MLS 042 Clinical Parasitology PDF

MLS 042 SEM 01...

MLS 042 SEM 01 CLINICAL PARASITOLOGY Prof. Louise Anne D. Santos, RMT, DTA, MLS (ASCPi)CM MEDICAL PARASITOLOGY INTRODUCTION TO PARASITOLOGY ★ Primarily concerned with parasites of human and their medical Anton Van Leeuwenhoek significance, as well as their importance in human ★ First scientist to introduce the communities single lens microscope TROPICAL MEDICINE Louis Pasteur ★ Branch of medicine that deals with tropical diseases and other ★ First published a scientific special medical problems of tropical regions study on a protozoal disease ★ Communicable and non-communicable diseases in tropical that led to its control and areas prevention during the investigation of an epidemic TROPICAL DISEASE silkworm disease ★ Illness, which is indigenous to or endemic in a tropical area ★ Invented Pasteurization that o Indigenous = Certain Area was soon applied as a process o Endemic = Community to beer and milk ★ May also occur in sporadic or endemic proportions in areas that are not tropical o Sporadic = Scattered/Isolated o Epidemic = Rapid spread of disease to a large number of hosts PARASITES ★ Living organisms ★ Depends on a living host for their nourishment and survival Sample images of a Silkworm ★ They multiply or undergo development inside the host Patrick Manson PARASITIC INFECTIONS ★ Founded the Field of Tropical Medicine 1. ANTHROPONOSIS - Found in MAN alone Charles Louis Alphonse Laveran 2. ZOOANTHROPONOSIS - Mainly affects man, but animals ★ Discovered the malarial parasite can become infected during the life cycle of the parasite 3. ANTHROPOZOONOSIS - Mainly in animal, but may be Ronald Ross acquired by man ★ Showed the transmission of malarial parasite via mosquitoes ★ Vector of Plasmodium: female Anopheles TYPE OF PARASITES ECTOPARASITE ★ Living outside the body of the host ★ “Infestation” ENDOPARASITE ★ Living inside the body of the host ★ “Infection” OBLIGATE PARASITE ★ Needs a host at some stages of their life cycle to complete Rudolf Ludwig Carl Virchow their development and to propagate their species ★ Father of Modern Pathology o EX. Taenia ★ Introduced the word “zoonosis” FACULTATIVE PARASITE ★ May exist in a free-living state PARASITOLOGY ★ May become parasitic only when the need arises ★ Area of biology that is concerned with the phenomenon of ★ No host dependence of one living organism on another o EX. Acanthamoeba ERRATIC PARASITE ★ Found in an organ which is not its usual habitat ★ Also known as “Wandering” Parasite as its place is unpredictable ACCIDENTAL PARASITE ★ Where the parasite is not usually found ★ Also known as “Incidental” Parasite o EX. Usually located in the GI tract but wander in lungs or liver o EX. Usually in animal but accidentally affected a human TEMPORARY PARASITE ★ Lives on the host only for a short period of time 3 BSMLS 06 A.Y. 2023-2024 | NOE, GENEVA MAE M.  MLS 042 SEM 01 CLINICAL PARASITOLOGY Prof. Louise Anne D. Santos, RMT, DTA, MLS (ASCPi)CM PERMANENT PARASITE WHAT IS A HOST? ★ Remains on or in the body of the host for its entire life or until ★ An organism that harbors the parasite the host dies ★ Provides nourishment and shelter to the parasite SPURIOUS PARASITE ★ Relatively larger than the parasite ★ Free-living organisms that pass through the digestive tract without infecting the host CLASSIFICATION OF HOSTS PSEUDOPARASITE DEFINITIVE HOST ★ Mistaken as parasite ★ Parasite attains sexual maturity and adult stage ★ Pseudo = Not genuine ★ Where parasites develop to mature HYPERPARASITE ★ Primary host ★ Parasite that parasitizes another parasite INTERMEDIATE HOST ★ Harbors the asexual or larval stage of the parasite EXPOSURE AND INFECTION ★ Parasite don’t mature anymore INCUBATION PERIOD ★ Secondary host ★ Period (time) between infection and evidence (appearance) o EX. Plasmodium of symptoms ▪ DH: female Anopheles PRE-PATENT PERIOD ▪ IH: Human ★ Period between infection or acquisition of the parasite PARATENIC HOST ★ Evidence or demonstration of infection ★ Parasite does not develop further to later stages ★ When infection in the blood took effect ★ Stops development AUTOINFECTION RESERVOIR HOST ★ Results when an infected individual becomes his own direct ★ Allows parasite’s life cycle to continue and become an source of infection additional source of infection ★ Parasite from one site to another in one host ACCIDENTAL HOST SUPERINFECTION ★ Where the parasite is not usually found ★ When an already infected individual is further infected with the same species, leading to massive infection with the parasite SOURCES OF INFECTION 1. Contaminated soil and water 2. Food 3. Insect vectors 4. Animals 5. Another person 6. Self (Autoinfection) MODES OF INFECTION 1. Oral transmission - via mouth 2. Skin transmission ▪ EX. Cutaneous Larva Migrans Life Cycle RELATIONSHIP OF HOST & PARASITE SYMBIOSIS ★ Living together of unlike organisms ★ May involve protection or other advantages to one or both organisms ★ Close with one another 3. Vector transmission COMMENSALISM ▪ Biologic – developed within the vector before ★ Two species live together transmission ★ One species benefit from the relationship without harming or ▪ Anthropod – bugs, flees, mosquito, biting flies, benefiting the other cockroaches, beetles, crustacean, cope pod MUTUALISM ▪ Mechanical/Phoretic – transports parasite ★ Two organisms mutually benefit from each other 4. Direct transmission 5. Vertical transmission PARASITISM 6. Iatrogenic transmission ★ One organism (parasite) lives in or on another, depending on the latter for its survival 3 BSMLS 06 A.Y. 2023-2024 | NOE, GENEVA MAE M.  