Par

asi
tol
ogy

Parasi
tol
ogyisthear
eaofbiol
ogyconcernedwi
tht
hephenomenonof
dependenceofonel
iv
ingor
ganism onother.

Medicalparasi
tol
ogyi
sthesci
encet
hatdeal
swithor
gani
smsl i
vi
nginthe
humanbody( t
hehost
)andthemedi
calsi
gni
fi
canceoft
hishost–par
asit
e
rel
ati
onship.

Par
asi
te

Apar asit
eisanor ganism t
hati senti
rel
ydependentonot herorganism,
refer
redtoasi tshost,al
lorpar tofi
tsli
fecycleandmet aboli
c
requi
rement s.Str
ict
lyspeaking, t
heterm par
asit
ecanbeappl i
edtoany
i
nfectiousagentbut, byconv enti
on,i
tisgeneral
lyrest
ri
ct edtoinf
ecti
ons
causedbypr otozoaandhel mi nthesandexcludestheviruses,bact
eriaand
fungi

NatureofPar asites-
Apar asitecouldbeuni cellular
,wor m oranart
hropod.
FeaturesofPar asites
1.Smal lerthant heirhost ,
2.Out numbert hehost ,
3.Shor tli
fespant hant hei
rhost ,and
4.Hav egr eaterrepr oducti
v epotenti
al t
hanthei
rhost.
Classifi
cationofpar asit
e

Par
asi
tescanbeCl
assi
fi
ed:
-

I
.Accor dingt othei
rhabitat
:ont hebasisofthei
rlocati
on,parasi
tesmaybe
di
videdi nt otwotypes
1.Ectopar asit
es:
Organismswhi chliv
eont hesur f
aceoft hebody,
exampl ethehumanl ouse,
pediculushumanus, areknownasect oparasi
te
NB.Thei nf ecti
onbyt heseparasit
esisknownasi nfestat
ion.Theyar
e
i
mpor tantasv ect
ortransmit
ti
ngpat hogenicmicr
oor gani
sms.

2.Endopar
asi
tes:
Organi
smsthatli
vewi
thi
nthebodyoft
hehost(i
nthebl
ood,
tissue,
body
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cavi
ti
es,di
gestiv
etractandotherorgans)ar
eknownasendopar asi
tes.All
prot
ozoanandhel mint
hicparasi
tesonmanar eendopar
asi
tes.
Theinvasion
byendoparasi
tesisknownasi nf
ection
Accordi
ngtotheirdependenceonthehost:

Obl
igatepar
asi
tes:or
gani
smst
hatcannotexi
stwi
thoutahostexampl
e:-
t
oxoplasmagondii

Facul
tat
ivepar
asit
es:or
gani
smsthatunderf
avour
ableci
rcumst
ancesmay
l
iveei
theraparasi
ti
corfr
eel
ivi
ngexi
stenceexampl
es:-

a)Naegl
erai
afowl
eri

b)Acant
hamoebaspp

c)Bal
amut
hiamandr
il
lar
is

Acci
dentalpar
asit
es:or
gani
smsthatat
tackunusual
host
(e.
g.
Echi
nococcusgranul
osi
sinman)

Aberr
ant
:parasi
tes:organi
smst hatat
tackahostwher
etheycannotl
i
veor
devel
opfur
ther(
e.g.toxocaracanisi
nman)

Free-li
vi
ng:
theter
mfree-
li
vingdescri
besthenon-
parasi
ti
cst
agesof
exist
encewhichar
eli
vedindependent
lyofahoste.
g.hookwormshav
e
activ
ef r
eel
ivi
ngst
agesinthesoil
.

II
I.Accordi
ngt othei
rPat hogenicity:
1.Pathogenicparasit
es: -Itcausesdi seaseinthehost.E.g.E.hi
, stoly
tica
2.Non-Pathogenic(commensal )parasit
e:-
Theparasit
ederivesfoodand
protect
ionfr
om thehostwi thoutcausi ngharmtot hehost.E.g.Entamoeba
coli
3.Oppor t
uni
sticparasites:-Par asit
eswhi chcausemi l
ddiseasei n
i
mmunol ogi
call
yhealthyi ndividuals,buttheycausesev er
ediseasei n
i
mmuno- def
ici
enthost s.
Example
 Pneumocy sti
scar ni i
,
 Toxcoplasmagondi i
,

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I sosporabel
Whyahumanembr yoorf oetusisnotaparasi
te?
Humanembr t
oorfoet
usdev el
opsinsi
detheuter
usoft
hemot herformor
e
t
hanninemont hsderi
vi
ngi tsnouri
shmentfrom t
hemother
.Inspit
eofthi
s
i
tisnottreat
edasapar asit
e

Compar
isonbet
weenpar
asi
teandhumanembr
yoorf
oet
us

No Par
asi
te Humanembr
yoorf
oet
us

1 Apar asi
teisanorganism ofone Ahumanembr y
oorfoetusi san
speciesli
vi
nginoronanor ganism of organism ofonespecies(homo
otherspecies(ahetero-speci
fi
c sapiens)livi
ngintheuteri
necav i
tyof
rel
ati
onship)andder i
vingits anor ganism ofsamespeci esand
nouri
shmentf rom t
hehost deri
v i
ngitsnour i
shmentfrom the
mot her.Thisisadependent
rel
ationship,butnotaparasiti
c
rel
ationship

2 Apar asi
tei
saninvadingor
gani
sm ahumanembr yoorfoetusi sformeda
comingtoparasi
ti
zethehostf
rom an fer
ti
lizedeggcomingfrom ani nsi
de
out
sidesource source,beingf
ormedint heov ar
yofthe
motherf r
om wherei
tmov esintothe
ovi
ductwher eitmaybef ert
il
izedto
for
mt hezygot
e

3 aparasi
tei
sgener
all
yhar
mful
tosome Ahumanembr yoorfoetusdevel
opi
ng
degr
eetothehost i
nt heut
ri
necav
itydoesnorusual
ly
causeharmtot
hemot her

4 Apar asi
temakesdi rectcontactwit
h Ahumanembr yomakesdi r
ectwit
h
thehost’
stissuesof t
enholdingonby theutri
neliningofthemot herf
oronlya
mouthpar t
s, hooksorsuckerst othe shortperi
odt ime.Itsoonbecome
ti
ssueinvol
v ed(intesti
nall
ini
ng, l
ungs, i
solatedinsideitsownamni oti
csac
connecti
vetissue) andmakesi ndir
ectcontactwit
hthe
mother

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5 Whenapar asi
teinvadeshosttissue, Whent hehumanembr yoattachesand
thehostti
ssuesomet imesr esponds i
nv adestheli
ningt i
ssueoft he
byformingacapsuleofconnect ive mot her’
suterus,theli
ningtissue
ti
ssuetosurroundtheparasiteand respondsbysur roundingthehuman
cutsi
tfrom othersurr
oundingtissue embr yobutdoesnotcuti tofffr
om the
mot her.rat
heritestabli
shesameans
ofclosecontact

6 Whenapar asiteinvadesahost ,
the Mot herdoesr eacttopresenceoft he
hosttissuesomet i
mesr espondsby embr y obypr oducinghumor al
for
mi ngant ibodiesinr esponset o ant i
bodies,butt hetrophoblast(the
somat icantigens(mol ecules j
acketofcel l
ssur r
oundingtheembr yo)
compr isingt hebodyoft heparasit
e) blockst heact i
onoft heseant ibodi
es
metabol i
cant i
gens(mol ecul
es andt hereforet heembr yoisnot
secretedorexcr etedbyt heparasite). rejected.Thisr eacti
onisuni quetothe
Parasitism usual l
yinvolvesan embr y o-
mot herr el
ati
onship.
i
mmunol ogicalresponseont hepar tof
thehost

Host

I
tisdefi
nedasanorganism whi
chhar
bour
sthepar
asi
teandpr
ovi
dest
he
nour
ishmentandshel
tertothel
att
er.

Ty
pesoft
hehost

Def
ini
ti
vehost

Thehostwhichharbourst
headul
tpar
asite,
themosthighl
ydevel
oped
for
m ofapar asi
teorwher
ethepar
asi
terepli
cat
essexuall
y.Whenthe
mosthighlydevel
opedfor
misnotobv
ious,thedef
ini
ti
vehosti
sthe
mammal ianhost.

I
nter
medi
atehost

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Thisisthehostwhi chalter
nateswit
ht hedefini
tivehostandhar
boursthe
l
arvalorasexualstagesofapar asi
te.Somepar asit
erequi
retwo
i
ntermediatehostsf orcompleti
onoftheirl
ifecy cl
e.Thesear
erefer
redto
asfir
standsecondi nter
mediatehostsrespecti
v el
y.E.
g.Cowisthe
i
ntermediatehostforTaeniasaginataandE. g.humanf orpl
asmodium
speci
es.
Paratenichost

I
tisahostinwhi
chlar
valst
ageofpar
asi
tesur
viv
esbutdoesnotdev
elop
f
urther
.Iti
sof
tennotanecessar
ypar
toft
heli
fecycl
e.

Reser voirhost :
ahostt hatmakest hepar asi teavailablef ort het ransmi ssiont oanot her
hostandi susual l
ynotaf fectedbyt hei nf ect i
on.
Compr omi sedhost
Acompr omi sedhosti sonei nwhom nor mal def ensemechani smsar e
i
mpai red(e. g.AI DS),absent(congeni tal def icienci es)orby passed(e. g.
penet rati
onofski nbar rier).Suchhost sar eext remel ysuscept ibl
et oa
vari
et yofcommonaswel lasoppor tunisticpat hogens.
Zoonosi s
Thist ermi susedt odescr ibeanani mal infect iont hatisnat urally
tr
ansmi ssiblet ohumansei therdirect l
yori ndi rectlyv i
aav ector.Exampl e
ofpar asiticdiseasest hatar ezoonosesi ncl udel eishmani asis,sout h
Amer i
cant r
ypanosomi asi
s, rhodesienset rypanosomi asis,japonicum
shi
st osomi asis,tri
chinosis, fasci
oliasis, hydat iddi seaseand
cryptospor idiosis.
Vect or
Av ectori sanagent ,usual lyaninsect st hatt ransmi tsandi nfectionfrom
onehumanhostt oanot her.
Typesofv ectors
1-Mechani cal vector:thet erm mechani cal isusedt odescr ibeav ector
whi chassi stsint het ransferofpat hogensbet weenhost sbuti snor
essent ialinthel i
f ecy cl
eoft hepar asit eexampl ehousef lythat
carriespar asitecy stsandeggs, bact eriaorv i
rusf rom infected
faecest ofoodt hati seat enbyhumans.

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2-Bi ologi cal v ector :av ect orinwhi cht hepat hogensmul tipleor
under godev elopment al changeswi thorwi thoutmul tipli
cat i
on.
Biologi cal vect orscanbecl assi f
iedi ntot hreecat egor i
eswhi char et he
followi ng: -
a)Pr opagat ivev ect or:whenapat hogenunder goesnocy clechangebut
mul tipliesi nt hebodyoft hev ector,transmi ssi oni ssai dt obe
propagat iv
e, e. g.plaguebaci lliinratf leas.
b)Cy clo-pr opogat ivev ector :thepat hogenunder goesacy clicchange
andmul ti
pliesi nt hebodyofar thropode. g.mal ariapar asitesin
femal eanophel esmosqui to.
c)Cy clo–dev elopment alv ector: whenpat hogenunder goescy cli
c
changesbutdoesnotmul ti
plyi nthebodyoft hev ector,e.g.fil
ar i
al
par asitei ncul exmosqui toandgui neawor ml ar v
aei nCy clops.
Associ ationofor gani sms
Hostpar asi ter elationshi psar eoft hef ollowi ngty pes
Sy mbi osi s
Anassoci ationi nwhi chbot hhostandpar asitear esodependentupon
eachot hert hatcannotl ivewi thouthel poft heot her .Neitherofpar tners
suf fersf rom anyhar mf rom t hisassoci ation.
Commensal ism
Anassoci ationi nwhi chonl ypar asi teder i
v esbenef itwithoutcausi ngany
i
nj uryt ot hehost .Acommensal livesonf oodr esiduesorwast epr oducts
oft hebodyandcapabl eofl eadi ngani ndependentl if
e.
Par asitism
Par asitism i sr elat i
onshi pi nwhi chapar asitebenef itsandt hehost
prov idest hebenef it.Thehostget snot hingi nretur nandal way ssuf fers
from somei nj ury.Thedegr eeofdependenceofpar asiteoni tshostv ari
es.

Hostparasi
ter el
ationshi
p
 Effectofpar asit
eontheirhost
 Consumpt ionofthenutr
iti
veel
ement
soft
hehost
.
 Obst r
uct i
onofpassages
 Bleeding
 Compr essi
onofor gans

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 Openi ngpat hwayt osecondar yinfections

 Tr ansmi ssi onofpat hogenst oman
 Pr edi sposi t
ionofmal ignancy
 Al l
er gydev elopment ,e. g.,Bi teofar thropode
HostSuscept i
bi li
tyFact ors
Notal l par asi t
ici nfect ioncausesdi seaseofcl i
nicalsignificance.Bothhost
andpar asi ticf act orsar einv ol ved.
HostFact or s
 Genet icconst i
tut ion
 Age
 Sex
 Lev el ofimmuni ty:nat ur al andacqui redi mmuni ty.
 Nut ri
tion( mal nut riti
onorundernut ri
ti
on)
I ntensi tyandf requencyofi nfect i
ons
 Pr esenceofco- exi stingdi seaseorcondi t
ionswhi chr educes
i mmuner esponse.e. g.Pr egnancy ,HIV
 Li fest yleandoccupat ion
Parasi tef act ors
 St rainoft hepar asi t
eandadapt ati
ont ohumanhost
 Par asitel oad(numberofpar asi t
e)
 Si te( s)occupi edi nt hebody
 Met abol icpr ocessoft hepar asite,parti
cul ar
lythenat ureofany
wast epr oduct sort oxi nspr oducedbyt hepar asitedur i
ngitsgrowth
andr eproduct ion.
Sour cesofi nfect ions
Parasi tei nfect ionsor iginat ef rom f ollowingsour ces
1.Cont ami nat edSoi lsandwat er :soilpollutedwi t
hhumanexcr et
aacts
asasour ceofi nf ectionwi th: -Ascarislumbr i
coides, S.st
ercolar
is,
Tr ichur ist ri
chur iaandhookwor ms.
Befor eacqui ri
ngi nfect ivit
yf orman, eggsoft hesepar asitesunder go
certaindev elopmenti nt hesoi l t
hesear eknownassoi l
t r
ansmi tted
helmi nthes.
Wat erpol lutedwi thhumanexcr et amaycont ainv i
ablecy st sofentamoeba
histolytica, giar dialambl i
a, bal ant i
di um coli,eggsoft aeni asol ium,
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hymenolepisnan, andt hei nfecti

v ecer cari
al stageofschi stosoma
haematobium, s. mansoni ands.j aponicum.
2.Freshwat erfishesconst it
ut et hesour ceofdi phyll
obot hri
um latum
andcl onor chissi nesis
3.Crabandcr ay f
ishesar ethesour ceofpar agoni muswest ermani
4.Raworunder cookedpor ki st hesour ceft richinell
aspi ral
is,t.
soli
um,
t.
sagi nataandsar cocy sti
ssui hominis
5.Raworuncookedbeef: isthesour ceofT. sagnita,toxoplasmagondi
andsar cocy sti
shomoni s.
6.Wat ercress: i
st hesour cefaci olahepat i
ca
7.Blood- suckingi nsect stransmi tplasmodi um spp, wucher eria
bancr ofti
, brugiamal ay i
,onchocer cav olvulus, t
rypanosomebr ucie
gambi ence, andbabesi aspp.
8.Housef l
y(mechani calcar r
ier)i sthesour ceofE. histolyti
ca.
9.Dog:i sthesour ceofEchi nococcusgr anul osusandt oxocaracanis.
10. Cat: isthesour ceoft .gondi i
11. Man: isthesour ceE. histolyt
ica,giardi alambia, enterobi
us
vermi cularisandH. nana.

Por t
al ofent r
yi ntothebody
Mout h
Thecommonestpor talofent ryofpar asit
esi sor althroughcont ami nated
food, wat er,soiledf i
ngerorf omi tes.Thi smodeoft ransmi ssi
onis
transferredasFaecal -oral r
out e.Manyi ntest i
nal parasit
esexampl es:
E.histoly
tica, gi ardi
al ambi a,bal anti
di um coli,E.vermicular i
s,T.t
richiura,
ascar i
slambr icoidesandE. T.C
Skin
Ent r
yt hr
oughski nisanot heri mpor tantpor tal ofentryofpar asi
tes.
Infectionwi thA. duodenal e,N. amer icanusands. stercoralisacqui r
edwhen
fil
ari-
forml arvaeoft hesenemat odespenet r atetheunbr okenski nofan
i
ndi vi
dual wal kingov erfaecal lycont ami natedsoi l
.Schist osomiasi scaused
bys. haemat obi um s.manoni ands. japanicum i sacqui redwhent he
cercar i
allar vae, i
nwat erpenet rat etheski n.Al argenumberofpar asitese.g.
plasmodi um spp, w.bancr ofti,b.mal ayi
,O. volvulus,l
eishmani asppand

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babesi aspp.Ar ei nt roducedper cut aneousl ywhenbl ood- sucking

ar thropodspunct ur et heski ntof eed
Sexual cont act
Tr ichomonasv agi nal i
si st ransmi ttedbysexual contact.E.hi stolyticaand
g. l
ambl iamayal sobet ransmi ttedbyanal –or alsextual pr acti
cesamong
mal ehomosexual s
Ki ssing
E. gingi v ali
si stransmi tt
edf rom per sont oper sonbyki ssingorf rom
cont ami nateddr inki ngut ensils.
Congeni tal
Inf ect ionwi tht.gondi iandpl asmodi um sppmaybet ransmi t
tedf rom
mot hert ofoet ust ranspl acent ally .
Inhal at ion
Ai rbor neeggsofE. v ermi cular i
smaybei nhaledi ntopost eriorphar ynx
l
eadi ngt oinfect ion.
Tr ansmammar y .E. g.s. st ercor alisLat rogeni ci nfecti
ons
Mal ar i
apar asi t
emaybet ransmi ttedbyt ransf usionofbl oodf rom the
i
nf ect eddonor .Mal ariamayal sobet ransmi ttedbyt heuseof
cont ami natedsy ringesandneedl est hismayoccuri ndr ugaddi cts.
ModeofTr ansmi ssi on
Di rectmodeofTr ansmi ssion: -
Thepar asi t
edosenotr equi rebi ol ogical vector sand/ orint ermedi atehost
s
andr equi r
eonl yasi nglehostt ocompl etei tslifecycle.Itmayuse
mechani calvect or sf ortr ansmi ssion.
Di rectModeofTr ansmi ssioncanbecl assifiedas:
I.Hor izont al DirectModeofTr ansmi ssi on: Transmi ssioni s
mai nlyef fectedt hr ough: -Feco- oral rout e: Mosti ntestinal parasites
transmi t
tedi nt hisway .
-Sexual i
ntercour se
-Bl oodt ransf usion
-Di r
ectski npenet rat i
on( soiltransmi ttedhel mi nthes)
II.Ver ticalDi rectModeofTr ansmi ssion:
Tr ansmi ssionoft hepar asi t
ei sf r
om t hemot hert ochildt hrough:
-Congeni t
al /transpl acent al

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-Tr ansmammar y( breastmi lk)

IndirectModeofTr ansmi ssion
Thepar asi tehascompl exl if
ecy cleandr equiresbi ological vectorsand/ or
oneormor ei nter medi at ehost sf ortr
ansmi ssion.
Gener al LifeCy clesofPar asites
DirectLi feCy cle
Apar asi tet hatcancompl et eitsl i
fecy cleinasi ngl ehost .
Exampl es: -
 S.st er coralis,
 Hookwor ms,
 G.l ambl i
a,
 E, .hi stolytica, etc.
IndirectLi feCy cle:
Whenapar asiter equi resani nt ermedi atehostorv ectort ocompl etei
ts
dev elopment .
E.g. ,
 Pl asmodi um speci es,
 Lei shmani aspeci es,
 Taeni aspeci es.et c.
Labor at or ydi agnosi s
Geni tal speci mens
Trophozoi teofT. vagi nal i
smaybedemonst r
atedi nt hev aginal andurethral
dischar geandi nt hepr ost aticsecr etions.
Cer ebr ospi nal fluid(CSF)
Trophozoi teofT. brucei gambi enseandT. rhodesi enseandt r
ophozoi t
esof
Naegl er iaf owl or i
, acant hamoebasppandbal amut hiamandr il
larsmaybe
demonst ratedi nCSF.
Sput um
i
ncasewher et hehabi tatoft hepar asiteisi nther espirator ytract,asi
n
par agoni mi asis,t heeggsofpar asgoni muswest er mani maybe
demonst ratedi nt hesput um speci menr arelymi gr ati
onofl arv
aeof
A.lumbr icoi ds, S.st ercor alis,A. duodenal e,andN. amer icanusmaybef ound
i
nt hesput um.I namoebi cabscessofl ungori nt hecaseofamoebi cl
iver
abscessbur sti
ngi ntot hel ungs, thetrophozoi t
esofE. histolyt
icacanbe

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det ectedi nt hesput um.

