Microbiology Updates- MEDICAL PARASITOLOGY AT GLANCE

By Dr Nishit Gupta, MD.wait for more updates

References:
1. Harrisons 18th edition
2. Ananthnarayan 9th edition
3. Parasitology by chatterjee
Parasitology the most ignored, most difficult and very essential for Exams.
Medical parasitology is the study of the invertebrate animals and the diseases they cause. Parasites are classified as
protozoans or metazoans.
The most important organisms are identified in the following table.

PROTOZOANS
COMMON
NAME
Important Genera

AMOEBAE

FLAGELLA
CILIATES
APICOMPLEXA
TES
Entamoeba
LUMINAL
Balantidium
BLOOD/TISSUE
Naegleria
(GUT<
Plasmodium
Acanthamoeba
UGIT)
Toxoplasma
Trichomonas
Babesia
Giardia
INTESTINAL
HEMOFLAG
Cryptosporidium
ELLATES
Isospora
Leishmania
Trypanosoma
* Pnumocystis, which has formerly classified as a protozoan, has been determined to be a fungus through ribotyping
and othe molecular techniques.

METAZOANS
Phyllum

Flat worms(Platyhelminthes)

Roundworm s

Classes:
Common name

Trematodes
(Flukes)

Cestodes
(Tapeworm)

Nematodes
(Roundworms)

Genera

Fasciola
Fasciolopsis
Paragonimus
Opisthorchis(clonorchis)
Schistosoma

Diphyllobothrium
Hymenolepsis
Taenia
Echinococcus

Necator
Enterobius
Wucherreria/ Brugia
Ascaris & Ancyclostoma
Toxocara, Trichturis & Trichinella
Onchocercae
Dracanculus
Eye worm (Loa loa)
Strongyloides

Some Basic Understanding

HOSTS: THE infected host is of two types
1. INTERMEDIATE: Host in which larval or asexual stages develop
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2. DEFINITIVE: Host in which the adult or asexual stages occur.

VECTORS: Vectors are living transmitters (e.g., a fly) of disease and can be
1. MECHANICAL: Which transport the parasite but there is no development of the parasite in the vector.
2. BIOLOGIC: in which some stages of the life cycle occur.
PROTOZOAN PARASITES:

SPECIES

DISEASE/ORGANS
MOST AFFECTED

FORM/TRANSMISSION DIAGNOSIS

TREATMENT

Entamoeba
histolytica

Amoebiasis: dysentery
- Inverted flask- shaped
lesions in large intestine with
extension to peritoneum and
liver, lungs, brain and heart.
- Blood and pus in stools
- Liver abscesses

Cysts
Fecal- oral transmission

Metronidazole
followed by
iodoquinol

Giardia Lamblia

Giardiasis- diarrhoea
Common cause for
malabsorption

Cysts
Fecal oral transmission

Cryptosporidium
sp.

Cryptosporidiosis Transient diarrhoea

Cysts- Undercooked meat,

water

Trophozoites /
cysts in stool
; Serology
(IHA)
Nuclei have
sharp central
karyosome and
fine chromatin
spokes
Trophozoites
/cysts in stool or
fecal antigen
test;
Falling leaf
motility
Acid fast
oocysts in stool
On Biopsy
shows cysts in
intestinal glands

Balantidium coli

Dysentery

Cysts contaminated food

or water

Ciliated
Trophozoites/
Cysts in feces

Tetracycline

Trichomonas
Vaginalis
(urogenital)

Trichomoniasis- often
asymptomatic or frothy
vaginal discharge

Trophozoites(motile) sexual

Motile
Trophozoites in
methylene blue
wet mount

Metronidazole

Naegleria

Free living microbe picked up

Primary amoebic
meningoencephalitis(PAM)- while swimming or diving
severe frontal headache,
nausea, high fever, altered
sensorium

Amphotericin
B(rarely
successful)

Acanthamoeba

Keratitis, Granulomatous
amebic encephalitis(GAE)

Motile
Trophozoites in
CSF
Culture- gram
negative
bacteria
Star shaped
cysts on biopsy,
rarely seen in

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Free living amoeba in

contaminated contact lens
solution (airborne cysts)

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Metronidazole

Keratitis- topical
metronidazole and
propamide
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CSF

isothionate
GAESulfadiazine
(rarely successful)

PLASMODIUM SPECIES
SPECIES

BLOOD SMEARS

PIGMENT

LIVER STAGE

Plasmodium Vivax

Schuffner dots

Persistent hypnozoites/
relapse

Plasmodium falciparum

Enlarged Host cell- RBCs; Single

ring forms ; Amoeboid
Trophozoites; gametocytes
Multiple ring forms

Maurer dots

No persistent stage

Plasmodium ovale

Oval, jagged, infected RBCs

Persistent Hypnozoites

Plasmodium malariae

Bar and band forms; rosette

schizonts; Acole forms
Banana shaped gametocytes

Schuffner dots
(James dots)
Zieman dots

No persistent stage

HAEMOFLAGELLATE
SPECIES

DISEASE

VECTOR/FORM/TRANSMIS
SION

DIAGNOSIS

TREATMEN
T

Trypanosomiasis
cruzi

Chagas disease
(American)