MLS 042 SEM 01 CLINICAL PARASITOLOGY Prof. Louise Anne D. Santos, RMT, DTA, MLS (ASCPi)CM ★ Usually survives at the expense of the host ★ Supporting Body Wall: o An outer layer, hyaline, non-cellular cuticle EFFECTS OF PARASITE TO HOST o Subcuticular epithelium DIRECT EFFECT o A layer of muscle cells ★ Mechanical Injury or Traumatic Damage ★ Alimentary tract is a simple tube extending from mouth to o May be inflicted by a parasite by means of pressure the anus as it grows larger ★ NO Circulatory System ★ Enzymatic Interference o They circulate via gas diffusion through the skin o E. histolytica trophozoites secrete CYSTEINE ★ Complete digestive tract and a muscular pharynx PROTEASES which digests cellular material o Entry: Mouth ★ Invasion and Destruction o Disposal: Anus o Plasmodium invades RBC → RBC rupture ★ Equipped with COMPLETE digestive and reproductive o Schistosoma japonicum to liver → Granuloma systems formation ★ Life cycle: o Hookworms destroying intestinal villi o egg stage → larval stage → adult stage ★ Nutrient Deprivation ★ DIOECIOUS: Provided with separate sexes (Male/Female) o Diphyllobothrium latum COMPETES with host ★ Have sensory organs (Chemoreceptors) in the anterior and VITAMIN B12 SUPPLY posterior ends called “Amphids” and ▪ Example: Megaloblastic Anemia “Phasmid” respectively INDIRECT EFFECTS ★ 1 worm = 1 sex (Can be Male or ★ Excessive proliferation of certain tissues due to invasion by Female) some parasites can also cause tissue damage in man ★ Male worm is easily identifiable via its spiral or curved ends EFFECTS OF HOST ON THE PARASITE REPRODUCTION SICKLE CELL DISEASE OVIPAROUS ★ Protection against Plasmodium falciparum ★ Lay immature, unembryonated, or unsegmented eggs DUFFY BLOOD GROUP SYSTEM OVIVIPAROUS / OVOVIVIPAROUS ★ Increases susceptibility to Plasmodium vivax ★ Lay embryonated and mature eggs HIGH PROTEIN DIET ★ Segmented stage ★ NOT suitable for intestinal protozoan development VIVIPAROUS / LARVIPAROUS INFECTIVE STAGE VS DIAGNOSTIC STAGE ★ Lay larva, not eggs o Larval (Newborn) Stage: Stage in development INFECTIVE STAGE that occurs before the adult form is reached ★ During which the parasite assumes a form in which it invades its host POSSESSION OF PHASMIDS DIAGNOSTIC STAGE ★ APHASMID: Trichinella, Trichuris, Capillaria ★ Can be detected using laboratory methods or naked eye ★ PHASMID: The rest of the nematodes LABORATORY DIAGNOSIS INTESTINAL NEMATODES ★ Microscopy Ascaris lumbricoides ★ Culture ★ Serological Test ★ Common Name: Giant Intestinal Roundworm ★ Skin Test ★ Vector: Flies and Cockroach ★ Molecular Method ★ Member of the Soil-transmitted Helminths: H.A.T.S. ★ Animal Inoculation ★ Member of the Unholy Three: H.A.T. ★ Xenodiagnosis o Hookworm, Ascaris, Trichuris ★ Imaging ★ Member of parasites having heart-lung migration: A.S.H. ★ Hematology o Ascaris, Strongyloides stercoralis, Hookworms o A.S.H are wandering/erratic parasites NEMATODES ★ HABITAT: Small Intestine GENERAL CHARACTERISTICS ★ FINAL HOST: Man ★ FAMILY: Phylum nemathelminthes ★ DIAGNOSTIC STAGE: Fertilized/Unfertilized egg ★ ADULT Nematode ★ INFECTIVE STAGE: Embryonated egg o Elongated o Cylindrical Worm MORPHOLOGY o Primary bilaterally symmetrical ★ White or Pink in color ★ Anterior end may be equipped with: o HOOKS ★ Large size wherein Male is shorter and Female is longer & o TEETH thicker o PLATES o MALE: 10 - 31 cm o PAPILLAE o FEMALE: 22-35 cm 3 BSMLS 06 A.Y. 2023-2024 | NOE, GENEVA MAE M.  MLS 042 SEM 01 CLINICAL PARASITOLOGY Prof. Louise Anne D. Santos, RMT, DTA, MLS (ASCPi)CM DECORTICATED FERTILIZED EGG CORTICATED ★ SMOOTH finely STRIATED CUTICLE with CONICAL anterior and posterior ends ★ Terminal mouth with 3 OVAL LIPS and SENSORY PAPILLAE ★ PAIRED reproductive organs in: GENERAL INFORMATION OF A. LUMBRICOIDES o FEMALE: Posterior Two-Thirds ★ Adult worms obtain nourishment from semi-digested food of o MALE: Single Tortuous Tubule host ★ Ventrally curved posterior end of male with TWO SPICULES ★ Average daily egg output: 200,000 FERTILIZED EGGS UNFERTILIZED EGGS ★ INFECTIVE STAGE: Embryonated ova 45-70 µm x 35-50 µm 88-94 um by 39-44 um ★ Optimal temperature of development: 25°C (RANGE: 21- Covered with THICK Contains AMORPHOUS 30°C) HYALINE SHELL and a MASS of Protoplasm with ★ Eggs are susceptible to desiccation (drying) DELICATE VITALLINE, refractile granules ★ Eggs are resistant to chemical disinfectants LIPOIDAL, INNER Thinner shell with irregular MEMBRANE which e highly coating of albumin EPIDEMIOLOGY impermeable If male is absent, there is no ★ Prominent in BOTH temperate and tropical zone Middle Glycogen layer cortication process Contains an OVOID mass of ★ MORE COMMON in warm countries in areas with poor unsegmented protoplasm sanitation May be covered by coarsely ★ Prevalent in children (5-9 years old) MAMILLATED ALBUMINOUS COVERING (Cortication) MODE OF TRANSMISSION ★ Hand-to-mouth after contact with contaminated soil o Can be direct or indirect ★ Use of night soil NOTE: Soil plays a major role in the development/transmission of this parasite until it finds its host PATHOLOGY AND SYMPTOMS A. Pneumonia, cough, fever, eosinophilia during larval migration B. Vomiting and abdominal pain Fertilized Egg Unfertilized Egg C. Intestinal perforation is possible ★ LARVA: HEART-LUNG MIGRATION o Resembling Loeffler’s Syndrome 3 BSMLS 06 A.Y. 2023-2024 | NOE, GENEVA MAE M.  