Urine
Whent hepar asitel ocalizei ntheur inaryt ract,theexami nat i
onofur ineis
usef ulinest abl i
shingpar asi t
ologi caldi agnosis, e.g.eggsof
s.haemat obi um andt rophozoi tesofT. vaginalismaybedemonst r
atedi n
theur i
ne.I ncaseofchy lur i
acausedbyw. bancr oftimi cr
of i
lairaear eoften
demonst ratedi nchy lousur i
ne.
Blood
Inthosepar asi ti
ci nfection, wher ethepar asiteitselfori nst ageofi t
s
dev elopment , circulatesi nt hebl oodst ream, t
heexami nationofbl oodf i
lm
formst hemai npr ocedur ef orspeci f
icdi agnosi sexampl edemonst rati
on
oft hef ollowi ngpar asites:
Plasmodi um spp, andbabesi aspp, i
nsi det heRBC, L.donov ani inside
monocy tes,tr ypomast igot esofT. b.gambi ensse, T.b.rhodesi enseand
T.cr uzi,andmi crofil
ar i
aeofW. bancr of tiandB. mal ay ii
nt hebl ood.
Stool
Exami nationofst ool isimpor tantf orthedi agnosi sofi ntestinal parasit
ic
i
nf ect i
onsandhel mi nthici nfect i
onsoft hebi l
iaryt r
acti nwhi cheggsar e
dischar gedi nt hei ntestine.
Inpr otozoal infections, thet rophozoi tesandeggscanbedemonst rated
wetmountst ool innor mal salineandl ogol ’
siodine.i nhel mi nthic
i
nf ect i
onseggs, l
ar vaeandadul twor msmaybedemonst r
at ed.
Demonst rationofpar asitesi nt hest ool sconf i
rmst hedi agnosi sand
goldenst andar di ndi agnonsi sofi ntest i
nal parasiticinfections.

Ti
ssuebiopsyandaspi r
ati
on
1.Amast igot
ef or
msofl .donovanimaybedemonst ratedi
nsi
dethe
reti
culoedothel
ialcell
si ntheaspi
rt
ati
onofspleen,bonemarrow,
l
iverandl y
mphnodes.
2.LarvaeofT.spi ral
isT.soli
um andT.mul
ti
cepsmaybedemonst rated
i
nt hemuscl ebiopsy.
3.TrophozoiteofG. l
ambl i
amaybedemonst rat
edint hebi
leaspir
ated
from duodenum byi ntubati
on.

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4.Tr ophozoi t
eofE. histolyticamaybedemonst r
atedi npusaspi r
ated
from amoebi cl iverabscessandi nt henecr otictissueobt ai
nedf rom
thebaseoft heul ceri nt hel argei ntestine
Classi f
icati
onofpar asites
Aspr oposedbywhi tt
akeri n1969al lli
v ingor ganismsbel ongst ofive
kingdomsmoner a,prot i
sta, f
ungi ,
plant aeandani mal .
Pr otozoawhi char eaukar yoticuni cellularor ganismsbel ongstheki ngdom
prot istaandhel mi ntheswhi char eaukar yot i
cmul ticell
ularorganisms
var yingi nlengthf r
om t hel esst han1mi li
met ertomor ethanamet er
bel ongst hekingdom ofani mal ia.
Medi cal Parasit
ologyi sgener allyclassi fiedinto:
1.Medi calProtozool ogy-Deal swi t
ht hest udyofmedi call
yimpor tant
prot ozoa.
2.Medi calHelmint hology-Deal swi tht hest udyofhel minthes(wor ms)t hat
affectman.
3.Medi calEntomol ogy-Deal swi t
ht hest udyofar thropodswhi chcauseor
transmi tdiseaset oman.
Nomencl at
ureofpar asites
Itref erst othenami ngofpar asi tes.Eachpar asit
epossessesagener i
cand
aspeci ficname.t hegenusnamei scapi tali
zed.Bot ht hegenusand
speci esar eit
ali
cized.Of tenthegenusnamei sabbr eviatedbyusi ngt he
fir
stl etteroft hegenusf oll
owedbyaper i
odt hef ullspeciesnamewhi chi s
nev erabbr evi
atedsuchasA. lumbr i
coi des, E.hist
oly t
ica.
Medi cal parasit
ologyhast hreephy la–phy l
um pr otozoa(medi cal
prot ozool ogy)andphy lum pl atehelmi nt hesandphy lum nemat helmi nthes
andphy lum nemat hel mint hes( medi cal hel minthology )eachphy l
um may
bef urthersubdi vi
dedasf oll
ows:
Phy lum

Subphy
lum

Super
class cl
ass subcl
ass

Or
der subor
der

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Super
fami
l
y famil
y subf
ami
l
y
Genus
Speci
es

Introduct iont opr otozoa

Pr otozoaar euni cellularaukar yoti
ccel lsmeasur i
ng1- 50um t hatar epl aced
i
nt hesubki ngdom, orphy lum pr otozoa.Pr otozoal cel l
sconsi stsofpl asma
membr ane, cytopl asm, endopl asmi cret iculum,met achondr ia,
gol gibody ,
ribosome, nuclearmembr ane, nucleasandchr omosomes.
Inaddi tion, theymaypossesspseudopodi a,
flagel l
aorci li
aasor ganellesof
l
ocomot ion.Si ngl epr otozoal cel
lper for msal lthef unct ions–r espirati
on,
digest ion, excret i
on, locomot i
onandr epr oduction.Sexual reproduct i
onal so
occur sI nsamepr otozoa.
Theyhav eshor tgener ati
ont i
me, highr ateofr epr oduct ionandt endencyt o
i
nducei mmuni tyt or einfectioni nthosehost swhosur vive.Manhabour s
mor et han50speci esbel ongsmor et han20gener a.
Theser angef rom compl etelynonpat hogeni ct ot hosecausemaj or
diseasessuchasmal aria,leishmani asi sandsl eepi ngsi ckness.I naddi ti
on
somepr ot ozoal iket oxopl asmagondi i areincr easingbei gnimpl icatedas
maj orpat hogensi npeopl ei nfectedwi thhumani mmunodef iciencyv i
rus
andi nt hoseunder goi ngi mmunosuppr essivet herapy .
Cl assificat ionofpr otozoa
Humanpar asit
ei nt heki ngdom ofpr ot i
sta,subki ngdom ofpr otozoaar e
classi fi
edunderf ourphy la
Sacr omast igophor a(cont ainingamoebaandf lagellates),
api compl ex(cont ainingspor ozoa) ,
ciliophor a( contai ningci l
i
at es)and
mi cr ophor a
Sar comast igophor a
Thi sphy lum i sf uthersubdi videdi ntot wosubphy la
 Mast igophor a
 Sar codi na
Mast igophor a
Theypossessoneormor ewhi pe-li
kef lagellaand, i
nsomecases

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andulutingmembr ane(e. g.trypanosomeandt richomonas) .Thesei nclude

i
nst i
nalandgeni tour i
nar yfl
agel l
ates, (giardia,t
richomonas, di enramoeba
andchi l
omat i
x )andbl oodandt i
ssuef lagellates( t
rypanosomas,
l
eishmani a)
Sacrodina
Thesear et ypicallyamoeboi dor gani sm usi ngpseudopodi af orbot h
l
ocat i
onandf eedingf lagell
,whenpr esentar eusual lyrestri
ctedt o
development lorot hert empot ystages.Thesei ncludeent amoeba,
endolimax, iodamoeba, naegleriaandacant hamoeba.
Apicompl exa
Thesepar asi t
esunger goacompl exl i
fecy clewi t
hal t
ernatingsexual and
asextual repr oduct ivephasesusual l
yi nv ol
v i
ngt wodi ffer
enthost s( e.
g.
art
hropodandv ertebrate).Thi sisseeni ncaseoft hepar asit esofcl ass
haemot ozoea(mal ari
apar asite)thecl asscocci deacont ain
cryptospor idium, cyclospora,isospor a,sarcocy st i
sandt oxopl asma.
Cil
iophor a
Thesear ecompl expr otozoabear i
ngci li
a( organel l
esofl ocomot ion)wi th
twoki ndsofnucl ei i
neachi ndivi
dual .Bal ant i
dium coli i
stheonl yhuman
pathogeni nt hisphy l
um.
Microspor a
Thesear eobl igat eintracell
ularpar asi t
ewi thauni quemodeofent eri
ng
hostcel l
sv i
aapol artubewi t
hinaspor e.About100gener aandabout
1000speci esar ecur r
ent l
yrecogni zedwor l
dwi de.

Amoebae
Amoebabel ongstophy l
um sar comast igophora,subphy l
um
sarcodina,supercl
assr hi
zopoda, classloboseaandoder
auamoeba, amoebi daandschi zopyrenda.
Variousgener ai
ncludedint heorderEuamoebaar eEnt amoeba, edoli
max
andi odamoeba.Whi legener aacanthamoebaandbal amut hiabelongtothe
orderamoebi da.Naegleri
abel ongst otheor derschizopyrenida.
Sixspeciesofamoebaear ecommonl yf oundinthehumangast roint
esti
nal
tr
actoft heseof ,fourbelongst othegenusofent amoeba-
E.hi
st ol
yti
ca,E.har
tmani ,
E.coliandther ecentredescribedE. di
spar.

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t her estr epr esent ssepar at egener a-endol i

maxnanaandi odomoeba
but schl ii
.Di ent amoebaf ragi l
is, l
ongconsi deredot herintest inal amoeba,
hasnowbeenshownt obeanaber rantt richomonadmi croscopeoft hese
onl yE. histoly t
icai smedi cal i
mpor tancei tcausesamoebi asi s,howev er
ot heri ntestinal amoebaear eofi nterestmai nlybecauset hei rtrophozoi tes
maybedi fficultt odi stingui shf rom t hoseofE. hi
stolyt
icabyl ight
Cl assif i
cationofamoeba
1.Pat hogeni camoeba
-Intest i
nal amoeba( e.g.Ent ameobahi stolyti
ca)
2.Nonpat hogeni camoeba
-Mout hamoeba( E.gingi valis)
-Intest i
nal amoeba(E.col i
, endol i
maxnana, E.hart
mani ,iodamoeba
but schl ii
).
3.Fr eel i
vingpat hogeni camoeba
-Naegl eraspeci es, acant hamoebaspeci es.
Ent amoebahi st olyti
ca
E.hist olyti
cawasf i
rstdescr i
bedbyl oschi n1875af terbei ngi solat edin
Russi af r
om apat i
entwi thdy senter icstool s.
Itder ivesi tsnamef rom i tsabi lit
yt ol ysev irt
uallyeverytissuei nt hehuman
bodyandbodyofexper i
ment al animal s.
Geogr aphi cal di stri
but ion
Itiswor l
dwi de, withhi gheri nci denceofami ebiasisindev el opingcount ri
es,
riskgr oupsi ncludemal e, homosext ual s, tr
av el
ersandr ecenti mmi gr
ants
andi nst i
tutional izedpol lutions.
Ongl obal scal e, i
trankssecondaf t
ermal ari
aasacauseofdeat hamong
peopl ewi thpar asi t
ici nfect ionspr oducedbypr otozoa
Habi tat
Tr ophozoi tes: dwel l i
nt hel umenorwal l
oft hecol on,l
iverandot herextra
i
nt est i
nal or gans.I tusual lyf eedsbact eriaandot herti
ssuecel l
s.
• Cy sts: foundi nt hest ool ofchr onicdy sentericpatient sandcar ri
ers.
Mor phol ogy
Thepar asiteexi stsi nt hreemor phol ogical forms
• Tr ophozoi te
• Pr ecyst s

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• Cy st
s
Trophozoite:
Size:
-12t o35μm, Usuallyasl ongas3or4r edbl oodcel l
s.
Shape:-elongatedf orm whenact iv
elymot il
eandr oundedf or
m whenat
rest.
Mot i
li
ty:
-Act i
ve,Progressiv e,dir
ectionalamoeboi dmot i
li
tyinfreshwarm
stoolspecimen.
Pseudopodi a:-Fi
ngerlike, broadl
yr oundedend.
Cy t
oplasm:-Wel ldif
ferentiatedintoectoplasm andendopl asm.-May
containingestedhost ’
sr edbl oodcel l
sindy sentericspecimens
Nucleus:-Singlenucleus, notv i
sibl
eint hemot il
ef orm butiniodinest
ained
smearcl earlyseen.
NBt rophozoiteisonlyf orm presentint hetissuesandi tusuallyappears
onlyindiarrhoeicfaecesi nact i
vecasesandsur vi
veonl yforafew hours.

Precyst
I
tissmal l
erinsize,
veryi
ngfr
om 10-
25um indiameter
.It
sisov al
withblunt
pseudopodium proj
ecti
ngfr
om peri
pher
y.Foodvacuol
esdisappear.There
i
snochangei nthenucl
euswhichshowscharact
eri
sti
csoftrophozoit
e.

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Cy st s
Itsisspher icalSize: 12-15μm indiamet eriti
ssur roundedbyat hick
chitinouswal lwhi chmakesi thighresistancet ogast r
icaci dadverse
env ieronment alcondi ti
onsandchl ori
neconcent rati
onf oundi npotabl
e
wat er .
Itst artsasuninucl eatebodybutl aterthenucl eusdi vi
dest oformt woand
thenf ournuclei
.Uni nucl eut
eandbi nucleateinaddi ti
onal sopossessa
glycogenmass, whi chst ainsbrowni niodineand1- 4chromi dial
or
chr omar oidbarst hesedonotst ainwi t
hi odi
nebutappear sasrefract
il
ein
oblongbar swi t
hr oundedendsi nnor mal sal
inepr eparati
on.
Cy st sarepresentonl yi
nt helumanoft hecolonandi nformedf aeces.
Stool maycont aincy stswi t
h1-4nucl eidependi ngont heirdegreeof
mat urati
on.E.histolyti
cacy stsarenotpr oducedi ntissue.

ModeofTr ansmi ssion

Infectivestage: Tetr
a-nucleatedmat urecyst.Manacquiresinfect
ionof
E.histolyti
cafrom:
-Ingest i
onoff oodordr i
nkcont aminatedbyi nf
ecti
vecyst.
Whoi satr i
skf oramebi asis?Peoplewi tht
hegr eat
estri
skf oramebiasi
s
i
ncl ude:
• peopl ewhohav etraveledtotropical
locati
onswher ethere’
spoor
sanitati
on
•i mmi grantsfrom tropicalcountr
ieswithpoorsanit
ar ycondit
ions
• peopl ewhol iveininstit
uti
onswi thpoorsanit
aryconditi
ons,suchas
prisons
• menwhohav esexwi thothermen
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• peopl ewi t
h compr omisedi mmunesy stems  andot herheal th
conditions
Lifecy cle
Entamoebahi stolyt i
car equiresasi nglehostt ocompl eteitsl i
fecy cl
e.
Whenmat uret etra-nucl eat edcy stf rom cont ami nat edf oodordr inkorf orm
handscont ami nat edwi thf ecesi si ngestedi texcy st sint hesmal lint
est i
ne
topr oducemet acy stict rophozoi tebyapr ocessofbi naryf ission.The
i
mmat uretrophozoi tesmi grat et ot hecol onandgr owt obecomemat ure
trophozoi t
est age, mul tiplybybi nnar yfissiont oinv adet hemucus
membr aneoft hel ar gei ntestine.Somet i
mesi tcanper forat ethei ntestinal
wal l
causi ngext ra-int est i
nal amoebi asi
s.
Thet rophozoi test agemaypasswi thdiarrheaordy sent ery.Af teraper i
od
ofgr owt handmul tiplicat i
on, ency st mentoccur sint helar gei ntest i
ne.In
thepr ocessofcy stf or mat i
on, thet rophozoitedi schar geundi gest edf ood
appear sspher ical inshapeandcondenset obecomepr e-cy st.Thepr e-cyst
secretscy stwal l
tof or m amono- nucleatedcy stwhi chisf oll
owedbya
nucleardi vi
siont opr oduceabi -
nucl eatedandt henat etra-nucl eated
mat urecy st.Cy standpr ecystwi l
l alsopassi nsemi -f or
medorf or med
stool,wher ecy stisi nfect i
vei fitisi ngestedbyanymeansoft ransmi ssion.