Reduvid bug

Blood films

Nifurtimox

Trypomastigote in saliva of
tsetse fly

Blood films, CSF,

high
immunoglobulin
levels in CSF

Acutesuramin

Stiboglucona
te
sodium(FRO
M CDC)

TRYPANOSOMA
brucei
gambiense

African sleeping
sickness

rhodesiense

Antigenic
variation

Leishmania
donovoni complex

Visceral
Leishmaniasis

Sandfly bite

Amastigotes in
macrophages in
bone marrow,
liver , spleen

Leishmania

Cutaneous

Sandfly bite

Amastigotes in

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Chronicmelarsoprol

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Leishmaniasis
(Oriental sore)
Leishmania
Brazilansis complex

Mucocutaneous
Leishmaniasis

macrophages in
cutaneous lesions
Sandfly bite

TAPE WORMS- GGASTROINTESTINAL INFECTIONS

CESTODE

TRANSMISSION

DIAGNOSIS

Taenia sagginata (beef)

Rare beef containing cysticerci is ingested

Proglottids or eggs in
feces(NIH swab)

Taenia solium (pork)

Autoinfection , infected raw pork, and vegetables

containing cysticerci

Eggs/ Biopsy

Diphyllobothrium
latum(fish)

Drinking pond water-larval forms

Proglottids or eggs

Echinococcus granulosus

Infection of eggs- hydatid cyst-

Imaging serology, or cysts

in liver lungs

Echinococcus multilocularis

Ingestion of eggs- alveolar hydatid cyst

No protoscolices

ROUNDWORMS - TRANSMITTED BY EGGS

Sticky swab of perianal region(NIH
swab); Ova have flattened side with
larvae inside

Enterobius vermicularis
(pin worm)

Large intestine, perianal itching

Trichuris trichtura
(whip worm)

Appendicitis ; rectal prolapse

Barrel shaped eggs with bipolar plugs

in stool

Ascaris lumbricoides

Ingest eggs- larva migrate thru lungs,

mature in small intestine obstruct bile
duct, appendicitis

Bile stained , knobby eggs adult- 6 to

12 roundworms

Visceral larva migrans- wander

aimlessly till they dieinflammation(pica)

`clinical and serology

Toxocara canis orcati

(dog/cat ascarids)

autoinfection

Fertilized and unfertilized eggs

ROUNDWORMS - TRANSMITTED BY LARVAE

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Necator americanus

Hookworm infection
Lung pneumonitis
Bloodsucking- anemia

Filariform larva invades skin of bare

feet- fecal larvae(upto 13mm), ova ,
oval transparent with 2-8 cell stage
visible inside
Occult blood positive

Ancyclostoma brazilense
Ancyclostoma caninum

Cutaneous larva migrans/intense skin

itching

Filariform larvae invades skin

Strongyloides stercoralis
(thread worm)

StrongyloidosisEarly- pneumonitis , abdominal pain,

diarrhoea
Later- malabsorption, ulcers, bloody
stools
Trichinosis myocarditis , larvae in
encyst forms in muscle- pain

Filariform larvae invades skin,

autoinfection-

Schistosoma
mansoni
japonicum

Intestinal Schistosomiasis- contact with

water ; skin penetration

Mature in veins of mesentery eggsgranulomas in liver

Schistosoma
haematobium

Vesicular Schistosomiasis- skin

penetration- bladder carcinoma in
Egypt and Africa
Swimmers itch- contact with water,
skin penetration
Raw fish ingestion

Eggs- itching

Operculated eggs

Sheep liver fluke

Operculated eggs

Fasciolapsis buski

Giant intestinal fluke

Operculated eggs

Paragonimus westermani

Lung fluke

Operculated eggs

Trichinella spiralis

Larva in stool, serology

Muscle biopsy, clinically
Fever, myalgia, splinter hmges,
eosinophilia

TREMATODES (Flukes)

Non human schistosomes

Clonorchis sinensis
(chinese liver fluke)
Fascioloa hepatica

Dermatitis itching

MISCELLANEOUS

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Babesia (primarily a cattle)

Humans
Babesisa microti
Toxoplasma gondii

Babeseoisis hemolytic , malaria like

Ixodes tick- giemsa stain of thin smear

or hamster inoculation

Cat is essential definitive host. Many

other animals are intermediate host.
1. Raw meat , pork
2. Contact with cat feces

-Serology
-High IgM or rising IgM acute
infection
-Biopsy

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