MLS 042 SEM 01 CLINICAL PARASITOLOGY Prof. Louise Anne D. Santos, RMT, DTA, MLS (ASCPi)CM ★ ADULT: Erratic o Bolus - Group of adult worms Trichuris trichiura o Hepatic ascariasis, migration to other tissues: ★ Common name: Whipworm Kidney, Appendix, and Pleural Cavity ★ More susceptible than A. lumbricoides ★ HABITAT: Large Intestines/Colon ★ FINAL HOST: Man ★ DIAGNOSTIC STAGE: Oval/Unembryonated egg ★ INFECTIVE STAGE: Embryonated egg INTESTINAL OBSTRUCTION MORPHOLOGY DIAGNOSIS ★ Attenuated whip-like anterior, mostly traversed with ★ Direct fecal smear examination esophagus ★ Finding the eggs in the stool ★ Robust posterior end containing: ★ Egg counting method to determine the number of adult o Intestines worms o Single set of reproductive organs ★ Unlike A. lumbricoides, Trichuris trichiura is similar in length for both male and female o MALE: 30-45 mm o FEMALE: 35-50 mm TREATMENT ★ Albendazole ★ Mebendazole ★ Pyrantel Pamoate ★ MALE: Coiled posterior end, with PREVENTION o Single spicule ★ Sanitary disposal of feces o Retractile sheath ★ Health education ★ FEMALE: Bluntly rounded posterior end ★ Thorough washing of vegetables ★ No night soils 3 BSMLS 06 A.Y. 2023-2024 | NOE, GENEVA MAE M.  MLS 042 SEM 01 CLINICAL PARASITOLOGY Prof. Louise Anne D. Santos, RMT, DTA, MLS (ASCPi)CM EGGS mucosa ★ 50-54 µm by 23 µm ★ Headache, fever, and cachexia may occur ★ Lemon-shaped or football-shaped ★ Has translucent polar plugs ★ Yellowish outer shell and transparent inner shell ★ Fertilized eggs are unsegmented ★ Eggs are less resistant to desiccation than Ascaris o Desiccation = Drying RECTAL PROLAPSE ANEMIA DUE TO TRICHURIASIS ★ May occur as adult worms suck some blood o Most likely to occur due to hemorrhage at the attachment site Trichuris trichiura Capillaria egg ★ Approx. 0.005 mL is lost GENERAL INFORMATION OF T. TRICHIURA per day per Trichuris ★ Anemia may be marked ★ Female lays approx. 3,000 to 10,000 eggs per day ★ Hemoglobin levels can be ★ Hatched larvae remain in the Intestinal Villus as low as 3 grams per 100 o Stay near Crypts of Lieberkühn for 3-10 days mL ▪ Crypts of Lieberkühn is a part/portion of the intestinal villi where the larva DIAGNOSIS penetrates in small intestine ★ Finding the egg using DFS (direct fecal smear) examination ★ Larvae molt into adolescence and migrate to the cecum ★ Light infection may require Concentration Method ★ The attenuated anterior end penetrates the intestinal mucosa where it gets its nourishment TREATMENT ★ Life span: 4-6 years ★ Drug of Choice: Mebendazole o Maximum: 8 years ★ Albendazole PREVENTION ★ Treatment for Infected Individuals ★ Sanitary disposal of human feces ★ Washing of hands ★ Intensive health and sanitation education ★ Thorough washing of uncooked vegetables HOOKWORMS EPIDEMIOLOGY ★ Necator americanus: New World Hookworm ★ High prevalence but light intensity ★ Ancylostoma duodenale: Old World Hookworm ★ Prevalence is as high as 80% in certain tropical regions ★ Children are more frequently infected MODE OF TRANSMISSION ★ Hand to mouth AFTER contact with soil contamination o Can be direct or indirect ★ Use of night soil PATHOLOGY AND SYMPTOMS ★ Light infection is usually UNRECOGNIZABLE ★ Only young children and infections involving more than GENERAL INFORMATION 30,000 eggs per gram of feces were likely to have evidence ★ Eggs develop into Rhabditiform Larvae (Feeding Stage) in 1- of Trichuriasis 2 days under favorable conditions, with an optimal HEAVY CHRONIC TRICHURIASIS temperature of 23 - 33°C ★ Frequent, small, blood-streaked stool ★ Develop into filariform larvae (Nonfeeding/Infective Stage) ★ Abdominal pain and tenderness ★ Active filariform larvae are located in the upper half inch of ★ Anemia the soil ★ Weight loss ★ Gain access through human host through hair follicles, ★ Occasional rectal prolapse with worms embedded in the pores, or unbroken skin, usually in the feet 3 BSMLS 06 A.Y. 2023-2024 | NOE, GENEVA MAE M.  MLS 042 SEM 01 CLINICAL PARASITOLOGY Prof. Louise Anne D. Santos, RMT, DTA, MLS (ASCPi)CM ★ Hookworms attach to the mucosa of the intestines through LARVA their buccal capsules and suck blood ★ Rhabditiform has two stages: L1 and L2 ★ Filariform is Infective ★ HABITAT: Small Intestine L1 Rhabditiform Larva L3 Filariform Larva ★ FINAL HOST: Man Short and Stout Long and Slender ★ DIAGNOSTIC STAGE: Egg/Larva Open mouth: Feeding stage Closed mouth: Nonfeeding stage ★ INFECTIVE STAGE: L3/Filariform Larva COMPARISON OF ADULT HOOKWORMS Long Buccal Cavity Sheathed, pointed tail HOOKWORM N. americanus A. duodenale Short/Small Genital Primordium New World COMMON NAME Old World Hookworm Hookworm SHAPE S-shaped C-shaped Semilunar cutting BUCCAL CAVITY 2 pairs of teeth plate COPULATORY Bipartite or Bidigitate Tripartite or Tridigitate BURSA Not barbed, bristle- SPICULE Barbed, fused like ★ Vulva of Necator is in the middle of the body ★ Vulva of Ancylostoma is at the posterior of the body ★ Buccal capsule of Necator has: o Dorsal pair of cutting plates o Concave dorsal median tooth o Deep triangular sub ventral lancets ★ Buccal capsule of Ancylostoma: o Two ventral pairs of teeth Rhabditiform Larva Filariform Larva MORPHOLOGY ★ Small, cylindrical, fusiform, grayish