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ClinicalFeat uresandPat hology

Thei ncubat ionper iodfor Ehistol yt
ica infectioni scommonl y2- 4weeksbut
mayr angef rom af ewday st oy ears.Asmanyas90%of  E
histolyti
cainfect i
onsar ealsoasy mpt omat ic.Thei nfectioni ssel f
-li
mited
butmayber ecurrent.Amebi asisi smor esev ereinver yy oungpat i
ents,
in
el
der l
ypat i
ents, andi npatientsr eceivingcor ti
costeroids.  Thecl i
nical
expr essionofamebi asismayber elatedt ogeogr aphy. Fori nstance,
amebi ccoliti
si sthepr edomi nantpr esent at i
oni nEgy pt,wher eas
amebi cli
verabscessespr edomi nateinSout hAf r
ica.
Maybeasy mpt omat icorexhi bitamoebi cdy sent eryorext r
a-intesti
nal
amoebi asisint heliver,br
ain, spleen,lung, etc.Amoebi cdy sent eryoccurs
whenEhi stolyti
cat rophozoitesi nvadet hewal lofthelar ge
i
nt estineandmul t
iplyinthesubmucosa, formi nglargef laskshapedul cers.
Theamoeabai ngestr edcel l
sf rom, damagedcapi ll
aries.

AmoebicLi
verAbscess:
Occasi
onal
l
yamoebai scar
ri
edt
othel
i
veri
nthepor
tal
cir
cul
ati
onand

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form abscesses, usual lyi nt her i

ghtl obe.Ther ei spai n&t ender nessov er
theliv er, wast ingandf ev erwi thchi ll
s&ni ghtsweat s.Pat i
ent swi t
hl argeor
mul ti
pl eabscessmaybecomej aundi cedandanemi c.
Othermani fest ationsofamebi asi s
Ameboma
Ameboma, al esscommonf orm ofi nt est i
nal disease, arisesf rom the
format ionofannul arcol oni cgr anul at i
oni nr esponset ot hei nfecti
ng
organi sms, whi chr esul tsi nal argel ocal lesionoft hebowel .
Pleur opul monar yamebi asi s
Pleur opul monar yamebi asi sismostcommonl yt her esul tofcont i
guous
 
spreadf rom al iverabscessr upt uringt hrought her ighthemi diaphragm.
Howev er ,acaseofamebi cl ungabscessacqui redt hr oughhemat ogenous
spreadhasbeenr epor ted.Thet y pical agegr oupi s20- 40y ear s.Themal e-
to-f
emal er atioi s10: 1.
Appr oxi mat ely10%ofpat ientswi thamebi cliv erabscessdev elop
pleuropul monar yamebi asi s,whi chpr esent swi thcough, pleuriticpain, and
dyspnea.
Ahepat obr onchi al fistulai sanunusual probl em char acterizedbyt he
expect or ati
onofsput um r esembl inganchov ypast e.Thet rophozoi tesof  E
histoly ti
ca  maybef oundi nt hesput um sampl e
Cerebr alamebi asi s
Amebi cabscessesr esultingf r
om hemat ogenousspr eadhav eoccasi onal ly
beendescr ibedi nt hebr ain.
Cer ebr al amebi asi soccur sin0. 6%ofamebi cl i
v erabscesscases.Pat i
ents
commonl ypresentwi tht heabr uptonsetofnausea, vomi ting, headache,
andment alstat uschanges.
Comput edt omogr aphy( CT)r ev eal sirregul arl esi onswi t
houtasur roundi ng
capsul eorenhancement .At i
ssuebi opsysampl er ev ealst het rophozoi tes.
Progr essi oncanbev eryr apid,somet i
mesl eadi ngt odeat hwi thin12- 72
hour s.
Amebi cper itoni ti
s
Amebi cper itoni ti
si sgener all
ysecondar ytoar uptur edl i
v erabscess.Lef t-
l
obel iverabscessesar emor eli
kel yt or uptur e.Pat ient spr esentwi thf ever
andar igiddi stendedabdomen.Roughl y2- 7%ofl i
v erabscessesr upt ure

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i
nt ot heper itoneum
Amebi cper icar ditis
Amebi cper icar ditisisr arebuti st hemostser iouscompl icat ionofhepat ic
amebi asi s.
Itisusual lycausedbyar upt ureofal eft-
li
v erl
obeabscessandoccur sin
3%ofpat ient swi thhepat icamebi asis.
Itpr esent swi thchestpai nandt hef eaturesofcongest ivehear t
failur eGeni tour i
nar yamebi asi s
Geni tour inar yi nv olvementmaycausepai nfulgeni talulcer sorf al
lopi
an
tubeamebi asi s.
Amebi cappendi citis
Incount riesofhi ghpr evalence, amebi asisoccasi onallypresent sas
acut e appendi citi
s.
 
Mai nlyi ngay( anal sex)andhet erosexual (oral)who, mani festedaspeni s
amoebi asi s, 
Labor ator ydi agnosi s
Di agnosi sofamoebi asismaybeconf i
rmedbyoneormor et ests
dependi ngont hel ocat i
onoft hedi seaseLabor ator ydiagnosi sofi nt
estinal
amoebi asi si sbasedon:
1)Exami nat i
onofaf r
eshdi arrhei cordy sentericf aecal speci menorr ectal
scr api ngf ormot i
leamoebaeusi ngsaline,orExami nat i
onoff ormedor
semi -f ormedf aecesf orcy stst ages.Suchst ool canbeexami nedbydi rect
sal ineand/ ori odi nesmear ,andZi ncsul phatef l
oat ationorcent ri
fugal
float at ionmet hod.
St ool cul ture:i susef ulespeci allyincasesofchr onicandasy mpt omatic
i
nt est i
nal infect ionsexcr etingl essnumberofcy stsi nthef aeces
Bloodexami nat i
oni tshowsmoder ateleucocy tosi s
Ser ol ogi cal test :thesear enegat i
vei nearlycases, howi nl at erstageof
i
nv asi vei nt est inal amoebi asisant ibodiesappearser ological t
estbecome
posi ti
v e: theset esti nclude:
-i
nder ecthaemaggl utinati
on( IHA)
-i
ndi rectf l
uor escentassay(ELI SA)
Enzy me- linkedi mmunosor bentassay( ELISA)
Aspi rat i
ont rophozoi teofE. histolyticamaybedemonst r
at edbymi cr
oscopy

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ofpusaspi r
atedbypunct ureofamoebi cli
verabscessinlesst han15%
cases.
Liverbi opsytrophozoi teE.histolyt
icacanbedemonst ratedinthe
speci mensofl i
v erbiopsyf rom caseofamoebi chepatiti
sorwal lofl i
ver
abscess.
Sigmoi doscopy
Sigmoi dscopyisausef uldaignost i
cpr ocedureinwhichat hin, flexi ble,
l
ight edi nstr
ument ,calledasi gmoi dscopei susedtovisuall
yexami net he
l
owerpar tofthel argei ntest
inef oramebi cul
cersandt aketi
ssueorf luid
sampl esf r
om thei nt esti
nallining
Imagi ngst udies
Anumberofsophi sticatedimagi ngt ecni qui
essuchascomput ed
tomogr aphyscansCT, magnect i
cr esonancei maging(MRI )andal trasound
canbeusedt odet ermi newhet heral iv
erabscessi spresent.Oncel ocated,
aphy sicianmayt henuseaf ineneedl et owi t
hdrowasampl eoft issuet o
deter mi newhet hert heabscessi sindeedcausedbyanamebi ci nf ection
Different i
alDiagnosi sofAmoebi cDy senteryandBacill
aryDy sent er y

Amoebi
cdy
sent
ery Baci
l
lar
ydy
sent
ery

Odor Of
fensi
ve Odor
less

Col
orofbl
ood Dar
kred Br
ightr
ed

Exudat
e Fewpuscel
l
s Manypuscel
l
s

hi
E. st
oly
tica- Pr
esent Absent

Consi
stency Mucusadher
entt
o Notadher
ent
t
he

Bact
eri
a Numer
ous,
mot
il
e Scant
y,nonmot
il
e

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Tr eat ment
Tr eat ementofamoebi asisi sbasedont heuseofamoebi ci
desand
repl acementoff luidelect roly
test histablewillshowy ouant i
moebi cdrugs
Amoebi cideswi thl umi nal acti
on
-di-iodohy roxy qui n
Di l
oxani def uroat e
-par omomy cin
Amoebi cidesef fect i
vei nthel i
v er,
i
ntestinalwallandot hertissue
-emet ine
-dehy droemet ine
Amoebi cidesef fect i
veonl yl i
ver
Chl or oqui ne
Amoebi cidesef fect i
vei nbot ht i
ssueandt heintest i
nal l
umen
Met roni dazol e
nitroi mi dazol e
Pr ev ent i
on
Theamoebi cinfect ioncanbepr eventedbyav oidingf aecal contami nat
ion
off oodandwat er .Ther eshoul dbepr operdisposal ofhumanf aeces
thr oughpr operdr ainagesy st
em.
Pur ifi
edwat ershoul dbedi st
ributedt hroughpipli
nest oav oid
cont ami nat ion.Boi lwat erissaf e.
t heamountofchl orinenor mallyusedt opurif
ywat eri sinsuf f
icienttokill
cy st s,higherl ev el ofchl orinear eef f
ectivebutwat ert hust reatedmustbe
dechl orinat edbef or euse.
Asy mpt omat i
ccar r
ierspassi ngl argenumberofcy st sint heirstoolare
i
mpor tantsour ceofi nfect i
on.
Theyshoul dber emov edf rom f ood-handl i
ngoccupat ionsandt reat
ed
pr oper ly
.
Usi nghumanexcr etaasf erti
li
zermayl eadtocont ami nationofv egetables,
veget abl est hatar eusual lyeat enrawshoul dbecl eanedwi th
uncont ami nat edr unni ngwat er.Foodexposedt ofliesandcockr oaches

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shoul dnotbeconsumed.Oneshoul dwashhandsbef oreeat ingandaf t

er
def ecat ion.Homosex tualsshoul dbeav oidanal -
oral sexual pract ices.
Ent amoebaHer tmanni
Geogr aphi calDi stri
but ion:Cosmopol itan
Habi tat :bot ht rophoz oiteandcy stl i
vei nthesmal lintesti
ne
Mor phol ogy
Knownas“ smal lrace”ofE. hi stolyticabecauseofsi mi l
arit
yi nt heir
mor phol ogy .I tfeedsonbact erianotr edbl oodcel l
s.
Trophozoi te
Trophozoi te
4-12μm, smal l
erthanE. hi
stoly t
icaAct ivebutl essv igorousdi rect ional
mot i
litybyf inger -
li
kepseudopodi aSi nglenucl euswi thfinebead- l
ikecoarse
chr omat inegr anulesont het hicknucl earmembr aneandhasl argecent eral
kar yosome.
Cy st:-5- 10μm i nsizeandspher ical i
nshape.1- 4nucl ei;Mi nuter icegrain
shapedchr omat oidal barsandgl ycogenmassi nthei mmat urecy ststage.
Lifecy cle
Simi lart ot hel ifecy cleofE. histolytica.Itrequi r
esasi nglehostandhasf ive
mai ndev elopment alst ages.
ModeofTr ansmi ssion
Thr oughcont ami nat edf oodordr ink, orfrom handscont ami natedwi t
h
faeces.
Pat hol ogy :-Har ml esscommensal
Labor ator yDi agnosi s:
-Findi ngt hechar act eristi
ct rophozoi teandcy ststagesi nst ool specimen.
Differ ent i
al char acter s:
-Cy stofE. her tmannii ssimi lart ot hatofE. histolyt
ica/E.di sparbutt he
formeri ssmal l
erinsi ze.
-Cy stofE. her tmannii salsosi mi l
art ot hatofE. nanabutt hel aterhas4-
holel ikenucl eusanddon’ thav echr omat oidbody
Ent amoebacol i
Geogr aphi calDi stri
but ion:Cosmopol itan.
Habi tat Bot ht rophozoi teandcy stsi nt helargeintest i
neofman
Mor phol ogy

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Trophozoi te:-
Size: 15- 50μm( av er age25μm) ,usuallybi ggert hanE. histol
ytica
Shape: Ov al orel ongat ed
Mot i
lity:-Sl uggish, non- pr ogressi veandnon- direct i
onal
-Shor tbl untpseudopodi aCy toplasm: Ect oplasm andendopl asm notwel l
different iat ed.Nucl eus: Singlenucl eus, vi
siblei nthef reshstat ewi thout
staini ng.Thi cknucl earmembr anelinedwi t
hcoar sechr omat ingr anules
andeccent ri
ckar yosome.I nclusions: Bact eria, Yeast s,butnev err edbl ood
cells.
Cy st:-
Size: 12- 20μm al itt l
el ar gert hant hecy stofE. hi stolyti
ca.
Shape: roundedorsl ight lyov al.
Nucl eus: 1-8nucl ei; thicki rregularnucl earmembr anel arge,diffuse,often
eccent rickar yosome
Cy topl asm: bri
ghtpal ey ellowi niodinest ainedsmear .
Lifecy cle
Simi lart ot hel ifecy cl eofE. histolyt
ica.
Modeoft ransmi ssi on
Ingest i
onofcont ami nat edf oodordr inkbyi nfect i
v ecy st.
Pat hol ogy :
-Har ml esscommensal ,maycausedi arrheai nchi l
dr en.
Labor ator ydi agnosi s:-
Findi ngt hechar act eristict rophozoi teandcy stst agesi nstool speci men.
Canbedi ff
er entiat edf rom E. histolyti
cabyi tsl argersi ze.Thecy stof
E.col ishowsagr eat erv ar iati
oni nshapeandsi zet hant hoseof
E.hist olytica
Ent amoebagi ngiv alis
Geogr aphi caldist ribut ion:wor ldwi dedi stri
but i
on
Habi tat :Or al cavit y
Mor phol ogy :-
Hast r ophozoi t
est ageonl y,nocy stst age
Trophozoi te:-
• Si ze: -10-20nm
• Mot il
ity:sluggi sh
• Cy topl asm: wel ldi fferentiateintoect oplasm andendopl asm
• Pseudopodi a: -mul tiple

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• Nucl eus:-si ngle,delicat enucl earmembr anelinedwi t

hf i
ne
chr omat i
ngr anul esandSmal lcent r
al karyosome.
Lifecy cle:
Iti
sr epr oducedbybi naryfissi onandt ransmi tt
edf rom oneper sont o
anot hert hroughki ssing, dropl etsspr ayf rom t hemout h,contami nated
spoonsorcups.
Pat hol ogy :nonpat hogeni ccommensal amoebae
Labor ator yDiagnosi s:-
Findingt hechar acter i
st i
ct r
ophozoi t
estagef r
om
swaboft heor al cav it
y.Itist heonl yspeci est oingesthost ’
sleukocy tes
andhasnumer ousf oodv acuol es.I
tshoul dbedi fferentiatedfrom
Trichomonast enaxwhi chbel ongt of lagellat esandf oundi nor alcavity.
Endol i
maxnana
Geogr aphi caldi stri
but i
on:cosmopol itan.
Habi tat :Trophozoi teandcy sti nthelar gei nt esti
ne.
Mor phol ogy :
-
Trophozoi te
• Si ze: 6-15μm ( average10μm)
• Mot i
li
ty:mul t
iplesmal lroundedbl untpseudopodi amov i
ngsl owl y
in
alldirection.
• Cy toplasm: ver ygranul arwi thsmal lv acuol es
•I nclusion: Bact eria.
• Nucl eus: singl elargei rregularlyshapedeccent ri
ckar yosomeand
thicknucl earmembr anewi t
houtl i
ningofchr omat ingranul es.
Cy st:-
• Si ze: 8-10μm
• Shape: oval
• Nucl eus: 1-4nucl eil
ar ge, ir
regularkar y osome
• Cy toplasm:Deepy ell
owi shcol ori niodi nesmear .
LifeCy cle:-Trphozoi t
est ager eproducesbybi naryfissi
onandmanacqui r
es
i
nf ect i
onf rom cont ami natedf oodordr inkwi thmat urecy ststage.
Labor ator yDiagnosi s:-
Findingoft hecy standt rophozoi testagesi nf ecal
smear .
Iodamoebabut schi li
Geogr aphi caldi stri
but i
on:Cosmopol itan.

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Habi tat:bot htrophoz oit eandcy stint hel argei ntestine.

