem: short, stouter Double bulb muscular esophageal pharynx Intestine: straight cylindrical tube FL Male: broadly fusiform, smaller than FL Fem Ventrally curved tail, 2 copulatory spicules Gubernaculum but no caudal alae Human pinworm, seatworm, society worm Ant end: cuticular alar expansions Post: prominent esophageal bulb Fem: long pointed tail, uteri of gravid is distended with eggs, dies after laying eggs Male: curved tail, single spicule, dies after copulation Pudoc worm Fem: typical and atypical Male: chitinized spicule and long spicule sheath Trichina worm, garbage worm, tissue roundworm, muscle worm Fem: vulvae opening at ant 5th, single ovary Blunt posterior end, club shaped uterus Male: single testis, cloaca at the caudal portion is guarded by 2 conspicuous papillae Larva: encysted, spearlike burrowing tip Wuchereria bancrofti Adult: long, creamy white, filiform Microfilaria: minute, snake-like; enclosed in a hyaline sheath Sheathed, tail pointed & free of nuclei Brugia malayi Sheathed, 2 distinct nuclei at tip of tail Loa loa Sheathed, continuous row of nuclei Onchocerca volvulus Adult: thin, wirelike; coil up in knots inside infected skin nodules Unsheathed, nuclei do not extend up to the tip Mansonella ozzardi Unsheathed, numerous nuclei but do not extend to the tip Mansonella perstans Unsheathed, numerous nuclei, extends to the tip Mansonella streptocerca Nuclei continuous to the tip, relatively straight but strongly bent in shepherd’s crook curve Rat lungworm Adult: Pale and filiform Fem: blunt-shape posterior end Male: well developed caudal bursa COMMON NAME MOT DIAGNOSTIC INFECTIVE EGGS LIFESPAN DISEASE ASCARIS TRICHURIS HOOKWORM STRONGY CAPILLARIA ENTEROBIUS TRICHINELLA WUCHERERIA
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