white ★ Females are larger than males o Female: 9-13 mm by 0.35-0.6 mm o Male: 5-11 mm by 0.3-0.45 mm ★ Ancylostoma duodenale is larger than Necator americanus ★ Has relatively thick cuticle ★ Paired female and single reproductive organ ★ Male posterior is equipped with broad, translucent, membranous caudal bursa with rib-like rays used to attach to females during copulation EGGS ★ Bluntly rounded ends with a single thin transparent hyaline shell ★ Protoplasm is unsegmented during oviposition ★ Protoplasm is divided into 2-8 cell stages of division in a fresh stool ★ Eggs of A. duodenale and N. americanus are ALMOST INDISTINGUISHABLE o N. americanus: 64-76 µm by 36-40 µm o A. duodenale: 56-60 µm by 36-40 µm PATHOLOGY AND SYMPTOMS LARVAL PENETRATION ★ HUMAN HOOKWORM o Allergic reaction: Ground Itch 3 BSMLS 06 A.Y. 2023-2024 | NOE, GENEVA MAE M.  MLS 042 SEM 01 CLINICAL PARASITOLOGY Prof. Louise Anne D. Santos, RMT, DTA, MLS (ASCPi)CM ▪ Severe itching at the site of larval PREVENTION penetration of the skin ★ Sanitary disposal of feces ★ Protection of susceptible individuals ★ Treatment of infective individuals ★ Education on health and sanitation Strongyloides stercoralis ★ Common name: Threadworm ★ HABITAT: Small Intestines ★ FINAL HOST: Man ★ ANIMAL HOOKWORM ★ DIAGNOSTIC STAGE: Rhabditiform larva o Ancylostoma braziliense - Creeping eruption ★ INFECTIVE STAGE: Filariform larva o Ancylostoma caninum - Cutaneous Larva Migrans (CLM) MORPHOLOGY LARVAL MIGRATION ★ Parasitic female is 2.2 mm by 0.04 mm ★ HEART-LUNG MIGRATION (ASH): Pneumonitis ★ Slender tapering anterior end and short conical posterior end ★ Pulmonary lesions and Hemorrhage: Wakana disease ★ Long and slender esophagus extending to the anterior fourth ★ Pneumonia and alveolar hemorrhage, bloody sputum of the body ADULT ★ VULVA is located in the 1/3 length of the body ★ Tissue damage at the site of attachment ★ UTERI contain a single file of 8-12 thin shelled ova ★ Enteritis and pain - blood loss and anemia ★ FREE LIVING FEMALE is 1 mm by 0.06 mm ★ Chronic Blood Loss → Iron Deficiency Anemia o Has a muscular bulbed esophagus o Intestine is a straight cylindrical tube EPIDEMIOLOGY ★ FREE LIVING MALE is 0.7 mm by 0.04 mm ★ N. americanus is prevalent in the Western Hemisphere, o Has a ventrally curved tail Central and South Africa, Southern Asia, Indonesia, o Has two copulatory spicules Australia, and Pacific Islands ★ A. duodenale is dominant in the Mediterranean region, Northern Asia, and west coast of South America ★ Prevalent in areas of poor sanitation ★ Prevalent in the presence of shaded sandy soil or loam, warm climate, sufficient moisture, and a population that is fond of walking barefoot Adult Male Adult Female EGGS ★ Rarely found ★ Chinese Lantern Appearance DIAGNOSIS ★ Finding of eggs in the stool o DIRECT FECAL SMEAR: Moderate to Heavy LARVA Infection STRONGYLOIDES RHABDITIFORM LARVA o CONCENTRATION MEHODS for light infection ★ “Feeding Stage” ★ Harada-Mori Culture ★ 225 by 16 µm ★ Kato-Katz Method ★ Has an ELONGATED ESOPHAGUS with PYRIFORM POSTERIOR BULB TREATMENT ★ Slightly SMALLER and less ATTENUATED than hookworm ★ Drug of choice: Albendazole ★ SHORTER BUCCAL CAPSULE and LARGE GENEITAL PRIMORDIUM 3 BSMLS 06 A.Y. 2023-2024 | NOE, GENEVA MAE M.  MLS 042 SEM 01 CLINICAL PARASITOLOGY Prof. Louise Anne D. Santos, RMT, DTA, MLS (ASCPi)CM STRONGYLOIDES FILARIFORM LARVA PREVENTION ★ “Non-feeding Stage” ★ Sanitary disposal of feces ★ Infective ★ Protection of susceptible individuals ★ Similar to the filariform larva of hookworm but is usually smaller and has a notched tail ★ Treatment of infected individuals ★ Education on health and sanitation Notched Tail (Filariform) Enterobius vermicularis ★ Common names: o Pinworm o Seat worm Pyriform Posterior Bulb ★ HABITAT: Large Intestines (Rhabditiform) ★ FINAL HOST: Man ★ DIAGNOSTIC STAGE: Embryonated egg COMPARISON OF HOOKWORM & THREADWORM ★ INFECTIVE STAGE: Embryonated egg HOOKWORM THREADWORM L1 Rhabditiform Larva MORPHOLOGY BUCCAL CAVITY Long Short GENITAL PRIMORDIUM Small Prominent ★ Adult female is small (8 – 13 mm. by 0.4 mm) o Has cuticular alar expansion at the anterior end L3 Filariform Larva called “Cephalic Alae” SHEATH Sheathed Unsheathed o Prominent esophageal bulb and pointed tail TAIL Pointed Notched o Uteri may be distended with eggs if gravid EPIDEMIOLOGY ★ Male is smaller (2 – 5 mm. in length) o Curved tail and a single spicule ★ Resembles hookworm but prevalence is LOWER in the ★ Seldom seen temperate regions ★ Especially prevalent in tropical and subtropical regions ★ Areas where warmth, moisture and lack of sanitation are present MODE OF TRANSMISSION ★ Hand to mouth AFTER contact with soil contamination o Can be direct or indirect ★ Use of night soil PATHOLOGY AND SYMPTOMS ★ Strongyloidiasis LARVAL PENETRATION ★ Allergic reaction to the site of larval penetration LARVAL MIGRATION EGGS ★ Heart-Lung Migration → Pneumonia ★ Elongated and embryonated ADULT (Cochin China Diarrhea) ★ Flattened on one side ★ Honeycomb appearance of the intestinal mucosa ★ D-shaped ★ Long-standing and heavy infection result in weight loss due ★ Translucent shell consists of outer triple albuminous covering to: an inner embryonic lipoidal membrane o Chronic Dysentery ★ Eggs become infective in 4 – 6 hours o Malabsorption o Steatorrhea AUTOINFECTION ★ Infective larva will penetrate the intestinal mucosa DIAGNOSIS ★ Stool Examination o Rhabditiform larvae are usually passed in the feces ★ Baermann Funnel Technique ★ Recommended Culture Method: Harada Mori Filter Paper Culture Technique PATHOLOGY AND SYMPTOMS TREATMENT ★ Pruritus ani/Nocturnal pruritus ani ★ Albendazole ★ Poor appetite, loss of sleep, loss of weight, hyperactivity, ★ Ivermectin enuresis (involuntary passing of urine), insomnia, grinding of 3 BSMLS 06 A.Y. 2023-2024 | NOE, GENEVA MAE M.  