Mor phology :-
Tr ophozoi te:-
Size: 10- 25μm
Shape: compact ,leaf- like
Mot i
li
ty: sluggi shbycl ear ,rounded, fi
ngerl ikepseudopodi a.
Nucl eus: single, nochr omat i
ngr anulesont henucl earmembr aneandhas
l
ar gekar yosomesur roundedbyachr omat icgr anul es.
Incl usion: bact eria;lar gef oodv acuolepackedwi thgl ycogenmasst hat
st ainsdeepbr ownwi thi odinesol uti
on.
Cy st:-
Size: 8-10μm
Shape: rounded, ov al ori rregular
Nucl eus: single, veryl ar geov al karyosomesur roundedwi thclust
erof
gr anul es.
Vacuol e: verylar gegl ycogenv acuol eof tent akinguphal fpartofthecy st
andst ainsbr owni shr edbyi odinesol ut i
onhencet henamewasgi venas
Iodamoeba.
Lif eCy cle:-Thet rophozoi t
er epr oducesi nt hel argei ntest
inebybi nary
fissi on.Thei nfect ivest agei st hemat ur ecy stst ageandmanacqui res
i
nf ectionf rom cont ami nat edf oodordr i
nk.
Pat hology :Itisnon- pat hogeni c.
Labor at orydi agnosi s:-Fi ndingt hechar acteristi
ct rophozoi teandcy st
st agesi nt hedi r
ectf ecal smearexami nat ionorusi ngconcent rat
ion
techni que.
Ent amoebapol ecki
Mostcommonl yinfect spi gsandmonkey s;butmaycausemi l
ddi arrheain
humanhhumaman
freel i
vingamoebae
freel i
vingamoebaeoft hegener anaegl eriaandacant hamoebaand
bal amut hi aar ef acul tat i
v epar asi t
esofman.Theyar eubiquit
ousi nnat ure,
fundcommonl yinsoi l andwat er(swi mmi ngpool s,tapwat erandheat ing
andai rcondi ti
oni nguni ts)
wher etheyf eedonbact eri
a,butasoppor t
uni st
s, theymaypr oduceser i
ous

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i
nf ect ionoft hecent ral ner voussy st em andt heey e.Ther ef oret heyar e
knownasoppor t uni sticamoeba.Theseamoebaemaybenat ur alhostsfor
l
egi onel l
aaswel l asf orot herbact eriasuchl isteriamonocy togens, v i
brio
chol er a, my cobact er i
um l epr ae, andpseudomonasaer uginosa.Becauseof
theirwel lknownr esi stancet ochl orine, t
heamoebi ccy stsar econsi dered
tobev ect or sf ort hesei ntercellularbact eria.
Theseamoebaehav eal sobeenf oundt obeaccept ablehostf orChl amy dia
pneumoni a, echov i
rusesandpol iov i
r uses.
Fr eel i
v i
ngamoebaebel ongt ophy l
um sar comast i
gophor a, subphy l
um of
sar codi na, super cl assr hizopoda, classl oboseaandor dersamoebi daand
schi zopy reni da, gener aacant hamoebaandbal amut hiabel ongst ooder
amoebi daandgenusnaegl eriabel ongst heor derschi zopy rinda.
t her ei sonl yonenaegl eriaspeci esN. fowl eriwhi chi spat hogeni ctoman.
Sev er al acant hamoebawhi chi spat hogeni ctoman
.Bal amut hiamandr illarisisnewl ydescr i
bedf ree-li
v i
ngamoeba.Thenucl ei
oft heoppor tunist icamoebaepossesal argecent ralnucl eolusor
kar yosomear oundt hehol eandnucl earmembr anewi thoutchr omat i
n
gr anul es.Thi sf eat ur eshel pst odi ffer entiatet heseamoebaef r
om
E.hist oly t
ica.
Naegl er i
af owl er i
Geogr aphi calDi st ribut ion:-Itisfreel i
v i
ngpat hogeni camoebaewi t
h
wor l
dwi dedi stribut ion.
Habi t
at : Nasal cav i
ty ,Cent ral ner voussy st em,
Mor phol ogyN. fowl eri hast wost agesmot il
etr ophozoi tesandnon- mot il
e
cy sts
Tr ophozoi tes
Occur si nt wof or msamoeboi dandf l
agel lare.amoeboi df or mi senlogat e.
Itisact ivelmot ilebymeansofpseudopodi aitmeasur es15- 30um
(av er age22um)i sl engt h.Ithasdi st i
nect ivephagocy ti
cst r
uct ureknownas
amoebost omes.Theyar eusedf orengul fment .I
nt issuet rophozoi t
eingest
er ythrocy t
es, leukocy tesandcay sedest ruct i
onoft issuet her eproduction
ofN. fowl er iai sbsi mpl ebi nar yfissionoft rophozoi te
Flagel lat e
Flagel lat e

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Thef lagel l
at esar ecigarorpearshapedwi tht wof l
agel laatt hebr oader
end.Theymov er apidlyf orwar dorspi nsl owl yi nci r
cleamoebaet hat
transf ormi nt of lagellatesar eknownasamoebof l
agel lates
Cy st
Ar euni nucleat e,spher ical, 7-15um i ndi amet erandar esur roundedbya
relati
v elythincy stwal l
Cy stsandf l
agel l
atef orm ofN. fowl erihav enev erbeenf oundi nt i
ssuesor
CSF.
Lifecy cleandpat hogenesi s
Theamoeboi df or m ofN. fowl eri i
st hei nv asi vest ageoft hepar asite.Man
acqui resi nfect ionbynasal cont ami nationdur i
ngswi mmi ngi nf reshwat er
l
akes, pondsorswi mmi ngpool scont ainingi nf ect ivef orms.I nf ectionmay
alsobeacqui redbyi nhal at i
onofdustcont ai ningi nfectivef or msi tisl i
kely
thatf l
agel latef orm orcy stsofnaegl er
iaf owl ericoul dent ert henose.
Howev er,sincet heamoeboi df or mi st hei nv asiv est ageofpar asite,
theref oreitappear st hatf lagel l
at efor msr ev ertt oamoeboi df ormsandt he
amoeboi df ormsescapef rom t hecy st
si nt henose
Theamoeboi df or msi nv adet henasal mucosa, cribiform pl at eandt r
av el
alongt heol fact oryner vest obr ain.Theyf irsti nv adeol factor ybul bsand
thenspr eadt omor epost eriorr egionsoft hebr ainl eadi ngt or apidl yfatal
i
nf ectionknownaspr imar yamoebi cmeni ngoencephat i
ts( PAM )pat ient
dev elopssev er efrontal headache, fever (39- 40) ,anor exia, nauseaand
vomi ting.
Involvementoft heol factor ylobesmayl eadt odi st urbances,
conf usion, i
rritabi l
it
y,seizur esandv isual dist urbances, conf usi on, irri
tabil
it
y,
seizur esandcoma.Thedi seaseusual lyr esul tsi ndeat hwi thin72hr sof
theonsetsy mpt oms.
Theper i
odbet weencont actwi tht heor gani sm andonsetofcl inical
sy mpt omsv ar yf r
om 2- 3day st oasl ongas7- 15day s.Cl i
ni cal pat ient
historiesi ndicat eexposur et ot heor gani sm v iaf reshwat erl akesor
swi mmi ngpool sshor tlybef oreonsetpat ienthadbeenpr ev iousl yheal th
wi t
hnospeci ficunder lyi
ngpr obl ems.pat hogeni cN. fowler ior gani sms
hav eal sobeeni solatedf rom nasal passagesofi ndividual swi thno
history ofwat erexposur et hussuggest ingt hepossi bili
tyofai rbor ne

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exposur e
Labor ator yDi agnosi s:-
Labor ator yDi agnosi s:-Onlyamoeboi dt r
ophozoi t
est agei sfoundi nman.
Findingt heamoeboi dt rophozoi test agei ncer ebrospi nalfl
uid(CSF) .I tcan
bef oundi nunst ainedorGi emsast ainedCSFsmear .TheCSFappear st o
becl audy ,pur ulentandmaycont ai neosi nophilsandr edbloodcel ls.
Prev entionandcont rol
• Av oidcont act s
• Av oidswi mmi ngandsnuf fingi nwat ersofpondsandl akes
• Boi li
ngt hedr inki ngwat er
• Cooki ngf oodandv eget ables
• Handwashi ngaf t
erdef ecat i
onandbef oreeat ing
• Cont rol mechani cal vectors
• Tr eati nfect edi ndivi
dual sandheal theducat i
on
Treat ment
Treat ment
Atpr esentt her eisnosat isfactoryt reatmentf orPAM.Ant i
bacterial
ant i
bioticsandant i
bi oticdrugsar ei neffectiv
e.Amphot eri
cinB, adr ugof
consi derabl et oxicityust heant inaegl eri
al agentf orther eisevidenceof
cli
nical effect ivenss
Acant hamoebaspeci es
Althoughonl yonespeci esofnaegl eriaisknownt ocausedi seasei nman
sev eralacant hamoebaspeci esincl udingA. culbertsoni ,A.
castellanii,
A.pol yphage, A.ast rony xis,A.healy iandA. div
ionesismaydoso
Mor phol ogy
Acant hamoebaexi stsasact i
vet rophozoi t
esandr esistantcysts.Ther eis
nof lagellatef or m.
Trophozoi tesofacant hamoebaar elarget hant hoseofnaegl eriaand
measur e24- 56um i nl enth.Theyhav ei r
regularappear ancewi t
hspi ke-li
ke
pswudopodi aknownasacant hopodi ahencet henameacant hamoeba, i
t
hasasi ngl enucl euswi t
hal argedensecent ralpromi nentnucleous
sur r
oundedbyahol e.
Cy stsofacant hamoebaar edoubl ewal l
edandt her eforequiteresi stantin
theenv i
ronment .Thesear espher ical,about20um ormor eindi amet erthe

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cy stwal lismadeupofanout erwr i

nl edect ocy tsandani nnerendocy st.
Acant hamoebadi ff ersf r
om naegl eriainnothav i
ngaf lagel latest ageandi n
for mingcy st sint issues.Tr ophozoi tesofacant hamoebamov esl owl ywhi le
thoseofNaegl er i
aar eact ivelymot il
e.
Lifecy cleandpat hogeni city
Manacqui resi nf ect i
onbyi nhal ationofaer osol ordustcont aining
trophozoi tesandcy st s.Thet rophozoi t
er eacht hel owerr espi rator yt ract
andf r
om t her et heyi nv adecent r
al ner voussy stem t hrought hebl ood
stream.Thei nf ect ionmayal sobeacqui r
edbydi r
ecti nv asi ont hrough
brokenorul cer edski norey e.
Acant hamoebacausesgr anul omat ousamoebi cencephi l
its( GAE)i toccur s
i
nper sonswhoar edebi l
itatedori mmunosuppr essedi ncl udi ngpat ients
wi thAI DSandt hoseunder goi ngi mmunosuppr essiv et her apy .Thedi sease
i
susual l
yofgr adual onsetandt akesapr ol ongedchr oni ccour sel asting
weeks, mont hsory ear s,andi schar acterizedf ocal granul omat ousl esions.
Acant hamoebamaycauseker atit
is.Acant hamoebaker et itiswasdescr i
bed
forf i
rstt i
mei n1974.I nf ect ionoccurbydi rectcont actofcor neawi th
amoebae, whi chmaybei nt roduced
Thr oughmi norcor neal traumabyexposur et ocont ami nat edwat eror
cont actl enses.Amoebaeat tacht ot hecont actl ensesst or edi n
cont ami nat edsol ut ionsar et ransf erredt ot heey ewhenl ensesar epl aced
ov erthecor nea.Amoebebecomeest ablishedaspar toft hecor neal fl
or a
andmayi nv adet hecor neal stromat hroughabr eaki nt heepi thelium.They
produceani nf ect iont hatpr ogr essest oacant hamoebaker etitiswhi ch
usual lydev elopsov eraper iodofweekst omont hs.itcausessev er eocul ar
pai n,affect edv ision.I fnotpr oper lymanagedi tmayl eadt olossofv ision.
Labor at orydi agnosi s
Diagnosi sofGAEI smadebydemonst rationoft rophozoi tesof
acant hamoebai nCSFort rophozoi tesandcy stsi nbr aint issue.Di agnosi s
ofacant hamoebaker at it
ismaybemadebyi dent i
fyingt rophozoi teand
cy stsincor neal scr api ngshowsmot il
e.
Tr eatment
Ther ei snosat isf act or yt reat ementf orGAE.Tot aexci sionoft hemassand
treatmentwi thket oconazol e, peni cill
inandchl orampheni col hasbeen

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claimedt obeusef ul.Acant hamoebaker ati

ti
smaybemanagedbyuse
combi nationofdi bromopr opami dineandpr opami dineuset hionat e
oint mentordr opsandneomy cindr ops.Topi cal micnozol eandsy stemic
ket oconazol et opical mi conazol eandNeospor i
nwi thepi thial debr i
dement ,
topi calcl ot r
imazol e;or al itraconazol ewi thtopi cal mi conazol eandsur gical
debr i
dementandt opical pol yhexamet hylenebi guani dehav eal sobeen
claimedt obesuccessf ul fort het r
eatmentofacant hamoebaker atit
is.
Bal amut hiamandr il
laris
• B. mandr ill
arisi snewl ydescr i
bedamoebal ikeacant hamoebasppand
unl i
keN. fowl ar iitdoesnothav eflagellat es
Mor phol ogy
Tr ophozoi te
B. mandr il
lari
sar ei rregul arorbr anchi ngi nshape.Thei rlengt hrangesf rom
12- 60um t heyar emot il
e.Thet r ophozoi tedev elopf i
nger l
ikepseudopodi a.
Cy st s
ar espher i
cal 6-30um i ndi amet erwi thtwowal l
st hei nnert hi nand
spher i
cal andt heout erwal lthickandwr inkledmuchl iket hecy stsof
acant hamoeba.Bot ht rophoz oiteandcy stsofB. mandr i
ll
ar i
sar ef oundi n
tissue.
Pat hogenesi s
Itcausesachr oni cCNSi nf ection( GAE)si mi l
art ot hatpr oducedby
acant hamoebaspp.I tusual l
yoccur sindebi li
t atedchr onical lyillpersons,
someoft hem maybeunder goi ngi mmunosuppr essi vet her apy .
Thepor tal ofent r
yandspr eadofB. mandr il
l
ar isi nfect ioni sbel i
ev edt obe
thesameasf oracant hamoebaspp.I ncubat ionper iodi snotknown
Labor atorydi agnosi s
Canbemadebyi dent i
fy ingt r
ophozoi teofB. mandr i
llarisist heCSFand
trophozoi tesandcy stsi nbr aint issue.
Flagel lates
Flagel latesar epr ot ozoat hatbearonet osev er al l
ongdel icat e,threadl i
ke
ext ensi onofcy topl asm t hesear eknownasf lagel lata(si ngul arflagell
um)
thesear ear i
sef rom bl ephar opl astandar eor ganel l
esofl ocomot i
on.The
flagellat esbel ongt ot hephy lum mast i
gophor a, classki ner opl astideaand
or dert rypansomat ideaccor dingt otheirhabi tatt hef l
agel latesar e

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classi f i
edi nt ot wobr oadgr oups
•I nt est i
nal , oral andgeni talflagel lates
• Bl oodandt issuef lagel l
ates
Intest inal ,oral andgeni tal flagell
at es
Gi ardi al ambl i
a
Gi ardi awasdi scov eredbyl eeuwenhocki n1681i nhisownst ool butnot
descr ibedunt il 1859byl ambl .theor gani sm wasnamedaf terpr ofessor
giar dofpar isandpr ofessorl ambl eofpr ague.
Geogr aphi cal di st ri
but ion
Gi ardi al ambl iai sacosmopol it
anpar asi te.Thehi ghestpr evalenceof
G. l
ambl iaoccur si nt ropi cal andsubt ropi calwher esanitati
oni spoor
trav eler stot ropi cal Af rica,mexi co, Russi a,southeastasi aandwest ernsouth
Amer icaar eatahi ghr i
skofacqui ringgi ardiasis.Giardi
ai nfects200
mi ll
ionpeopl ewor ldwi deandmaypr oducesy mpt omsin500, 000
i
ndi v idual sev er yy ear .Inf ect i
onsseem t obemor ecommoni nchi ldr
enthan
adul ts, mal nour ishedchi ldreni nlar gef ami li
es, orphanasy lums, and
element ar
yschool s.
Habi tat :Upperpar tsoft hesmal l i
nt est i
nemai nlyintheduodenum and
j
ej unum.
Mor phol ogy
Itexi stsi nt wof or ms:
Tr ophozoi te:-Size:10- 21by5- 15μm
Shape: pyriform( pear -
shaped) ,i
.e.r oundedant eri
orlyandpoi nt ed
post erior l
y.
Mot ili
ty:Pr ogr essi ve, rapid, t
umbl i
ngandspi nningoftenl i
nkedt oa
“falli
ngl eaf ”t ypeofmot i
lityinf reshl i
qui dst ools.Bil
aterall
ysy mmet r
ical
Cov exdor sal sur faceandaf l
att enedv entral si
deCont ents
Ant er ior l
yt her ear et wosucki ngdi scseachcont ainsanucl eus, 4pai r
s(8)
flagel la,
Cy st: -Si ze:8- 12μm, ovalshapewi tht hickcy stwal l
.
Finel ygr anul arcy topl asm cl earlysepar atedf rom cy stwal l
.
2-4ov al nucl ei atonepol e, eachwi thsmal l
,cent ralkaryosome.
Cy topl asm: clearwhenunst ained; yellowi shgr eenorbl uishini odine
sol ution

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Riskgr oups
Chi l
dr eni nchi ldcar eset ti
ngs, especi all
ydi aper -agedchi ldrenCl ose
cont act sofpeopl ewi t hgi ardi asis( forexampl e, peopl elivingint hesame
househol d)orpeopl ewhocar ef orthosesi ckwi t hgi ar diasis
Peopl ewhodr inkwat erorusei cemadef rom pl aceswher eGiar di amay
l
ive( forexampl e, unt reat edori mpr operlyt reat edwat erf rom lakes,
streams, orwel l
s)
Backpacker s, hiker s, andcamper swhodr i
nkunsaf ewat erorwhodonot
pract icegoodhy gi ene( forexampl e,properhandwashi ng)
Peopl ewhoswal l
owwat erwhi leswi mmi ngandpl ay i
ngi nr ecreat ional
wat erwher eGi ar diamayl ive, especi all
yi nl akes, ri
ver s, springs, ponds, and
streams
Internat i
onal trav elersPeopl eexposedt ohumanf eces( poop)t hr ough
sexual contact
Transmi ssion
Giardi ai nfectioncanoccurt hroughi ngest ionofdor mantmi cr
obi alcy stin
cont ami natedwat erorf ood, orbyf ecal oral rout e( thr oughpoorhy giene
[
pract ices)Thecy stcansur vi
v ef orweekst omont hsi ncol dwat er ,
socan
bepr esenti ncont ami nat edwel lsandwat ersy stems, especi al
lyst agnant
wat ersour ces, suchasnat ur allyoccur ri
ngponds, stor m wat erst or age
systems, andev encl ean- looki ngmount ainst reams
Theymayal sooccuri nci tyr eser voir
sandper sistaf terwat ertreat ment ,as
thecy st sarer esi stantt oconv ent ionalwat ertr eat mentmet hods, suchas
chlorinat ion.zoonot ict ransmi ssioni salsopossi ble, soGi ardi
ai nfect i
onis
aconcer nf orpeopl ecampi ngi nt hewi lder nessorswi mmi ngin
cont ami natedst reamsorl akes, especiallyt hear tifi
cial l
akesf or med
beav erdams( hencet hepopul arnamef orgi ardi asis, "beav erfev er").In
addi t
iont owat er bor nesour ces, fecal–or al tr
ansmi ssi oncanal sooccur ,for
exampl einday -car ecent ers, wher echildrenmayhav epoorhy gi ene
pract ices.
LifeCy cle
Requi resasi nglehostt ocompl etei t
scy cl eandr epr oducesbyasi mpl e
l
ongi tudi nal binar yf issi on
Cysti ngest ed→excy st ation→Tr ophozoi te→bi nar y