MLS 042 SEM 01 CLINICAL PARASITOLOGY Prof. Louise Anne D. Santos, RMT, DTA, MLS (ASCPi)CM teeth, irritability, abdominal pain, nausea, and vomiting ★ INFECTIVE STAGE: Larval stages found in the infected fish ★ Hemorrhagic colitis ★ Extraintestinal enterobiasis: Vagina, Uterus, Fallopian MORPHOLOGY tube ★ Male worms range from 1.5 – 3.9 mm ★ Autoinfection: External Autoinfection ★ Female works range from 2.5 – 5.3 mm ★ Oviparous and viviparous ★ Anterior End: Thin, Filamentous ★ Posterior End: Short, Thick ★ Esophagus has two rows of secretory cells (stichocytes) ★ Esophageal structure is called “Stichosome” ★ Recognized as a new species in the early 1960s from a patient in the Philippines who died of long illness characterized by intractable diarrhea and cachexia. EGGS ★ Guitar-shaped or Peanut-shaped ★ Striated shell DIAGNOSIS ★ With bipolar mucus plugs ★ Perianal Swab ★ Scotch Tape Swab ★ Cellulose Tape Swab PATHOLOGY AND SYMPTOMS ★ Abdominal pain, diarrhea and borborygmi ★ Weight loss, malaise, vomiting and anorexia ★ Protein loss and severe metabolic imbalance ★ Bipedal Edema TREATMENT ★ Mebendazole ★ Albendazole PREVENTION ★ Personal cleanliness ★ Hand washing before and after meals; after using the toilet ★ Malabsorption of fats and sugars ★ Anal region should be washed upon waking up ★ Decreased electrolytes specially potassium ★ Infected children should wear tight fitting pants ★ Can be fatal if untreated ★ Infected individual should sleep alone ★ Underwear, clothes, beddings should be laundered carefully DIAGNOSIS handled ★ Food should be protected from dust ★ Finding the characteristic eggs in the feces ★ Larvae and adult worms may also be present in the feces Capillaria philippinensis ★ Direct smear, wet mount, or stool concentration ★ Common name: Pudoc Worm ★ Parasites can be recovered from duodenum thru aspiration ★ HABITAT: Small Intestines TREATMENT ★ FINAL HOST: Man ★ High protein diet for protein loss ★ NATURAL HOST: Migratory Birds ★ Electrolyte replacement for electrolyte loss ★ INTERMEDIATE HOSTS: ★ Antidiarrheal drugs o Freshwater Fish ★ Mebendazole: 200 mg. b.i.d. for 20 days o Brackish Water Fish ★ Albendazole: 400 mg. once a day for 10 days ★ DIAGNOSTIC STAGE: Larva/Ova 3 BSMLS 06 A.Y. 2023-2024 | NOE, GENEVA MAE M.  MLS 042 SEM 01 CLINICAL PARASITOLOGY Prof. Louise Anne D. Santos, RMT, DTA, MLS (ASCPi)CM ★ Drug of Choice: Albendazole ★ Relapse may occur PREVENTION ★ Discouraging people from eating raw fish ★ Good sanitary practices ★ Treatment of all infected individuals ★ Information dissemination/ Educational programs particularly in endemic areas Epididymitis Chronic Hydrocele EXTRAINTESTINAL NEMATODES Elephantiasis FILARIAL WORMS COURSE OF INFECTION PATHOLOGY AND SYMPTOMS ★ Caused mainly by living, dead, and degenerating adult worms ★ Microfilariae cause less pathologic response DIAGNOSIS ★ Identification of microfilariae in the blood ★ History of exposure to endemic areas ★ Place a drop of blood on a slide and examine under LPO for actively moving microfilariae ★ Recommended time to collect blood: 8pm – 4am FILARIAL INFECTION CLASSIFICATIONS o Best time to collect: 10pm – 2 am ASYMPTOMATIC FILARIASIS ★ To determine the species: stain thick or thin blood smear ★ When children are exposed to infection at an early stage with Wright’s or Giemsa to bring about the differential ★ Adults exhibit microfilariae in the blood without symptoms characteristics ★ Moderate to general enlargement of the lymph nodes during physical examination OTHER DIAGNOSTIC METHOD ★ Blood examination shows numerous microfilariae KNOTT’S CONCENTRATION ★ Adults die and microfilariae disappear without symptoms ★ Used to detect light infection ★ 1mL of night blood is laked in 10ml. of 2% formalin solution INFLAMMATORY FILARIASIS ★ Sediment is examined directly or may be dried and stained ★ Immunologic phenomenon caused by sensitization to the product of living and dead adult worms NUCLEOPORE ★ Characterized by funiculitis, ★ Slightly more sensitive epididymitis, orchitis, ★ Filtration of 1 – 5 mL of heparinized blood through a 5μ of retrograde lymphangitis of Nucleopore filter extremities, localized ★ The stained filter is placed on a slide and examined swelling, and redness of arms and legs TREATMENT ★ May be accompanied by ★ Diethylcarbamazine fever, headache, vomiting ★ Ivermectin and malaise. ★ Most patients do not have PREVENTION microfilaremia ★ Control of mosquitoes and human sources of infection OBSTRUCTIVE FILARIASIS ★ Spraying of houses with insecticides and larvicides are ★ End result of filariasis effective for domesticated mosquitoes only ★ Develops slowly usually following years of continuous filarial ★ Protection of individual by screened quarters, bed nets, infection mosquito repellant, and protective clothing (educational and ★ Preceded by chronic edema and repeated inflammatory economic problem) attacks. ★ Cellular reaction and edema are replaced by fibroblastic Wuchereria bancrofti hyperplasia ★ Causative agent of: ★ High protein content of the lymph stimulates the growth of o Bancroftian filariasis dermal and collagenous connective tissue o Wuchereriasis ★ Over a period of time, the enlarged areas harden o Elephantiasis ★ Only known Definitive Host: Humans ★ Adult worms are located in the lymphatics ★ Microfilaria (larval stage) are found in the blood and lymph o Microfilariae are sheathed o Adults are tightly coiled in the nodular dilations of the lymphatic vessels and sinuses of lymph nodes 3 BSMLS 06 A.Y. 2023-2024 | NOE, GENEVA MAE M.  