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fi
ssi on→Ency st ation→cy sti nfaecesI nfect ionoccur sbyi ngest i
onof
mat ur et et ranucl eat edcy stwi t
hcont ami nat edf ood, dr i
nk, finger,etc.
Fol lowi ngi ngest ion, t
hecy stexcy stint heupperpar toft hesmal lintestinto
for mf lagel l
at es.Theybecomeat tachedt ot hei nt est inal wal lbyasucki ng
discandabsor bnour ishmentt hr ought hei rbodysur face.Theymul t
iplyby
l
ongi t
udi nal binarf i
ssionandsomeoft hem ar ecar rieddownt heint estinal
tractt ounder goency st ation.Thet rophozoi tesandi nf ect i
v ecystsar e
excr etedi nt hef aeces.
Pat hogeni ci ty
Thesef lagel l
at esdonoti nv adet het issue, butf eedonmucoussecr etions.
Wi tht hehel pofsucki ngdi skt hepar asiteat tachesi tsel ftot hesur faceof
theepi thial cel lsinduodenum andj ejunum andanappr eci ablenumberof
casesi tmaycauseduodenal andj ejunal irritationl eadi ngt oduodeni t
isand
j
ej uni tis.Pat i
entmaycompl ainofdul lepigast ri
cpai n, fl
at ulenceand
chr oni cdi ar hoeaofst eot or r
hoeat ype
.St ool isv olumi nous, foul smel l
ingandcont ainsl argeamountofmucus
andf atbutnobl oodt hi sisduet omal absor ptionsi ncet hepar asitesar e
coat edont hesur faceoft hemucosat husabsor pt ionsuf fers.Patientloses
wei ghtwhent hepar asi telocal izesi nt hebi laryt ract ,itmayl eadt ochr oni c
chol ecy st i
t i
sandj aundi ce.
Var i
ouscondi t i
onst hathav ebeenassoci atedwi thgi ar diasi sinthe
compr omi sedpat i
enti ncludehy pogammagl obul inaemi a, pr ot
einorcal oric
mal nut rition, gast ricachl or hy dria,bloodgr oupAandr educedsecr etoryI gA
l
ev el i
nt hegut .Al t
houghpat ientwi thHI Vi nf ectionhav eal sobeenf oundt o
hav egi ar di asi s.
Diagnosi s
Labor ator yDi agnosi s:-Findi ngt het rophozoi teandcy stst agesi nst ool
speci men.
• Thest ool isusual lyof fensi ve, bulky ,pal e,mucoi d( fatty),
diar r
heic
(wat er y)butt her eisnobl oodi nt hest ool .
Sev eral speci menscol lect edatdi fferentt imeneedt obeexami ned
becauset rophozoi t esandcy stsar eexcr etedi r r
egul arly.
Tr eat ment
Tr eat menti snotal way snecessar yast hei nfect ionusual lyr esolvesoni ts

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own.Howev er,ifthei llnessi sacut eorsy mpt omsper sistandmedi cations

areneededt ot reatit, a nitromi dazol e 
medi cationi susedsuch
as met r
oni dazol e,ti
ni dazol e, secni dazole  or ornidazol e.
TheWHO  and  infectiuosdi seasesoci et
yofamer i
ca recommend
met r oni dazol easf ir
stl i
net her apy .The USCDC  li
stsmet roni dazol e,
ti
nidazol e, and  nit
azoxani de  asef fectivef i
rst-li
net her apies;
 oft heset hree,
onlyni tazoxani deandt i
nidazol ear eappr ov edf ort het reatmentof
giardi asi sbyt heUS.
Dur i
ngpr egnancy , par omomy cini st hepr eferredt reatmentdr ugbecauseof
i
tspoori nt est i
nal absor ption, andt husl essexposur etot hef etus
Alter nat ively ,met roni dazol ecanbeusedaf terthef i
rsttri
mest er  
Prev ent ionandCont rol
• 1.I mpr ovingper sonal , fami l
yandgr oupsani tati
onandhy gi
ene.
• 2.Av oidcont ami nationoff ood, drinkandhandswi tht hef aeces.
• 3.Saf ewat ersuppl yandl atr
ineconst ruct ion.
• 5.Tr eat mentofi nfect edi ndiv i
dualsandheal theducat ion.
TheCDCr ecommendshand- washi ngandav oidi ngpot ent i
all
y
cont ami nat edf oodandunt reat edwat er.
Boi l
ingsuspectwat erf oronemi nuteist hesur estmet hodt omakewat er
saf et odr inkandki lldi sease- causi ngmi cr oorgani smssuchas  Gi ardia
l
ambl ia
Chemi cal disinfect ant sorf i
lter smaybeused
Dient amoebaf r
agi l
is
Dient amoebaf r
agi l
iswasi ni t
ial l
yt houghtt obeanamoeba.I tnow
cl
assi fiedasaf l
agel lat eev ent houghf l
agel laar enotobser vedwi thlight
mi croscope.
Went on1909f i
rstdi scov er edt hispar asite
Geogr aphi calDi stri
but i
on:Wor ldwi de:-
Wor l
dwi de
Habi t at:Int hel argei nt estine.
Mor phol ogy :Hast rophozoi test ageonl y, Nocy stst age.
Li
f ecy cle
D.Fr agi l
isi snotcompl eteunder stood.BecasuseD. fr
agi l
i
sdoesnothav e
ani dent ifiedcy stst at eDirectf oodbor norwat er bornt ransferf rom hostt o

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hosti sl ikel y.Ni net imeshi gherincidenceofD. fr

agi li
si npat i
ent swi th
pinwor mi nf ect i
onsuggest sthattheent er obiusv er micular iseggsmaybe
i
nf ectedwi t
ht hef lagel lateandser veast hechi efv ect orfort ransf ertoman.
Itrepr oducesasexual lybybi naryfission.
Pat hogenesi s
Itisconsi der edt obehar ml esscommensa. Itsmi ldlypat hogeni cinabout
25%ofi nf ect edi ndi v i
dual swhomaydev elopi ntermi ttentdi arrhoea,
abdomi nal pai nf lat ulencenausea, vomi ti
ng, anonexi a, mal aise,wei ghtloss
andunexpect edeosi nophi li
a.
Labor at or yDi agnosi s:-
Thet r
ophozoi test agei shighl yfr
agileand
disintegr at esexpl osi velyinwat eri
mmedi ately.Hencei tneedsi mmedi ate
exami nat ionoff r eshst ool speciment ofindt het rophozoi test age.
Treat ment
Thedr ugsofchoi cei nt het reatmentofsy mpt omat i
ccasesi nclude
tetracy clineandmet roni dazol e.
Chi l
omast ixmesni l
i
Chi l
omast ixmesni l
i Isacommonf l
agellatel ivi
ngashar ml esscommensal
i
nt hecaecum andcol onofman.Dav aine1854obser vedt hispar asitefor
thef ir
stt imei nt hest ool .
Weny on1910pr ov i
dedt hef i
rstaccur atedescr i
pt i
onoft hepar asi t
e.
Geogr aphi calDi st ri
but ion:
Ithasacosmopi tandi st ri
but i
onbuti smor epr ev alenti nwar mt hani ncool
cli
mat es
Habi tat:
Trophozoi teandcy stlivei nt hecolonandcaecum oft hel arge
Mor phol ogy
Trophozoi te:
Cy st:
LifeCy cle
Cy st→Ex cy stat i
on→Tr ophozoi te→Bi naryf ission→ency station→Cy stinthe
faeces
Trophozoi test ager epr oducesbybi naryfissi on.Thei nfect i
vest ageist he
cystf rom cont ami nat edf oodordr i
nk.

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Excy st at i
onoccur si nt hel argei ntestineandt rophozoitemul ti
pliesby
binar yf ission.
Labor ator yDi agnosi s:-
Findi ngt het rophozoi t
eandcy stst agesi nst oolspeci men.Thet rophozoite
stagei sv erysi mi l
art oGi ardialambl iaandTr ichomonashomi nis; and
needscar efuli dent ifi
cat ion.
Trichomonas
Genust richomonascont aint hreespeci eswhi choccuri nhuman
T.Tenax
T.Homi nis
T.Vagi nal i
s
Thesef lagel l
at esexi stonl yint rophozoi test age. cysti
cst ageisabsent .
they
hav ef ourant eriorf lagellaonel ateral fl
agel lum whi chat t
achedt ot he
surfaceoft hepar asi te.
Trichomonashomi nis
Geogr aphi calDi stribut i
on:Nextt oGi ardial ambl ia,i
tisprobabl ythemost
commonandmostcosmopol i
tanoft hei ntest inal f
lagell
atesofman.
Habi tat :Lar gei ntest i
ne.
Mor phol ogy :hast rophozoi testageonl y.
LifeCy cl e:-
Thet rophozoi test ager eproducesbybi naryf issionandr equiresdi recthost
tohostt ransmi ssi ont hr oughcont ami nat edf oodand/ ordr i
nk.
Ithashi ghpr ev alencei nchi l
drenandmor ecommoni nwar m cli
mat es.
Pat hol ogy :
Itisnon- pathogeni cbutmaycausedi arrhoeaandi nfecti
oncanbe
prev ent edbyper sonal hy gieneandsani tation.
Labor ator yDi agnosi s:Fi ndingt het rophozoi test agei nf r
eshst ool
speci men
Trichomonast enax
Itishar ml esscommensal oft hehumanmout h,l
ivi
ngi nt hetartarar ound
thet eet h, incav itiesofcar ioust eeth, i
nnect r oticmucosal cell
si nt he
gingi val mar ginofgumsi npuspocket sint onsi l
arf ol
li
cales
Geogr aphi cal dist ribut i
on
Wor l
dwi de.dist ribut ionwi thhighi ncidencei nwar m cli
mat es.

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Habi t
at :oralcav i
ty
Mor phol ogy :Hast rophozoi test ageonl y.
LifeCy cle:-
Thet rophozoi test ager epr oducesbybi naryf i
ssionandt ransmi ssi oni s
directf rom mout ht omout ht hroughki ssing, saliv
erydr opl et sandf omiti
s
orcommunal useofcont ami nat edf oodanddr i
nkingut ensi ls.
Pat hol ogy :
-Itisnon- pat hogeni c
Labor atoryDi agnosi s:-Findi ngt het rophozoi t
esi nunst ainedorst ained
smeari nswabt akenf rom t heor al cav it
y.
Trichomonasv aginal i
s
Geogr aphi calDi stribut i
on:
Wor ldwi dedi st ri
but ionandmai nlycommoni nt hetemper at er egi on.
Habi t
at :
-Inthegeni talt ractofmal eandcommonl yinf emal e, especi al
lythe
vagi na, cer v
ix, uri
nar ybl adde- r,pr ostat eandsemi nalv esicl es.
Mor phol ogy :
Hast rophozoi test ageonl y.
LifeCy cle:-
Thet rophozoi test ager epr oducesbyl ongitudinalbinar yf i
ssi onandmode
oft ransmi ssi oni susual lyv i
asexual intercour sebutal sobycommunal
bat hing, shar ingofwashcl ot hes, toi l
etequi pmentseat sandmot hert o
daught erdur ingbi r t
h.
Pat hol ogy :
Causest richomoni asi s.Maj orsy mpt omsar eVagi ni
tis,ur et hr i
tis, prostati
ti
s,
chaf fingofv ulv a,cer vical erosi on, burningsensat ion,yel l
owi shpr ulent
dischar ge, r
ev ersiabl est erili
tyi nmal e.
Labor atoryDi agnosi s:-
Findi ngt het rophozoi t
esi nunst ainedorst ainedpr epar ationofv agi nalor
uret hral dischar ges, ur i
nesedi ment ,
v aginal swab, prost atesecr etions
Prev ent ion
Sincei nfectioni scont ract edt hroughsexual intercourse, ther efor ethe
prev ent ivemeasur esi ncl ude: -
Det ect i
onandt r
eat mentofcases, bothmal esandf emal es.
Av oidenceofsexual cont actwi thi nfect edper sonsanduseofcondoms.
Ther ei snov acci necur rentlyav ial ablef oruseagai nstT.v agi nilis.

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Treat ment
Met r
oni dazol ei shi ghl yeffect ivet her apeut i
cagent .I
tisgi venor al
lymg
threet i
mesdai lyf orsev enday s2gr am or all
yasasi ngledose
Itiscont radicat edi npr egnancy .Int hissi tuationt opical ther apywi th
clot r
imazol e100mgdai l
yf orsev enday sisr ecommended.
Silumt aneoust reat mentofsexual par tner sisessent ialtopr ev ent
recur renceofi nf ect i
on.
Leishmani asis
Leishmani asisi sagr oupofdi seasescausedbypr otozoaoft hegenus
l
eishmani aani nfect i
oncausedbyapar asitet hati sspr eadt opeopl e
throught hebi teoft hef emal esandf ly.Phl ebot omusandLut zomy i
a.
Thedi seaseaf fect ssomeoft hepoor estpeopl eonear th, andi sassoci ated
withmal nutriti
on, popul ationdi splacement ,poorhousi ng, aweaki mmune
syst em andl ackoff inanci al resour ces.
Epi demi ol ogy
Leishmani asisoccur si n88t ropical andsubt ropical count ri
esf i
ve
cont inent s-Africa, Asi a,.16ar edev el opedcount ries,72ar edev eloping
wi thanest imat ed350mi l
lionpeopl eatr iskofi nf ecti
on.Theov eral
l
prev alenceoft hel eishmani asesi sest imat edat12mi l
lioncaseswi th0.5
mi ll
ionnewv i
scer alleishmani asi scasespery earand1. 0–1. 5mi l
li
onnew
cut aneousl eishmani asi scasespery ear
Mor et han90%ofv iscer alleishmani asi soccur sinSudan, Bangl adesh,
Nepal ,Brazi landI ndia, andmor et han90%ofcut aneousl ei shmani asi
sin
Brazi l,
Per u, Afghani st an, Syria, I
ranandSaudi Ar abia.Inr ecenty earst her ehav e
beenmaj orepi demi csofv iscer al leishmani asi sinsout her nSudan, eastern
India, Bangl adesh, andnor th-eastBr azi l
Increasedi nfect i
onsandt hespr ead
ofl eishmani asesar er elatedt oenv i
r onment al andbehav iour al changes
anddev elopment ,conf l
ictandwar ,br ingingnoni mmunepeopl ei ntocloser
cont actwi thv ect orsandr eser voirhost sAni ncreasei nt hei ncidenceof
Leishmani ainf ect i
onsi sal sobei ngr epor tedf rom HI Vpr ev alentar eas.
Leishmani aspeci esar ewi despr eadi nt heOl dWor l
d
andNewWor ld:
OLDWORLD( Af ri
ca, Asi a,Eur ope)

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• L.donov ani :Bangl adesh, nor theastI ndi a, Bur ma, Sudan, Keny aand
Hor nofAf r i
ca.I nf ectionsar eant hr oponot ic, i.e.f r
om onehumant o
anot her( rodent sanddogsmayser veasr eser v oir
si nsomear easof
Af r
ica) .
• L.inf ant um:Endemi ci ncent r alAsi a, nor theastChi na, Middl eEast
andt heMedi ter raneanbasi n.I nfect ionsar ezoonot i
c,i.e.from ani mal
tohuman, withdogs, foxes, andj ackal sser vingasr eser voirhost s.
• L.maj or :Wi despr eaddi st ri
but i
on, beingf oundi nsub- Sahar anAf ri
ca
from Senegal acr osst ocent ral Sudan, nor thI ndi a,Pakist an,cent ral
Asi a, Mi ddleEastandnor t hAf ri
ca.I nf ect ionsar ezoonot icwi thr ats
andger bilsser vingasr eser v oirhost s.
• L.tr opi ca:Mi ddl eEast ,east er nMedi ter raneancount ri
es, northAf r
ica,
nor thwestI ndiaandAf ghani st an.I nfect ionsar eant hroponot i
c.
L.aet hiopica:Foundonl yint hehi ghl andsofEt hiopiaandKeny a.
Infect ionsar ezoonot icwi thr ockandt reehy dr axesser v i
ngas
reser v oirhost s.
NEW WORLD( Sout hAmer icaandCent ral Amer ica)
• L.inf ant um ( L.chagasi )
:Cent ralAmer icaandpar t
sofSout hAmer i
ca,
especi allyBr az ilandVenezuel a.Inf ect i
onsar ezoonot icwi t
hdogs,
foxesandmar supi al
sser v i
ngasr eser v oirhost s.
• L.mexi cana:Tr opicalf or est si nMexi co( Yucat an),Guat emal aand
Belize.For estr odent sar et her eser voirhost s.
• L.amazonensi s:Tr opicalf orest sofBr azi landVenezuel aandal soi n
Trinidad.For estr odent sar et her eser v oirhost s.
• L.br azi li
ensi s:Tr opicalf or est sofSout hAmer i
ca, especi allyAmazon
forestandal soi nCent ral Amer i
ca.Reser v oirhost sar epossi bly
rodent sandsomedomest i
cani mal s
• L.panamensi s:Panama, Cost aRi ca, Col ombi a.Sl othsar ereser voir
host s.
• L.per uv i
ana:Andesi nPer u, Ar gent i
nianhi ghl ands.Dogsar enat urally
i
nf ect edbutt her ei sal sopr obabl yawi ldani mal host.
• Leishmani asi t uat i
oni nsomal i
a
`
Todat et her ear enor epor tsofcut aneousandmucocut aneous
l
eishmani asisi nSomal ia.Howev er, viscer al leishmani asisispr esent .

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AreasofSomal iawher eVLhasbeenr epor tedi ncl udet hecoast al areasi n

thesout hoft hecount ryt hear eaal ongt heShebel ler iveri nthesout hof
Somal ia, LowerJubar egi onandBai doai nBayr egi on.
Maj orr iskf act or s
Soci oeconomi ccondi tions
Pov er tyi ncr easest her iskf orleishmani asi s.Poorhousi nganddomest ic
sanit ar ycondi ti
ons( suchasal ackofwast emanagementoropen
sewer age)mayi ncr easesandf l
ybr eedi ngandr est i
ngsi tes,aswel last heir
accesst ohumans.Sandf liesar eat tract edt ocr owdedhousi ngast hese
prov ideagoodsour ceofbl ood- meal s.Humanbehav iour ,suchassl eeping
outsi deoront hegr ound, mayi ncreaser i
sk.
Theuseofi nsect icide- treat edbednet sr educesr isk.
Mal nut riti
on
Dietsl acki ngpr otei n-ener gy ,i
ron, vitami nAandzi nci ncr easether iskt hat
ani nf ect ionwi llprogr esst okal a-azar .
Popul at ionmobi l
i
ty
Epidemi csofbot hcut aneousandv iscer al leishmani asi sar eoften
associ at edwi thmi gr at ionandt hemov ementofnon- immunepeopl ei nto
areaswi thexi st i
ngt ransmi ssi oncy cl es.Occupat i
onal exposur easwel las
widespr eaddef orest at i
onr emai nimpor tantf act ors.
Forexampl e, peopl eset t
lingi nar east hatusedt obef or estsmaybe
mov ingnearsandf li
es’ habi tat.Thi scanl eadt oar apidi ncreaseincases.
Env i
r onment al changes
Env i
r onment al changest hatcanaf fectt hei nci denceofl ei
shmani asi s
i
ncludeur bani zation, domest i
cationoft het ransmi ssioncy cl
eandt he
i
ncur sionofagr i
cul tur al farmsandset tl
ement si ntof or estedareas.
Cli
mat echange
Leishmani asi si sclimat e-sensi t
ive, andst rongl yaf f ect edbychangesi n
rai
nf al l,temper atureandhumi dity.Gl obal war mi ngandl anddegr adat ion
toget heraf f ectt heepi demi ologyofl eishmani asisi nanumberofway s:
changesi nt emper at ur e, rainfallandhumi ditycanhav est r
ongef f
ect son
vect or sandr eser v oirhost sbyal teringt heirdi stribut i
onandi nf
luenci ng
theirsur v ival andpopul ationsi zes;
smal lfluct uat ionsi nt emper aturecanhav eapr ofoundef fectont he

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dev elopment al cycleof  Leishmani a  promast igot esi nsandflies, allowi ng

transmi ssi onoft hepar asi tei nar easnotpr ev iouslyendemi cf ort he
disease;
drought ,fami neandf loodr esul t
ingf r
om cl i
mat echangecanl eadt o
massi v edi spl acementandmi grat ionofpeopl et oar easwi tht ransmi ssion
of Leishmani a, andpoornut riti
oncoul dcompr omi set hei
rimmuni ty .
Tr ansmi ssi on
Leishmani aspeci esar et ransmi ttedbyt hebi teofani nfect edf emal e
sandf ly,bel ongingt ot hegenusPhl ebot omusi nAf ri
ca, Asi aand
Eur ope, andt hegenusLut zomy iai ntheAmer icas.About30speci es
ofsandf liesactasv ect ors, inf ectinghumansandani mal reser voir
host s.
Sandf lyv ect or s
Thef eedi ng, breedi ngandf li
ghthabi t
sofsandf li
esar especi esspeci fi
c.
Mostsandf li
esf eedmai nlyonpl antj uice
fl
iesal sor equi rebl oodmeal sf oreggdev elopment .Mostspeci esf eedat
night ,duskordawn.Sandf lyhabi tatsi ncluder ott
ingl eavesundert rees,
excr eta, ter mi tehi ll
s,andr odentbur rows. ,butf emal e
Thel i
fecy cl eofLei shmani aspeci es
Aper sonbecomesi nfectedwhenpr omast igot esar ei nocul
at edatt het ime
af emal esandf lyt akesabl oodmeal .Thepr omast igotesaret akenupby
macr ophagesanddev elopi nt oint racel lularf or mscal ledamast i
got es.They
mul tiply, rupt uref rom t hemacr ophages, andi nfectnewcel ls.
Inv iscer al leishmani asist heamast i
got esmul tiplyint hemacr ophagesof
thespl een, li
v er,bonemar row, lymphgl ands, mucosaoft hesmal lintestine,
andot hert issuesoft her et i
cul oendot helialsy stem.Bl oodmonocy tesar e
alsoi nf ect ed.
Incut aneousl eishmani asist hepar asi tesmul ti
plyinski nmacr ophages
(histiocy tes) .
Thel i
fecy cl ei scont inuedwheni ntr acel l
ularandf reeamast i
got esar e
i
ngest edbyaf emal esandf l
y .Afterabout72hour s,theamast i
got es
becomef lagel l
atedpr omast igotesi nt hemi dgutoft hesandf ly .
Theymul tiplyandf il
lthelumenoft hegut .Af ter14–18day s( dependi ngon
speci es) ,thepr omast i
got esmov ef or war dt ot heheadandmout h-par tsof

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thesandf ly .Thesal i
v arygl andsar enotpar asi ti
zed.
Clini
cal classi ficationofLei shmani a
Leishmani acanbeeasi l
ycl assi fiedbasedoncl i
nicallyandt heirsit
eof
diseasepr ogr essi on.
Theyar ecl assi fi
edi nt ot hree
 1.Vi scer al Leishmani a
 2.Cut aneousLei shmani a
 3.Muco- cut aneousLei shmani a
• Viscer al leishmani asi s( VL)
Thisist hemostsev er ef or m ofl ei shmani asis.I scausedbyL.donov
ti ani
andL.i nfant um ( L.chagasi ).i
nendemi careas, thedi seasei smor echr onic
withyoungadul tsandchi ldrenbei ngmor ecommonl y i
nfect ed.
Aboutt wi ceasmanymal esar eaf fect edthanf emal es.
Inepidemi cs, all agegr oupsar esuscept i
ble( exceptt hosewi thacquired
i
mmuni ty)andt hedi seasei sof tenacut e.Wi thoutt reat ment , VLisusual ly
fatal
.Si gni ficantadv anceshav ebeenmadei nt het reatmentofv i
scer al
l
eishmani asi s
signs&Sy mpt oms
Sy mptomsi nchr onicVLi nclude: -
i rregul arfev er
 Spl enomegal y
 hepat omegal y
l ymphadenopat hy ,
l ossofwei ghtwi t hwast ing
 di ar rhoea,
l owwhi tecel landpl ateletcount s,andanaemi a.
Skinchangesar ecommon.Thel ocal I
ndiannamef orVL, kal
a-azar
(meani ngbl acksi ckness)i sar ef erencet ot hegr ey i
shcol ourwhicht he
pati
ent ’sski nbecomes.
InacuteVLt her eisspl enomegal y , highundul at i
ngf ev er
, chill
s,profuse
sweat i
ng, r apidwei ghtl oss, fatigue, anaemi a, andl eucopeni a.Oftent here
i
sepi staxis( nosebl eed)andbl eedi ngf rom t hegums.
IntheNewWor ld,VLi sendemi corspor adic.
Asy mptomat i
ci nfectionsandsubcl i
nicalformsoft hedi seasear emor e

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common.Mal nutritionandot heri nf ect i

onsi ncr easet her i
skofdev eloping
sy mpt omat icVL.
Inact ivev iscer allei shmani asist her ei sapoor cel l
-medi atedi mmune
responseandt her ef or ethepar asi t
esmul tiplyr api dly.
Ther eis, howev er,ahumor alresponsewi thl argeamount sofpol yclonal non
-speci f
icimmunogl obul inespeci all
yI gG bei ngpr oducedandal sospeci fic
ant i-
leishmani alant i
body .Pat ient swhohav er ecov eredf rom v isceral
l
ei shmani asisar ei mmunef r
om r einf ectionbutr elapsescanoccur ,
par ticularlyi nt hosecoi nfectedwi thHI V.
Postkal a-azarder mal l
eishmani asis( PKDL)
InI ndi aandoccasi onal lyi nEastAf rica, acut aneousf orm ofl eishmani asis
canoccurabout2y ear saf tert reatmentandr ecov er y
from v iscer al l
eishmani asis.Thi si sr ef erredt oaspostkal a-azarder mal
l
ei shmani asisandaf f ectsabout20%ofpat i
ent si nI ndia.
Hy popi gment edandr aiseder ythemat ouspat chescanbef oundont hef ace,
trunkoft hebody , andl imbs.
Thesemaydev elopi nt onodul esandr esembl et hoseofl epr omat ous
l
epr osy ,fungal infect i
onsorot herski ndi sor der s.Occasi onal l
yt herei s
ulcer at i
onoft hel ipsandt ongue.Amast igot esar epr esenti nt hepapul es
andnodul es.
HI Vcoi nfect ion
Inar easwher ebot hl eishmani asi sandHI Vi nf ect i
onoccur , vi
scer al
l
ei shmani asis( VL)i sbei ngi ncreas-i ngl yr epor tedi nt hosewi th
i
mmunosuppr essi on
causedbyHI V.Fr equent l
ypar asi tesi nfectnotj ustt her eticuloendot helial
sy stem butal sot hel ungs, cent ralner voussy stem, nor mal skin, andbl ood.
Par asi teshav ebeenf oundi nphagocy ticcel lsi nt heper i
pher albloodi nup
to75%ofpat ients( 98%i nbonemar rowaspi rat es)Pat ientswi t
hVL/ HIV
coi nfect i
ondonotr espondwel l totr eat ment .Inmostpat i
ent s,VLi sr apidly
progr essiv eandVLaccel eratest heonsetofAI DSi nt heabsenceof
ant iretroviral treat ment .
Rel apsesar ecommonI nsout her nEur opebet ween25–70%ofadul tVL
casesar eest imat edt obeHI V-related.I ntrav enousdr uguser sar e
par ticularlyatr isk.

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Inot herpar tsoft hewor l

d, e.g.I ndia, EastAf r i
caandBr azil,
ther iskof
Leishmani a/ HI Vcoi nfectionisi ncreasi ngasVLi sbecomi ngmor e
urbani zed, andHI Vi nfectioni sbecomi ngmor ecommoni nrur alareas
Labor at or ydi agnosi s
Exami nat ionoft i
ssuebi opsy , (
spl een, bonemar row, l
y mphnode
aspi rat i
ons)andmayshowamast i
goi tes.
Cul tur eofbl ood, bonemar row, andot hertissuedemonst rates
promast igot es
• Tr eat ment
• Tr eat ment
 St ibogl uconat e
 Al l
opur inol
 Pent ami dine
 Amphot er i
cinB
Cut aneousl eishmani asis( CL)
Thecl ini cal for msofCLv aryaccor dingt othe
speci esofpar asite, region, andr esponseoft hepat ient
OLDWORLDCL
L.tropi ca:I nfect i
oni sof t
enr ef erredt oasdr yur ban
ori
ent al sor e.
Drypai nlessul cers25–70mm i ndi amet erar epr oducedwhi char esel f
-
heal i
ng
usual lyaf t er1–2y ear sbutof tenl eav edi sfigur i
ngscar s.Thepat ientis
i
mmunet or ei nfection.Rar elyther emaydev elopmul tipleunheal ingl esi
ons,
oftenont hef ace.
Thiscondi tioni sknownasl eishmani asisr ecidivans( LR)andi sthoughtt o
beanal l
er gicst ate.I tcanl astmanyy earsandi sdiffi
culttot reat.
Unt reat edLRi sdest ruct i
veanddi sfigur i
ng.
L.maj or :I nf ect ioni sof tenr efer redt oaswetor ientalsor e.Theear lypapule
i
sof teni nf lamedandr esembl esaboi lof5–10mm i ndiamet erwhi ch
rapidl ydev el opsi ntoal argeunev enul cerwhi chi ssel f-
heal i
ngi nasl i
tt
leas
3–6mont hs.
Mul tiplel esi onsmayoccuri nnon- immuneper sons.
L.aet hi opi ca:Acut aneousl esioni spr oducedt hatissi milartot ypical

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orient al sor ewi thheal ingi n1–3y ear s.L.aet hiopi cahowev er,cancause
diffusecut aneous
l
eishmani asis( DCL)i npat ientswi thl it
tleornocel lmediatedi mmuni ty
agai nstt hepar asite.Thi sisani ncur abl econdi tionchar act eri
zedbyt he
format ionofdi sfiguringnodul esov ert hesur faceoft hebody .Thenodul es
cont ai nlar genumber sofamast igot es.
L.aet hiopi cacanal socausemucocut aneous
l
eishmani asis.
NEW WORLDCL
L.mexi cana:Causeschi clero’sul ceror‘ baysor e’.
Lesi onsoft hebodyt endt obesel f-heal i
ngbutt hose
ont heearmayl astupt o30y ear sandent i
rely
dest royt hepi nnaoft heear .
L.per uv i
ana:Mai nlyi nfect schi ldr en.Thesi ngl eor
fewl esionsar epai nlessandusual lyheal spont aneousl y
afterabout4mont hs.Thei nfect ioni sknownl ocal lyas‘ut a’.Itoccursat
highal tit
udesi ndr yv alleys.
L.guy anensi s:Maygi v er i
set opai nlessdr ysi ngl e
ulcer sormul t
iplel esionsscat ter edal l overt hebody .Thedi seasei soften
referr edt oas‘ for esty aws’ (‘
pi anboi s’).Spont aneousheal ingi srareand
relapsesar efrequent .
L.panamensi s:Causessi ngl eorf ewski nul cer s
whi char enotsel f-heal i
ng.Ly mphat ici nv olvementi scommon, r
esulti
ngi n
secondar ynodul es.
Diffusecut aneousl eishmani asi s( DCL)
DLCi susual ycausedbyL.aet
l hiopi ca( OldWor ld)andL.amazonensi s
(NewWor ld).Ski nlesi onsdev elopov eral ar gear eaoft hebody .The
l
esi onsont heey ebr ows, noseandear sr esembl et hoseofl epromat ous
l
epr osy .
Atf irstt hel esionsar esmoot h, andf irm.Lat ert heybecomescal yand
rough.Theydonotheal spont aneousl y.DCLcausedby
L.amazonensi si sr esist antt ot reat ment .Wi thL.aet hiopica, relapsestend
tooccuraf tert reatment .
Lab- Dxandt reat ment

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• Lab- Dx
Culture
Treat ment
• Sodi um St i
bogluconat e
• Ther mot herapy
Mucocut aneousl eishmani asis(MCL)
Alsoknownas‘ espundia’,MCLi scausedbyNew
Wor ldLei shmani aspecies,
 L.br azili
ensi s,
 L.panamensi sand
 occasi onal lybyL.guy anensi s.
Inimmunosuppr essedper sons,mucosal l
esionscanbecausedby :
• L.donov ani,
• L.maj or,
• L.i nf antum.
MCLi st hemostsev ereanddest ructiveform ofcut aneousl ei
shmani asi
sin
Sout hAmer i
ca.Lesi onsar esimi l
arindev elopmentt ot hoseofor i
ental
sore
andt her esul tingul cersmaybecomev erylargeandl ong- l
asti
ng.Earlyin
theinf ection, par asit
esmaymi grat etoti
ssuesoft henasophar ynxoft he
palate
andsomet i
mesaf termanyy earswhent hef ir
stlesionhasheal edther e
beginsasl owcont i
nuouser osi
onoft heset i
ssues.
Disfigurat i
oni sof t
enext remewi thcompl etedest ruct i
onoft henasal
septum, per forat i
onoft hepal ate,anddamaget othet issuesoft heli
psand
l
arynx.
Patient swi thahi storyofi nadequat etreatmentandpr olongedscar ri
ng,
tendt odev elopMCL.Mucosal lesionsdonotheal spont aneousl
yand
secondar yandof tensev erebact eriali
nfectionscanoccur .
ASudanesef or m ofMCLi sreferredtoasor onasal leishmani asi
s.
Dxandt reatment
Diagnosi s
-Sampl ef rom t hel esi
onmayshowasamast igoit
est age.
Treat ment

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Samewi thVL.
Measur est opr ev entandcont rol l
ei shmani asis
Earlydet ect ionandt reat mentofi nf ect edper sons,especi al
lyinar eas
wher ehumansar et heonl yori mpor tantr eser voi
rsofi nfecti
on.
Personal pr otectionf rom sandf l
ybi tesby :
–Usi ngi nsectr epel lant s, althoughi nhotandhumi d
conditionst heyar eofl imi teduseduet opr ofusesweat i
ng.
–Av oidi ngendemi car easespeci allyatt imeswhen
sandfliesar emostact ive.
–Useofi nsecticidei mpr egnat edbednet sandcur t
ains.
Vectorcont rolbyt heuseofl ightt raps, stickypapert r
aps,
orresidual insect icidespr ayingofhousesandf arm buildings
wher et hisi spract i
cal ,oral t
er nat i
v elyusi ngi nsecti
cide
paintsinasl ow- releaseemul sifiablesol ut ion.
Dest ruct ionofst raydogsandi nfect eddomest icdogsi n
areaswher edogsar et hemai nr eser v oirhost s.
Eliminat i
onandcont r ol ofr odent si nar easwher et hesaresour cesof
humani nfect i
ons.
Whenev erpossi bl e,sitinghumandwel lingsawayf r
om t hehabi tatsof
animal reser voirhost swher esandf liesar eknownt obr eed, e.g.r odent
burrows
Trypasomes
Trypansomear ehaemof lagel latest hatl ivei nhebl oodandt issueoft hei
r
humanhost s.
Genust ry panosomeTheycauseadi seasecal l
edt r
y panosomi asis
Twodi stinctf ormsoccuri nhumanswhi char e: -
1.Trypanosomebr ucei compl ex( Af ricansl eepingsi ckness).
 Tr y panosomebr ucei gambi ense( west ern)
 Tr y panosomebr ucei rhodensi ense( eastern)
.
2.Trypanosomecr uzi (Amer icant rypanosomi asisorChagas’ di sease).
NB: bot ht heyr equi r
ev ect orf ort ransmi ssion
Trypanosomebr ucei forTset sef l
y
Trypanosomecr uzi fort ritomi nebug.
Trypanosomagambi ense

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ogy

Geogr aphi calDi st r

ibut ion:Westandwest er ncent ralAf ri
ca, ext endi ngf rom
Senegal acr osst oSudananddownt oAngol a.
Habi tat:
Habi tat:
Itinhabi ts
• Tr y pomast igot es:I nbl oodv esselsandi nt er cellularspacesofLy mph
nodes, spl een, li
v er, Br ain, CSFet c.
• Met acy clict rypomast igot es:I nthemi dandf oregutoft heGl ossi na
(tset sef li
es)
Mor phol ogy :hast ry pomast i
got eandmet acy cl i
ct rypomast igot est ages
Lifecy cle
• T. b.gambei nsepassesi tlifecy clei nt wohost st hev er t
ebr atehost s
ar emangameani mal anddomest icani mal sandi nv ertebr at ehosti n
thet set sef l
yofgenusgl ossi na(g. palpal is, G.fusci pesand
G. tachi noi des)bot hf emal eandmal efliesbi temanandmayser veas
v ect or
Met acy clict r
y pomast igot esar ei nocul at edt hrought heski nwhenan
inf ect edt set sef lyt akesabl oodmeal .Thepar asi t
esdev el opi nt o
longsl endert ry pomast igot eswhi chmul tiplyatt hesi t
eofi nocul ation
andl ateri nt hebl ood, l
y mphat icsy st em, andt issuef luid.Theyar e
car r i
edt ot hehear tandv ar i
ousor gansoft hebodyandi nt hel ater
st agesofi nfect iont heyi nv adet hecent ral ner voussy stem ( CNS) .
Try pomast igot esar ei ngest edbyat set sef lywheni tsucksbl ood.I nt he
mi dgutoft hef ly,thepar asi tesdev elopandmul tiply.Af ter2–3weeks, t
he
trypomast igot esmi gr at et ot hesal i
varygl andsoft het set sef lywher et hey
becomeepi mast igot es, mul tiply ,anddev elopi nt oi nfect i
v emet acy clic
trypomast igot es.
Pat hogeni city
T.b.gambi ensecausesAf ricant ry posomi asis( WestAf ricansl eepi ng
sickness)i tischr onici nnat ur el astingupt o4y ear s.Thechr oni cnat ureof
thedi seasecanbeat tri
but edt oant i
genv ar i
at i
oni nwhi chwav esof
par asitaemi aoccurnt hebl oodofi nfect edper son.Mandev el opi nf ect i
on
byt hebi teofi nfect edt set sef lybl oodandt r
ansmi tinfect i
on.
Theybi tedur ingdayusual lyi nt heear l
ymor ningandev eni ngmet acy cli
c