MLS 042 SEM 01 CLINICAL PARASITOLOGY Prof. Louise Anne D. Santos, RMT, DTA, MLS (ASCPi)CM ★ Nocturnal periodicity is very distinct Anopheles Mansonia EPIDEMIOLOGY ★ Sri Lanka, Indonesia, Philippines, China, Korea, Japan and other Asian countries MOSQUITO VECTORS ★ Similar with W. bancrofti, B. malayi is also correlated with the Culex quinquefasciatus population density, presence of vector, and poor sanitation ★ Night biter ★ Domesticated Loa loa ★ Urban mosquito ★ COMMON NAME: Aedes polynesiensis o Eyeworm ★ “Brush mosquito” o Human loiasis ★ Day biter ★ HABITAT: Subcutaneous ★ Non-domesticated ★ Nocturnal periodicity is diurnal 0 ★ Rural ★ Sylvatic Anopheles ★ Urban or Sub-Urban MOSQUITO VECTORS EPIDEMIOLOGY ★ Can be found in tropical and sub-tropical areas ★ Africa, Asia, Philippines ★ Correlated with the population density, presence of vector, and poor sanitation Brugia malayi ★ Causative agent of Malayan Filariasis ★ Adult and microfilaria closely resemble W. bancrofti ★ Nocturnal periodicity is less distinct PATHOLOGY AND SYMPTOMS ★ Damage is usually caused by migrating worm MOSQUITO VECTORS ★ Worm may migrate to the eye and damage the cornea ANOPHELES ★ Immune reactions to the worm may cause inflammation ★ Urban or Sub-Urban called “Calabar Swelling” MANSONIA ★ Night biters 3 BSMLS 06 A.Y. 2023-2024 | NOE, GENEVA MAE M.  MLS 042 SEM 01 CLINICAL PARASITOLOGY Prof. Louise Anne D. Santos, RMT, DTA, MLS (ASCPi)CM ★ The painful swelling usually in the extremities PATHOLOGY AND SYMPTOMS ★ Recurrent swelling can lead to the formation of cyst like HUMAN OCHOCERCIASIS enlargements of the connective tissues around the tendon ★ Also known as “River Blindness” sheaths ★ Microfilariae can also enter the eye by passing along the ★ Dying worms can also cause chronic abscesses followed by sheaths of the ciliary vessels and nerves from under the granulomatous reactions and fibrosis bulbar conjunctiva directly into the cornea ★ Dead microfilariae in the eye lead to an inflammatory immune response and the eventual formation of secondary cataracts and ocular lesions DIAGNOSTIC METHOD KNOTT’S CONCENTRATION ★ Used to detect light infection INFLAMMATORY REACTIONS ★ 1mL of night blood is laked in 10mL of 2% formalin solution ★ Microfilariae can also cause inflammation of regional lymph ★ Sediment is examined directly or may be dried and stained glands which remove foreign material from the distal skin CAPILLARY BLOOD ★ This inflammation along with the loss of tissue elasticity can lead to protruding lymph glands enfolded in pockets of skin ★ 2 thick smears → Stained with Giemsa ★ This condition is especially prominent in the areas around the TREATMENT scrotum o “HANGING GROIN” EFFECT ★ Diethylcarbamazine ★ Surgical removal of parasite DIAGNOSTIC METHOD Onchocerca volvulus ★ Skin Snips ★ COMMON NAME: Blinding Worm TREATMENT ★ HABITAT: Subcutaneous ★ Ivermectin ★ Nocturnal periodicity is non-periodic 0 Mansonella ozzardi ★ Only filarial worm parasitizing humans in South America ★ HABITAT: Subcutaneous ★ PERIODICITY: Non-Periodic ★ Microfilaria are found in the blood and sometimes in the capillaries and intravascular spaces of the skin o Usually asymptomatic ★ May cause adenopathy, pruritic and maculopapular skin lesions, arthritis, fever, and marked eosinophilia MOSQUITO VECTOR Simulium Black Fly Microfilaria of M. ozzardi in a thick blood Smear (Stained with Giemsa) 3 BSMLS 06 A.Y. 2023-2024 | NOE, GENEVA MAE M.  MLS 042 SEM 01 CLINICAL PARASITOLOGY Prof. Louise Anne D. Santos, RMT, DTA, MLS (ASCPi)CM MOSQUITO VECTORS MOSQUITO VECTOR In some areas of Primary Vector South America Mansonella streptocerca ★ Infects both humans and monkeys in Africa (Congo) KEY DIFFERENCES OF FILARIAL PARASITES ★ HABITAT: Skin ★ PERIODICITY: Non-Periodic ★ Microfilaria are found primarily in the skin o Sometimes in the blood ★ Patient may present with a pruritic rash and pigmentation changes ★ Tail of Mansonella streptocerca is often referred to as a “Shepherd’s Crook” MOSQUITO VECTOR Mansonella perstans ★ Common parasite of humans and apes in Africa o May also be found in Latin and South America ★ HABITAT: Body Cavities ★ PERIODICITY: Non-Periodic INTESTINAL TISSUE NEMATODES ★ Microfilaria is found in the blood and in the skin Trichinella spiralis ★ Majority of infections are benign ★ COMMON NAMES: ★ May cause Calabar-like swellings, pruritus, hives, fever, and o Muscle Worm headache. o Trichina Worm ★ Causes Ugandan or Kampala eye worm condition when ★ All stages of development, including the adult and larval stages adult worms invade the conjunctiva and periorbital occur within a single host connective tissue ★ MALE has conical papillae ★ FEMALE has club-shaped uterus Microfilaria of M. perstans in a thick blood smear (Stained with Giemsa) 3 BSMLS 06 A.Y. 2023-2024 | NOE, GENEVA MAE M.  