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formsar ei njectedi nt ot hesubcut aneoust issueofmanatt het i

meof
bit
ing.Someofpar asitemayent erdi r ectlyi ntot hebl oodst ream but
maj orityoft hem mul tiplel ocal ly.Dev elopatt hesi teofbi te.Chance( 3-4cm)
i
tishar dandpai nful nodul eandf luidwi thdr awnf rom i tcont ai nact i
vely
divingt rypomast igot e.Itr esol v i
ngspont aneousl ywi thin1- 2weeks.
Thent het rypomast igot esspr eadt hroughoutt heent i
rebody .Theymov e
throught hebl oodandl ymphat icv essel sandmul ti
pl er apidl y.Pat i
entf irst
exper iencei nt er
mi ttentr ecur ringf ev erassoci atedwi thl ymphoadenpat hy
l
y mphnodesi nt hepost er i
orcer vical regi onoft heneckar efr equent ly
i
nv olved, produci ngal esi onknownaswi nter bot tom’ ssi gn.
Hepat ossl enomegal ymayal sobeev identdur ingt heear lyst ageof
i
nfect ion.
Thet ry panosomesi nv adet hecent ral ner voussy stem, gi vingsy mpt omsof
meni ngoencephal i
tis,incl udingt rembl ing, inabi l
ityt ospeakpr oper l
y ,
progr essi vement al dul l
ness, apat hy ,excessi vesl eepi ng, andi ncont inence.
Ther ei susual l
yr apidwei ghtl oss, cont inuingi rr
egul arf ev er,oedemaoft he
l
imbsandi nabi l
itytowal kwi thouthel p.I funt r eated, comadev elopsand
fi
nal l
ydeat h
Labor at oryDi agnosi s
1.Tr ypomast i
got esi nwetbl oodf i
lm- toobser vemot i
li
t ,
2.Thi ckort hinst ainedbl oodf il
msorbuf fycoatf rom Mi cro-haemat ocritor
capi l
l
ar yt ubecent ri
f ugal concent rat i
ont echni que.
3.Exami nat i
onofaspi ratef rom enl argedl ymphgl and, chancherf l
uid, CSF
4.Test ingser um f orant i-trypanosomal ant ibodi es.
Othert est s
• –Measur ementofhaemogl obin.Rapi dlydev elopi nganaemi awi th
ret i
cul ocy tosisi saf eatur eofAf ri
cant r
y panosomi asi s.Itdev elops
ear lyi nt hedi seaseandi sduemai nlyt ohaemol y sisandt her emov al
ofi mmunesensi tizedr edcel lsf rom t heci rcul ationbyt hespl een.
• –Measur ementoft heer ythr ocy tesedi ment ationr ate( ESR) .A
si gni f
icantandr api dr isei nESRoccur sear lyint hedi seasewi thv ery
hi ghr at esbei ngr eachedast hedi seasepr ogr essesduet ochanges
inpl asmapr oteins.
• –Tot al whi tebl oodcel lcountanddi fferent ial.Amoder at e

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leucocy tosiswi thmonocy tosi s, l

ymphocy tosisandpr esenceof
pl asmacel l
sar e
commonf i
ndi ngsi nAf ricant rypanosomi asi s.
• –Checki ngur i
nef orpr otein, cel l
s, andcast soncet r
eatmenthas
st arted.
Treat ment
Surami ni susedt ot reatpat i
ent swi t
hpr imar ystagei nf ect i
onst hatdonot
i
nv olv et heCNS.Becausei tdoesnotcr ossbl ood-bar rieri tisnoef fecti
ve
agai nstt hesecondar yCNSst age.
Iti
sr elat ivelyt oxicandmaycauseopt i
cat rophy m bl i
ndness, nephrotoxi
cit
y
andadr enal insuf fuci encyi nsomepat i
ent s.Pet ami dinei sethionate, l
i
ke
surami ndoesnotcr osst hebl ood- br ainbar rier,theref orei tcanal sousedi n
i
nitial st ages.I tmaypr oducenephr ot oxicity,hepat oxi cityandpancr eati
c
toxicityi nsomepat ient s.
Met ar sopr ol cancr osst hebl oodbr ai nbar rierandusedt otreatpat i
entsin
l
atesecondar yCNSst agesoft ryapanomi asi s.
Prev ent i
onandCont rol
1.Vect orcont rol:
-Byspr ay ingv ehicl eswi thinsect icideast heyent erandl eav ethe
tse-tsef lyi nfest edar ea,
-Byusi ngandmai nt ainingi nsect i
ci dei mpr egnat edt se- t
sef l
yt r
aps,
-Bysel ect ivelycl ear ingt hebushandwoodar easespeci all
yar ound
gamer eser ves, wat erhol es, bri
dges, andal ongr i
v erbl anks.
2.Det ect i
ngandt reat inghumani nfect ionsatear l
yst age.
3.Rest r icti
ngt hemov ementofgameani mal stowi thinf encedgame
reser ves.
4.Heal theducat ion.
Labor at oryDi agnosi s
1.Tr y pomast igot esi nwetbl oodf ilm- t
oobser vemot ili
t,
2.Thi ckort hinst ai nedbl oodf i
lmsorbuf f
ycoatf rom Mi cro-haemat ocri
tor
capillar yt ubecent r i
f ugal concent rationt echni que.
3.Exami nat i
onofaspi rat ef r
om enl ar gedl y mphgl and, chancherf luid,CSF
4.Test ingser um f orant i-
tr
y panosomal antibodi es.
Trypanosomar hodesi ense

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Geogr aphi calDi st ri

but ion:EastAf rica, Cent ralAf ri
ca, andSout hernAf r
ica,
extendi ngf rom Et hiopi adownt oBot swana.
Habi tat:
Trypomast i
got es:Mai nl yi nt hebl oodandCSF, alsoi nlymphnodes, spleen,
Brai net c.
Met acy cl i
cTr ypomast igot e:Int hemi dandf oregutoft hei nsectv ect or.
Mor phol ogy :
Mor phol ogy :hast rypomast igot eandmet acy cl
ict rypomast igot est ages
thatar emor phol ogi cal si milart ot rypomast i
goteandmet acy cl i
c
trypomast igot est agesofT. gambi ensebutpost eriornucleat ed
trypomast igot est agesar ecommon.
Pat hageni city
thedi seasepr oducedbyT. b.rhodesi ense(eastAf r i
cansl eepi ngsickness)
i
ssi mi lart ot hatofT. b.gambi ense.howev erther ear ediffer encei nt he
cli
ni cal mani fest ionsoft hedi seaset heycauset hemaj ordi fference
bet weent hem i st hatt hedi seasepr oducedbyT. bgambi ensei schr onicin
nat ur elast i
ngupt oy ear s, wher east hedi seasepr oducedby
T.b.r hodesi ensei smor eacut erarelyl astingmor ethan9mont hsbef ore
deat hoccur
i
nT. b. rhodensi ensei nf ect i
on, f
ebr i
lepar oxy smsar emor ef requentand
oedema, weakness, rapi dl ossofwei ght, my carditisandf ev erar est ri
king
sympt oms, butl y mphnodeenl argementi sl esspr onounced.Mani aand
delusi onar eof tennot ed.
Labor at orydi agnosi sandt r
eat mentandpr ophylaxi saresameasf or
T.b.gambei nsei nf ect i
on.
Trypansomabr uei gambi ence
Hist or yandgeogr aphi cal dist ri
but i
on
• Thi scondi t i
on, causedbyTr y panosomacr uzi ,isl
imi tedt oSout hand
Cent ral Amer ica.Car losChagas, invest i
gat i
ngmal ariai nBr azi li
n
1909, acci dent allyf oundt hist rypanosomei nt hefaecesofr eduv i
id
bugt hebl oodofamonkeybi ttenbyt heinfect edbugs.I twasonl y
lat ert hatChagasf oundt het rypanosomei nt hebl oodofasi ckchi ld
andshowedt hati twasr esponsi blef oranendemi cdi sease, whi ch
camet obenamedaf terhi m.Chagasnamedt hepar asi teT.cr uzi

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afterhi sment orOswal doCr uz.

Habi t
at
Itliv esast ry pomast igot eint hebl oodandasamast igot ei n
ret iculoendot helial cel lsandot hert i
ssuecel l
sofmanandmanymammal s.
Inmant hemostf requentl ocat ionsoft hepar asi tesar er eticuloendot helial
cel lsofspl een, liver, lymphnodes, bonemar rowandmy ocar dium.Par asite
mayal sooccuri ncel lsofst riatedmuscl es,ner voussy stem, histiocy stes
cel lsofcut aneoust i
ssue, cellsoft heepi der mi s,andi nt hei nt estinal
mucousmembr ane.
Mor phol ogy
Twomai nmor phol ogi cal formsar eseeni nhumanhost s:
• Tr y pomast i
got ef or m
• Mast igot ef or m
• Tr y pomast i
got ef or m:
thesear epr esenti nt hebl oodf orpat ientdur ingt heear lyacut est ageand
ati nt erv al ther eaf teri nsmal lernumber s.Inst ainedpr epar ationt he
par asiteassumeachar act eristicC–shapei tmeasur es20µm i nl engt h,
hasacent ral nucl eusandal argeki netopl astsi tuat edatt hepost er iorend
twof ormsoccuri nt hebl ood, al ongsl enderoneandashor tbr oadone.
Amast i
got ef or ms
Amast i
got ef or ms: thesear er oundorov alinshape, measur e1. 5-4. 0µm i n
diamet er ,hav eal argenucl eusandki net opl ast .Inf i
xedandwander i
ng
hist iocy st esespeci allyi nspl een, l
iver,
lymphnodes, andbonemar row.
Lif ecy cle
T. cr uzi passesi t
sl ifecy cl eint wohost sonei nmanort her eser voi rhost s
suchasar mandi l
los, opossums, woodr ats,andr accoons, theot heri n
bloodsucki ngi nsect ,ther eduv ii
dbug( panst rongl usmegi st us, tr
iat oma
i
nf est ansandr hodni uspr ol i
x us) .
Dev elopmenti nr eduv iidbug
Bugsacqui rei nfect ionbyf eedi ngonani nfect edmammal ian
host .trypomast igot esi nt hebl oodmeal transf ormt oamast igot esi nt he
for egutandmul ti
pl ebybi nar yf issioni nt hemi dgut ,theydi videbybi nar y
fissi oni nt heepi mast igot est age.I nt hehi ndgut ,epi mast igot esat tacht o
theepi thel i
um, transf or mt omet acy sl
ici nfect ive)t rypomast igot esandar e

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excr et edi nt hef eacesoft hebug.Thedev elopmentofT. cruzi int hev ector
takesar ound10- 15day s.
Dev el opmenti nman
Thei nf ectivef or msofT. cruzi aref oundi nbug’ sf aeces.thebugst endt o
def ecat ever ysoonaf t
ert aki ngabl oodmeal .Si ncet hebug’ ssal iva
cont ai nsani rritant ,t
heper sont endst oscr at ch, thusscr atchingi nt he
i
nf ect ivef or msf rom t hebug’ sf aeces.Mostr eduv i
idbugsar enoct urnal
andf eedonsl eepi ngi nhabi tantsoft hehouse.
Thei nf ectioncanal sobet ransmi ttedbycont ami nati
onofabr adedski n
andt heconj unct iva,bloodt ransf usi on, organt ransplantation,placent al
transf er ,andacci dent al i
ngest ioinofpar asit
izedr eduv i
i
nbugst he
met acy ctict rypomast igotest husi ntroduced, inv adecel l
sof
reticul oendot hel i
al syst em and
• Cont i
nue
othert issuespar ticular l
ymuscl eandner voust issueandar etransf ormed
i
nt oamast igotef orm, ar eagai nt ransf or medi ntot ry
pomast igot ef orms
whi char eliberat edi nt hebl ood.Thi sleadst odi ssemi nationofi nf ection
andi nf ectsf reshr eduv i
idbugswhent heynextf eed.
Pat hogeni city
T.cr uzi causessout hAmer i
cant r
y ponosomi asi sorchagas’ diseasA
zoonot icdiseaset hatcanbet ransmi ttedt ohumansbybl oodsucki ng
reduv i
idbug.I ncubat i
onper iodmaybeasshor tast woweeksorsev eral
mont hsi finfect ioni sacqui redbybl oodt ransf usi on.Prolongedi ncubat i
on
per i
odi nr eci pient spoorcapaci tyofci rculatingbr oadbl oodf ormst o
i
nv adecel l
Att hesi teofent ryT. cruzi asubcut aneousi nflammat or
ynodul edev elops.
Itisknownaschagoma.Rar elymul tiplechagomashav ebeendescr ibed.
Whent heent ryist hroughconj unct i
v a,thepat ientdev el
opspai nless,
i
nf l
amedper iopht halmi c,uni lateral oedemaandconj unctivit
is.I tisknown
asRomana’ ssi gn.Thepr i
mar ylesi oni saccompani edbyf ev er, acut e
regional l
ymphadeni ti
s
anddi ssemi nat i
ont obl oodandt issues.Thepar asit
ecanusual lybe
det ect edwi thin–weeksast rypomast i
got esi nt hebl ood.
Acut ei nfect i
onsar emor ecommoni nchi l
drenabout10%ofchi ldrendi e

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dur ingt heacut est age.Att hisst agepat i

entdev elopsf ev er,
hepat ospl enomegal y, gener ali
zedl ymphadenopat hy ,facial orgener alized
oedema, rash, v omi ting,
diar rhoeanor exi aandECGchangesl ikesi nust achy car dia, incr easedQ- R
i
nt er val T- wav echangesandl owQRSv ol
tage, andpat ientmaydi eofacut e
my ocar di tis.Itmayal sol eadt omeni ngoecphal i
tismai nlyi ni nfant sand
AIDSpat ient s.
Pat ient ssur vi
vingt heacut einfect ion, developchr oni cdi seasei nwhi ch
car diacchangesar emostcommonwi thar rhy thmi as, pal pitations, chest
pain, oedema, di zziness, syncopeanddy spnoe.
Pat ientmayal sodev el opdi l
atat ionofoesphagus(megaoesphagus)and
colon( megacol on)l ossofper ist al
sisr egur gitat i
on, dy sphagi aandsev er e
const ipat ion.
Congeni t al tr
ansmi ssi oncanoccuri nbot ht heacut eandchr oni cstagesof
thedi sease.Commoncl i
nicalfindi ngsofcongeni tal infect ionar est i
llbi r
th,
l
owbi rt
hwei ght , my cocar dit
is, neur ological terat i
onsanddeat hshor tl
y
afterbi rth.
Labor at or ydi agnosi s
Mi cr oscopeexami nat ion
Inacut ei nfect ionT. cruzi maybef oundt r
ansi ent l
yi nper ipher al bloodby
directmi cr oscopeofgi emsast ainedandunst ained, wetbl oodf il
m.I ft he
par asi tesar escant lyandcannotbeseeni nt hinst ai nedandunst ainedf il
m,
thickf il
m orconcent rat edmet hodsmaybeempl oy ed.Thel atterincl ude
• Haemat ocr i
tecent r
ifugat ionf oll
owedbysear chingf or
tr
y pomast igot ei nori mmedi at eabov et hebuf fycoatl ay er.
• Al lowi ngt hebl oodt ocoagul at eandsear chingf ortr ypomast i
got esin
cent rifugedser um andl ysi sofr edcel lswi th0. 85%ammoni um
chlor ideandcent rif
ugat i
ont osedi mentt r ypomast igot es
Bi opsy
Biopsyofi nv oledl ymphonodeormuscl emayr ev eal amast igot efor m of
T.cr uzi
Ser ol ogical
Ser ol ogical det ect sexposur et oi nfect i
onr at hert hanact iv ei nfect i
on.
Ant ibodi esagai nstT. cruzi maybedet ectedi npat ientser um by

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compl ementf ixat i

ont est,indirectf luorescentant i
bodyt est,enzy me- l
inked
i
mmunosor bentassay.
Treat ment
Noef fectiv especi fict reatmenti sav ail
able.Nifurtimoxandbenzni dazole
havebeenusedwi thsomesuccessi nt heacut ecases.Al lopur i
nol and
ketoconazol ehav eal sobeenf oundusef ul.
Prev ention
• Er adi cat i
onofbugs
• Tr eat i
ngi nfect edper son
• scr eeni ngbl ooddonor s
• heal theducat ionandhousi ngi mpr ovement
Spor ozoa
Spor azoabel ongt ot hephy l
um api compl exa.Thephy l
um itcont ainst wo
cl
assesnamel yhaemat ozeaandcocci dea.
Thepar asi teofcl asshaemat olozoeaoccuri nt hebloodoft heirvertebrate
host s.Thi scl asscont ainst woor der
•* Haemospor idacont ainingt hegenuspl asmodi um whi chcauses
mal ariaand
•* Piropl asmi dacont ainingt hegenusbabesi awhi chisr areand
acci dent alpar asiteofman.
Theycompl etet hei rlif
ecy cleint wohost s.
Thepar asi teofcl assofcocci deaei therunder gowhol eoft heirli
fecy clein
asingl ehostt ypical l
yi ntheepi thelialcellsoft hegutordi v i
deasi milar
cyclebet weent wohost s.Thi sclasscont ai
nsoneor der:
Thiscl asscont ainsoneor der :
• Ei mer iidawhi chcont ainsf ivegener a
• Toxopl asma,
• cr ypt ospor idium,
• cy cl ospor a,
•i sospor aand
• sar cocy stis
mal ariapar asites
i
n1880, aFr enchar mysur geon, Char l
esl averanf oundanddescr ibedt he
mal ariapar asite.Romanowskydev elopedast ainingmet hodofmal aria

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par asitei n1891.Thel ifecy cleofmal ariapar asi tewasdescr ibedbyt he

It
al i
ansci ent i
st sami cobi gnami , bat tistagr assi andGi ovanni bast ianell
iin
1898.
Ronal dr oss, anar myser geoni nI ndi anmedi cal servi
ce, whi l
ei ni ndia
demonst r
at edt hatmosqui toesofanophal i
sspeci esactasv ect orsof
mal ar i
apar asite.I n1976t ragerandJensencul t uredmal ar i
apar asi t
esi n
vitrof ort hef i
rstt i
me.Mal ar i
apar asi tesbel ongst ogenuspl asmodi um
ther ear eappr oxi mat el y156namedspeci esofpl asmodi um whi chef fects
var i
ousspeci esofv er tebr atesf ourar eknownt oi nfect ed: -
• pl asmodi um f alcipar um
• pl asmodi um v ivax
• pl asmodi um mal ariae
• pl asmodi um ov ale
mal ariacont inuest obeani mpor tantv ector–bor nedi seasewi than
annual mor tal it
y4- 5mi li
oncases.Thei ncidenceofmal ari
ai si ncreasing
duet or esist anceofv ect orst oi nsect icidesanddr ugr esi stance
par asi ti
c.
Oft hef ourspeci est hati nf ecthumansp. vivaxandp. falciparum account s
95%ofi nf ections.P. vivaxhaswi destdi st r
ibut ed, extendi ngt hroughoutt he
tropical andsubt ropical andt emper at ezones.
Plasmodi um f al ciparum i sgener al l
yconf inedt ot ropical , p.mal ariaeis
spor adi callydi stributedandp. ov al eisr arei nmuchoft hewor ldbut
relativelycommoni nwest er nAf rica.
InSomal i
a: P.fal ciparum i sr esponsi bl ef orappr oximat el
y90%ofmal ari
a
casesi nSomal ia
Ter msusedt odescr ibet hel ev el ofendemi cityofmal ar i
a
Thet ermsusedar ehy poendemi city( lowestl ev el),mesoendemi city,
hy perendemi cityandhol oendemi city( highestl ev el)
.
Theset ermsdef i
net hei ncr easi ngl ev elsofpr ev alence
ofmal ar iaasest imat edbysur v ey sofspl eenandpar asi t
er atesi n
par ti
cul aragegr oups.Hol oendemi candhy per endemi cmal ar i
aar efoundi n
areasofst ablet ransmi ssi on.Mesoendemi candhy poendemi cmal ari
aar e
foundi nar easofunst ablet ransmi ssi on.
Plasmodi um speci esandt heirdi st ribut ion