MLS 042 SEM 01 CLINICAL PARASITOLOGY Prof. Louise Anne D. Santos, RMT, DTA, MLS (ASCPi)CM HABITAT ★ ADULT: Small Intestine ★ LARVA: Encysted in striated muscle (Skeletal muscle) ★ FINAL HOST: Pigs and other mammals that are omnivores/carnivores ★ ACCIDENTAL or DEAD-END HOST: Man PATHOLOGY AND SYMPTOMS ★ Trichinosis ★ Trichuriasis ★ Trichinellosis LARVA (MUSCLE) ADULT ★ Larval Migration causes: FEMALE o Fever ★ Long, cylindrical worm with smooth milky-white cuticle o Facial Edema o Resembling a long piece of white twine o Eosinophilia ★ Has a blunt anterior end and a tapering recurved tail ★ Muscle pain at the site of encystation ★ Measures about a meter (60–120 cm) in length and 1–2 mm ADULT (SMALL INTESTINE) in thickness ★ Diarrhea ★ The body of the gravid female is virtually filled with the ★ Abdominal pain branches of an enormous uterus, containing some 3 million embryos ★ VIVIPAROUS MALE ★ RARELY SEEN ★ Much smaller than female being only 10–40 mm long and 0.4 mm thick NOTE: Female worm survives for about a year, while Male worm survives for not more than 6 months T. spiralis in skeletal muscle LARVA LABORATORY ★ Measures 500–750 μm in length ★ Muscle biopsy and 15–25 μm ★ Immunotests ★ Has a broad anterior end and a o Bentonite Flocculation test slender filiform tail which extends o Bachmann Intradermal test for a third of the entire body length o Beck’s Xenodiagnosis ★ Cuticle shows prominent striations ★ The larva swims about with a coiling TREATMENT and uncoiling motion ★ Removal of muscle with encysted larva ★ Thiabendazole ★ Prednisone PATHOLOGY AND SYMPTOMS Dracunculus medinensis ★ Dracunculiasis ★ COMMON NAMES: ★ Inflammatory ulcers of legs and feet o Guinea Worm o Fiery Serpent of the Israelites o Dragon Worm o Serpent Worm ★ LONGEST NEMATODE OF MAN o Up to 1 meter in size ★ Has thick cuticle and a large uterus that fills the body cavity ★ Contains rhabditiform larvae ★ HABITAT: Subcutaneous Tissue ★ INTERMEDIATE HOST: Aquatic Crustacean (Copepods) ★ DEFINITIVE HOST: Man LABORATORY ★ MOT: Ingestion of Infected Copepods (Cyclops) ADULT WORM DETECTION ★ Diagnosis is evident when the tip of the worm projects from the base of the ulcer 3 BSMLS 06 A.Y. 2023-2024 | NOE, GENEVA MAE M.  MLS 042 SEM 01 CLINICAL PARASITOLOGY Prof. Louise Anne D. Santos, RMT, DTA, MLS (ASCPi)CM ★ Calcified worms can be seen by radiography LARVA DETECTION ★ By bathing the ulcer with water, the worm can be induced to release the embryos o Can be examined under the microscope TREATMENT ★ No treatment, removal only PATHOLOGY AND SYMPTOMS ★ Eosinophilia ★ Symptoms of Meningitis LABORATORY ★ Increased Eosinophil count in the Cerebrospinal Fluid Toxocara canis ★ COMMON NAME: Dog Ascaris ZOONOTIC NEMATODES ★ MOT: Ingestion of embryonated egg ★ Angiostrongylus cantonensis ★ CLINICAL MANIFESTATION: ★ Toxocara canis o Visceral or Ocular larva Migrans ★ Toxocara cati ★ DIAGNOSTIC TECHNIQUE: ★ Ancylostoma braziliense o EIA (Enzyme Immunoassay) – Antibody testing ★ Ancylostoma caninum Toxocara cati ★ Dirofilaria immitis ★ COMMON NAME: Cat Ascaris ★ Anisakis ★ MOT: Ingestion of embryonated egg Angiostrongylus cantonensis ★ CLINICAL MANIFESTATION: o Visceral or Ocular larva Migrans ★ COMMON NAME: Rat Lungworm ★ DIAGNOSTIC TECHNIQUE: o EIA (Enzyme Immunoassay) – Antibody testing ★ NATURAL or DEFINITIVE: RATS ★ INTERMEDIATE HOST: Mollusks (Snail) Ancylostoma braziliense o Pila luzonica (Kuhol) ★ COMMON NAME: Cat Hookworm o Brotia asperata (Suso) ★ MOT: Skin penetration by filarial larvae ★ CLINICAL MANIFESTATION: o Cutaneous larva migrans o “CREEPING ERUPTION” ★ DIAGNOSTIC TECHNIQUE: o EIA (Enzyme Immunoassay) – Antibody testing Ancylostoma caninum ★ COMMON NAME: Dog Hookworm ★ MOT: Skin penetration by filarial larvae ★ ACCIDENTAL HOST: Man ★ CLINICAL MANIFESTATION: ★ MODE OF TRANSMISSION: Ingestion of INTERMEDIATE o Cutaneous larva migrans HOST by man containing the infective larvae o “CREEPING ERUPTION” ★ DIAGNOSTIC TECHNIQUE: o EIA (Enzyme Immunoassay) – Antibody testing Dirofilaria immitis ★ COMMON NAME: Dog Heartworm ★ Very common filarial parasite of dogs ★ Causes coin lesion in the lungs (Man) ADULT FEMALE ★ Has a “Barber’s Pole” Appearance 3 BSMLS 06 A.Y. 2023-2024 | NOE, GENEVA MAE M.  MLS 042 SEM 01 CLINICAL PARASITOLOGY Prof. Louise Anne D. Santos, RMT, DTA, MLS (ASCPi)CM Anisakis spp. ★ COMMON NAME: Herring’s Worm ★ Fish and Marine mammal roundworms ★ Common in JAPAN ★ DEFINITIVE HOST: Whales/Dolphins ★ 1ST INTERMEDIATE HOST: Copepods ★ 2ND INTERMEDIATE HOST: Smaller fishes ★ 3RD INTERMEDIATE HOST: Larger fishes (Salmon) ★ MOT: Ingestion of raw fish infected with larvae GENERAL CHARACTERISTICS ★ COLOR: White, Yellowish, or Creamy White ★ ADULT: Flat ★ Segmented ★ Monoecious/Hermaphroditic ★ No Gastrointestinal Tract and Alimentary Tract ★ No Circulatory System ★ ENTRY OF NUTRIENTS: Integument ★ EXIT OF WASTE: Integument ★ Well-developed reproductive organs o Testes Anisakis spp. found in raw salmon o Ovary o Uterus PATHOLOGY AND SYMPTOMS ★ MODE OF TRANSMISSION: Oral Route ★ Abdominal pain and granuloma around migrating larva in ★ HABITAT: Small Intestine intestinal wall ★ CESTODE BODY CONSISTS OF: o Scolex ▪ Anterior Attachment Organ ▪ Spoon-like (Almond) o Neck ▪ Region of growth ▪ Point of proliferation for the next set of segments CESTODES ★ OTHER TERM: Tapeworm SYSTEMIC CLASSIFICATION ★ PHYLUM: Platyhelminthes ★ CLASS: Cestoda o Proglottids ▪ Chain of segments Strobila ▪ Stained with India ink Immature: Found in the neck Mature: At the middle portion where reproductive structures are found Gravid: Filled with eggs, CLASSIFICATION BASED ON THE FORM OF presence of egg in the uterus o Other structures: PARASITE IMPORTANT TO MAN ▪ Uterine Pore 3 BSMLS 06 A.Y. 2023-2024 | NOE, GENEVA MAE M.  MLS 042 SEM 01 CLINICAL PARASITOLOGY Prof. Louise Anne D. Santos, RMT, DTA, MLS (ASCPi)CM Found at the Medical Surface PSEUDOPHYLLIDEAN V.S. CYCLOPHYLLIDEAN Found in D. latum Where the eggs exit Pseudophyllidean Cyclophyllidean ▪ Genital Pore Scolex ✔ Spatulate or spoon- ✔ Globular scolex Site where male and female shaped ✔ 4 acetabula (“True organs meet ✔ With 2 bothria (“False Suckers”) Suckers”) ✔ May have rostellum or ✔ Ventral and dorsal hooks suckers ✔ Lateral genital pore ✔ With central genital ✔ No uterine pore or uterine pore ✔ Uterus: In different ✔ Uterus: Rosette-like shapes or patterns ✔ Anapolytic ✔ Apolytic Gravid ★ EGGS Segment o All eggs are non-operculated and mature s (embryonated), except for D. latum ▪ ONCOSPHERE Protects the embryo Contains hooklets ▪ HEXACANTH EMBRYO Embryo with 6 hooklets ✔ Always non-operculated ▪ D. latum ✔ Always operculated Eggs ✔ Mature Operculated and immature ✔ Immature (unembryonated) with ✔ Embryonated abopercular thickening ✔ Hexacanth (Thorn No oncosphere and hexacanth ✔ Called “Coracidium” Spike) or Oncosphere embryo ★ ADULT o Found in the intestines of the definitive host Embryo ★ LARVA o Encysted in the tissues of the intermediate host CHARACTERISTICS OF GRAVID PROGLOTTIDS ★ Process of egg release Required ✔2 ✔1 IH ✔ Larval form ✔ 2 larval forms ✔ Cysticercus Encysted ✔ L1 = Procercoid ✔ Cysticercoid Larvae ✔ L2 = Plerocercoid/ ✔ Hydatid cyst Sparganum) ✔ Coenurus ✔ Protoscolex APOLYTIC ★ Segments rupture to release the eggs (Lysis) INTESTINAL CESTODES ★ Detaches ruptures liberating the eggs ★ Diphyllobothrium latum ANAPOLYTIC ★ Taenia solium ★ Eggs are released through a uterine pore ★ Taenia saginata ★ Hymenolepis nana CRASPEDOTE ★ Hymenolepis diminuta ★ Overlapping of segments ★ Dipylidium caninum ★ Characteristic of Hymenolepis spp. ★ Raillietina garrisoni ACRASPEDOTE ★ No overlapping Diphyllobothrium latum ★ COMMON NAMES: o Broad Fish Tapeworm 3 BSMLS 06 A.Y. 2023-2024 | NOE, GENEVA MAE M.  MLS 042 SEM 01 CLINICAL PARASITOLOGY Prof. Louise Anne D. Santos, RMT, DTA, MLS (ASCPi)CM o Russian Broad Tapeworm ★ Broad proglottids with craspedote (overhanging) margins o Fish Tapeworm o Broad Tapeworm ★ INTERMEDIATE HOSTS o PRIMARY: Cyclops and Diaptomus ▪ Freshwater Copepods o SECONDARY: Trout, Salmon, Pike, Perch, Whitefish, and Turbot ▪ Freshwater Fishes ★ PARATENIC HOST: Carnivorous Fish (Bigger Fishes) PATHOGENESIS AND SYMPTOMS ★ DEFINITIVE HOST: Human ★ Infection is usually limited to a single worm ★ LARVAL STAGE ★ Large number of worms are rarely involved and cause o Coracidium → Procercoid → Plerocercoid intestinal obstruction ★ INFECTIVE STAGE: Plerocercoid or Sparganum ★ Infected individuals may show no signs of infection ★ DIAGNOSTIC STAGE: Presence of egg or scolex ★ Nervous disturbances, digestive disorders, abdominal ★ DIAGNOSTIC TECHNIQUE discomfort, weight loss, weakness and anemia may be o Stool Examination experienced ▪ Identification of eggs, scolex, or proglottids ★ D. latum infection results in hyperchromic, megaloblastic anemia with thrombocytopenia and leukopenia MORPHOLOGY OF EGGS ★ COLOR: Yellowish-brown DIAGNOSIS ★ 58-76 µm by 40-51 µm in size ★ History of travel to endemic areas accompanied by a raw fish ★ Has an inconspicuous operculum at one end and an abopercular diet and pernicious type anemia is suggestive knob at the other end ★ Finding the characteristic operculated eggs or proglottids in ★ Has a thick shell the stool through DFS or Kato technique ★ Can be confused with Plasmodium westermani TREATMENT ★ DRUG OF CHOICE: Praziquantel ★ Make sure that the scolex is expelled in feces ★ Re-examine the stool after 3 months if scolex was not seen PREVENTION AND CONTROL ★ Proper human fecal disposal ★ Avoidance of eating raw or undercooked fish MORPHOLOGY OF ADULT ★ Thorough cooking of fish before consumption ★ Broader than long ★ Absence of rostellum and hooks TAENIA SPECIES UTERUS ★ Dark MORPHOLOGY OF EGGS ★ Rosette-shaped ★ Yellowish-brown ★ Coiled ★ Spherical or subspherical in shape ★ Consists of a thick covering called “Embryophore” which is ★ striated ★ The embryo or the oncosphere is enclosed within the embryo ★ Three pairs of hooklets can be seen in the embryo ★ Eggs cannot be distinguished if T. saginata or T. solium ★ Scolex with suctorial groves 3 BSMLS 06 A.Y. 2023-2024 | NOE, GENEVA MAE M.  MLS 042 SEM 01 CLINICAL PARASITOLOGY Prof. Louise Anne D. Santos, RMT, DTA, MLS (ASCPi)CM DIAGNOSTIC TECHNIQUE ▪ Contains 30,000 to 50,000 ova ▪ Undergoes Apolysis ★ Scotch tape technique ★ Formalin-ether/Ethyl acetate concentration technique ★ Intravital staining o Example: India Ink EPIDEMIOLOGY ★ Very common in places where people eat raw or poorly cooked beef and pork ★ Poor sanitation and flooded pastures along rivers ★ Raw sewage disposed in the river ★ Use of nightsoil ★ Human feces are fed to cows/pigs which are then consumed Scolex Gravid Proglottid T. solium stained with (7 to 13 finger-like branches) India Ink by people as food CYSTICERCUS CELLULOSAE PREVENTION ★ Cysticercu