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Plasmodi um f alci par um

P.f alci par um isf oundmai nlyi nt hehot terandmor e
humi dr egionsoft hewor l
d.I tist hemai nspeci es
foundi nt ropical andsubt ropi cal Af ri
caandpar tsof
Cent ral Amer i
caandSout hAmer i
ca, Bangl adesh, Paki stan, Af ghani st an,
Nepal ,Sri Lanka, Sout hEastAsi a, Indonesi a,Phi li
ppi nes, Hai ti,Solomon
Islands, PapuaNewGui neaandmanyi slandsi nMel anesi a.
Italsooccur sinpar tsofI ndi a, theMi ddl eEast ,andeast ernMedi terranean.
Plasmodi um v ivax
P.v iv axi scapabl eofdev elopi ngi nmosqui t
oesatl owert emper atur est han
P.f alci par um andt her efor ehasawi derdi stributioni nt emper ateandsub-
tropi cal
areas.
P.v iv axi st hemai nPl asmodi um speci esi nSout hAmer ica( occur ringas
farsout hasnor t her nAr gent ina) , Mexi co, theMi ddleEast , norther nAf rica,
India, Paki stan, Sr i Lanka, PapuaNewGui neaandt heSol omonI slands.I ti
s
alsof oundi npar tsofSout hEastAsi a, Indonesi a, Phi l
ippi nes, Madagascar ,
tropi cal andsubt ropi cal Af ri
ca, Kor ea, andChi na.
Plasmodi um mal ar iae
P.mal ar i
aehasamuchl owerpr ev alencet hanP.f alcipar um andP.v ivax.
Iti sf oundi nt ropi calandsubt ropi calr egi ons.
Int r opi cal Africai taccount sf orupt o25%ofPl asmodi um i nf ections.I tis
alsopr esenti n
Guy ana, India,Sr i LankaandMal ay sia.Int hesecount r
iesi taccount sf or
l
esst han10%ofPl asmodi um i nf ect i
ons.
Plasmodi um ov al e&knowl esi
P.ov al ehasal owpr ev alence.I ti sf oundi nWestAf ricawher ei taccount s
forupt o10%ofmal ariai nfect ionsandhasal sobeenr epor tedf rom ot her
par tsofAf rica, andf rom t hePhi lippi nes, Indonesi a, Chi na, andpar t s
Plasmodi um knowl esi :Humani nf ectionswi t
hP.knowl esi , aspeci est hat
nat ur allyinfect smonkey s( macaques) , hav ebeenr epor tedf rom Mal ay sia
andThai land.Mor phol ogi cal yP.
l
• knowl esir esembl esP.mal ar iaebutunl i
keP.mal ar i
ae, parasi te
number shav ebeenr epor tedashi ghandcl inical sy mpt omsmor e

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sev er
Epi demi ol ogy
Mal ar i
aoccur sin100count rieswi thabout40%oft hewor l
d’
spopul ati
onat
ri
sk.
Eachy eart her ear eest imat edt obe275mi l
lioncl ini calcasesofmal aria
(90%oft hem i nsub- Sahar anAf ri
ca)r esultingi n1. 12mi l
liondeat hs, mostl
y
(75%)i nchi ldrenunder5y ear s.
Epi demi csar eincr easi ngduet oman- madeconf li
ct sandcl i
mat e-
associ ateddi sast er scausi ngt hemov ementofnon- immunepopul ationsto
mal ar i
aendemi car eas.
Ur banandper i
ur banmal ariaar enowsubst antial
probl emsi ncer tainar easofAsi aandAf r
ica.
Mal ariai sbecomi ngmor edi ffi
cul ttomanagei nar easofmul ti
drug
resistancewher eef f
ect ivedr ugsar eunav ai l
able.
Mal ar i
ai spr ev alenti nt ropical andsubt r
opi cal regi onsbecauseofr ainfal
l,
consi st enthi ght emper aturesandhi ghhumi dity, alongwi thst agnant
wat ersi nwhi chmosqui t olar vaer eadi l
ymat ure, pr ov i
dingt hem wi ththe
env i
ronmentt heyneedf orcont i
nuousbr eedi ng.
Theepi demi ologi cal feat ureofmal ari
ainSomal iai sdi videdi nto:
hypoendemi c( Nor th), mesoendemi ct ohypoendemi cint heCent reand
Sout handhy per -endemi ci nt her iverineareasoft heJubaandShabel le
ri
ver s
Mal ar i
ai smor ecommoni nr ural areasthani nci ties.
Riskgr oup
 Chi ldrenunder5y ears
 Nonbr eastf eedi ngi nf ant s
 Pr egnantwomen
 3f ol dincr easei nsev er edi seaseandmor t ality
I ncr easer iskofmi scar r i
ageandst i
llbirth
 Mal nut ri
tion
I mmuno- compr ami sedpat i
ent sspeci allyHI V
Tr ansmi ssion
Transmi ssi oni smor eint ensei npl aceswher ethemosqui toli
fespani s
l
ongerandwher ei tpr efer st obi tehumansr athert hanot herani mal s.

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Thel ongl ifespanandst ronghuman- bi ti

nghabi toft heAf ricanv ect or
speciesi st hemai nr easonwhynear ly90%oft hewor ld'smal ari
acasesar e
i
nAf r
ica.
Transmi ssi onal sodependsoncl imat iccondi t
ionst hatmayaf fectt he
numberandsur vival ofmosqui t
oes, suchasr ainfall pat t
erns, temper atur
e
andhumi dity.
Inmanypl aces, transmi ssioni sseasonal ,wi tht hepeakdur i
ngandj ust
afterther ainyseason.Mal ar iaepi demi cscanoccurwhencl i
mat eand
othercondi tionssuddenl yfav ourt r
ansmi ssioni nar easwher epeopl ehav e
l
itt
leornoi mmuni tyt omal aria.Theycanal sooccurwhenpeopl ewi thlow
i
mmuni t
ymov ei ntoar easwi thi ntensemal ariat ransmi ssion, fori nst ance
tof i
ndwor k, orasr ef ugees.
 Commonmeansoft ransmi ssion
• Bi teofanophel esmosqui to
 Ver yunusual meansoft ransmi ssion
 Congeni tal mal aria(f rom mat hert ochi ldt hroughpl acent a)
 Bl oodt ransf usion
 Cont ami nat edsy ringesandneedl es
I nNonendemi car eascanbet ransmi ttedbymosqui toesi nf ect ed
afterbi t
ingi nfect edt rav eler sandi mmi gr ant.
Eveni nt ropical andsunt ropi cal areat ranmi ssi onwi llnotoccur :
 Athi ghal titudes( >2500m)
 Dur i
ngcool i
ngseasonsi nsomear eas
I ndeser ts
I nsomei slandsi npaci ficocean, whi chhav enol ocal anophel es
speci escapabl et ransmi ssionofmal aria
I nsomear eawher et ransmi ssionhasbeeni nter ruptedt hrough
successf ul cont rol
Gener alLi f
eCy cleofMal ariapar asites:
 Mal ariapar asi tesr equi ret wohost stocompl etet heirl i
fecy cl e.
Femal eAnophel esmosqui toesast hedef initi
v ehost ,wher esexual
reproduct ion( spor ogony )t akespl aceand
 humanbei ngast heint ermedi atehost ,wher et heasexual
reproduct ion( schi zogony )t akespl ace.

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 Spor ozoi tesf rom i nf ectedf emal eAnophel esmosqui toar ei nject ed
wi tht hesal ivai nt ot hebl oodci r culationofmanwhent hev ector
takesabl oodmeal .Af t
erci rcul atingi nt hebl oodst r
eam
fornotmor ethanonehour ,thespor ozoi tesent eri nt ot hel ivercel l
s.
Twocy clesoccuri nman, inthel iverasexo- ery throcy ti
cschi zogoni c
reproduct ionandi nt her edbl oodcel lsaser ythr ocy t
icschi zogol nic
reproduct ion.
Inthel i
vert hepar asit esmul t
iplyanddev elopi nt oschi zont s.Whenmat ur
e
theschi zont ,
thel i
v ercel l r
upt urer eleasi ngl ar genumberofmer ozoi tes.
Themer ozoi tesent ert her edbl oodcel lsanddev elopt ot rophozoi test age.
Thet rophozoi tef eedsonhaemogl obi nandf ormsmal aria
pigment( haemozoi n).Thet rophozoi test agedev el opsi ntoschi zont es. In
theschi zontnucl eardi visiont akespl acet opr oducel argenumberof
mer ozoi test hatar er eleasedf r
om t heschi zontt oi nv adesnewr edbl ood
cell
s.
Af t
ersev eral er ythrocy ticschi zogoni cr epr oduct ions, t
hemer ozoi tes
devel opi nt o
gamet ocy tes.
Tocont inuet hel ifecy cl e,thegamet ocy tesar ei ngest edbyaf emal e
Anophel esmosqui towhi letakingabl oodmeal .
Inthest omachoft hemosqui to, t
hemal eandf emal egamet ocy tesunder
gof ert i
l
izat i
onandpr oducesazy got e.
thezy gotedev elopsi nt oamot ileooki net ewhi chpenet ratest hest omach
wall oft hemosqui tot of orm anoocy st .
Insi
det heoocy stlar genumber sofspor oz oitesar ef ormed.Theoocy st
ruptur esr eleasi ngt hespor oz oitest hatal soent eri nt ot hesal i
v ar ygl andt o
bet ransmi ttedt oanot heri ndividual whent hei nsectt akesabl oodmeal .
-Recr udescence( duet osmal lnumberofer ythr ocy ticpar asi tesr emai ning
i
nt hebl oodaf terapr ev iousat tack)occur sinPl asmodi um f alcipar um and
Plasmodi um mal ariaeov eral ongper iodofmal ar iaei nfect ion.
-Relapseduet ohy pnozoi te(dor mantf ormswhi chpr ecedeschi zont
devel opmenti nt hel i
v eroccuri nv ivaxmal ariaandl esscommonl yi nOv al
e
mal aria.
Mal ariaI ncubat ionPer iod

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Followi ngt hei nf ect i

v ebitebyt he  Anophel es mosqui to,aper iodoft ime
(the“ i
ncubat ionper i
od” )goesbybef oret hef irstsy mpt omsappear .The
i
ncubat ionper iodi nmostcasesv ariesf rom 7t o30day s.
Theshor terper iodsar eobser v edmostf requent l
ywi t
h P.f alcipar um  and
thel ongeroneswi th P.mal ariae.
Ant i
mal ar i
aldr ugst akenf orpr ophy l
axisbyt raveler scandel ayt he
appear anceofmal ariasy mpt omsbyweeksormont hs, longaf tert he
travelerhasl ef tthemal aria-endemi car ea.
(Thiscanhappenpar t
icularlywi th  P.v i
vax  and  P.ov ale,bot hofwhi chcan
producedor mantl iverst agepar asi tes; thel i
v erstagesmayr eact ivateand
causedi seasemont hsaf t
ert hei nfect i
vemosqui tobi te.)
Suchl ongdel ay sbet weenexposur eanddev elopmentofsy mpt omscan
resulti nmi sdi agnosi sordel ay eddi agnosi sbecauseofr educedcl i
nical
suspi cionbyt heheal t
h-car epr ov ider.
Retur nedt rav eler sshoul dal way sr emi ndt hei rheal th-car epr ov ider sofany
travel inmal ar ia-riskar easdur ingt hepast12mont hs.
Pat hogeni cit
y
Af t
erani ncubat ionper iodof12day sf orp. falcipar arum 13, 17day sf or
P.vivaxandP. ov al eand28- 30day sf orP.mal ariaepat i
entdev elops
mal aria.Thet y pical pictureofmal ar i
aconsi st soff er brilepar oxy sm,
anemi aandspl enomegal y.
Ferbr i
lepar oxy sm
Itgener al begi nsi nt heear lyaf ternoonandcompr isesoft hr eest ages-
• col dst age
• hotst age
• swear i
ngst age
int hecol dst agel astingf or15- 60mi nut est hepat ientexper iences
intensecol dandshi vering.Thi sf ollowedbyhotst agel ast ingf or2- 6hr
s
whenpat i
entf eelsi ntensehot .Thepat ientdev elopshi ghf ever (40. 0-
40. 6℃) ,sev er eheadache, nauseaandv omi ti
ng.Ther eafter ,fev erends
bycr isisaccompani edbypr of usesweat i
ng.
Theper i
odi cityoft heat tackv ar ieswi tht hespeci esoft heinf ect edpar asi
te.
Theper i
odi cityi s48hour sinP. vivax( beni gnt erti
an)andP. ov al e( ovale
terti
an)and72hour sinP. mal ar iae( quar tan)

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Anemi a
Af teraf ewpar oxy sms, anemi aofami crocy ticoranor mocy ti
c
hy pochr omi ctypedev el opsasar esultof :_
DirectRBCl ysi
sasar esul tofl ifecy cl
eoft hepar asite
Spl enicr emov al ofbot hi nf ect edanduni nf ect edRBC
Aut oi mmunel ysisofcoat edi nfect edanduni fect edRBC
Decr easei ncor por ationofi roni ntoheme
Incr easedf ragileofRBC
Decr easedRBCpr oduct ionf rom bonemar rowsuppr ession
SinceP. vivaxandP. ov alei nf ectonl yret i
cul ocy test her ef
or ethe
par asitaemi aisusual lyl imi tedt oar ound2- 5%ofav ail
ableofRBCssot hat
thenumberofi nf ectedcel lsi ssomewhatl imi ted.P. falci
par um tendst o
i
nv ideal lagesofr edbl oodcel lsandt het hepr opor tionofi nfectedcells
mayexceeds50%
Spl eenomegal y
Af teraf ewpar oxy smsspl eenget senl argedandbecomespal pable.
Spl enomegal yisduet omassi vepr ol i
ferat i
onofmacr ophagewhi ch
phagocy tosebot hpar asi ti
zedandnon- par asitizedr edbl oodcel l
s.
Non–i mmunepr egnantwomenar esuscept iblet oal ltheusual
mani fest ationsofmal ar ia.Mor eov ert heyhav eani ncreasedr i
skof
abor ti
on, st il
lbi
r t
h, premat ur edel i
ver yandofl owbi r
t hwei ghtoft hei
r
i
nf ant spr egnantwomenar epar ticular l
ypr onet ohy pogly caemiaand
pul monar yoedema
Per niciousmal aria
Per niciousmal ariaiscompl exofl ife-t
hr eat eningcompl i
cat i
onst hat
somet i
messuper enei nacut ef alciparum mal ar ia.Itisduet oheav y
par asitizat i
onandi soft hr eet ypes:
• Cer ebr al mal aria
• Al gi dmal ar i
a
• Sept i
caemi cmal ar ia
Cer abr al mal aria
Cer ebr al mal ar
iai sasev erecompl icationoff al cupar um mal ari
aand
frequent lyl eadst odeat hev enwhenappr opr i
at et herepyhasbeengi venit
i
schat act erizedbyhy per py rexi a,comaandpar al ysis.Capi l
lari
esoft he

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brainar epl uggedwi thpar asiti

zedr edbloodcel l
seachcel lcontaini
ng
mal ariapigment .Inholoendemi car eaofmal ar
ia,cerebr al
mal ar
iaoccur si
n
childrenbet ween
• 6Mont hsand5y ears,mostcommonl yinchi l
drenaged3- 4y ears.
Algidmal aria
Itresembl essur gicalshockwi t hcol dclammyski n,peripheral
circulator
y
fai
lureandpr ofoundshockpat ientmayal sodev elopv omiti
nganddi arr
hea
ordy sent ery.
Sept i
caemi cmal ari
a
Iti
schar acter i
zedbyahi ghdegr eeofpr ost
rati
on, thereishighcont i
nuous
feverwi thi nv olv ementofv ar i
ousor gans.
• Phy sical findings
• Phy sical findingsmayi nclude:
– El ev at edtemper atur e
– Per spi rati
on
– Weakness
– Enl argedspl een.
InP.f alciparum mal ari
a, additional fi
ndingsmayi nclude:
– Mi ldj aundice
– Enl argementoft hel iver
–I ncr easedr espi r
at oryr ate.

Manif
estat
ionsofsev erecompl icatedf alci
parum mal aria
Severecomplicat
edf alci
par um mal ari
aismani festedby :
– Hyperpyrexia( hi
ghf ev er)
– Neurologicalsigns:I mpairedconsci ousness:pr ostrat
ion(
in
abi
lit
ytosi tinachi l
dol denought odoso, orinabili
tyt
odri
nk
orsuckiny oungerchi ldren),drowsiness,delir
ium, comaand
sei
zures.
– Severeanemi a, par t
icularl
yinchildren,rapidl
yf at
al i
nthe
absenceoft r
ansf usion.
– Renalfail
ure: oli
gur i
a, anuri
a,intheabsenceofsi gnsof
dehydrati
onorper si
stingaf t
eradequat er ehydrat
ion.
– Hypoglycemi a.

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– Pul monar yedema: par ti

cul arlyinadul ts, almostal way sf atal.
– Macr oscopi chaemogl obinur ia: dar kr edur i
ne( blackwat erf ever)
– Respi ratorydi stress: slowdeepbr eat hingduet omet abol i
c
aci dosi s.
Spont aneoushemor r
hageandcoagul opat hy: lookf orpet echi aei nski nor
conjunct ivaeorbl eedingf rom nose, gum andgast r oint estinal t ract
Blackwat erf iver ,wher ehemogl obi nf rom ly zed  redbl oodcel lsl eaksi nto
theurine.
Genet icf act orst hatpr otectagai nstmal ari
a
●P.v iv axi sr ar elyf oundi nWestAf ricaorot herpl aceswher et her edcel ls
ofthepopul ationl ackt heDuf f
ybl oodgr oupant i
gensFy aandFy b.The
glycophor inr ecept orswhi chP.v i
v axneedst oat tacht oandi nv ader ed
cellsar emi ssi ngonDuf f
ynegat iver edcel ls.Thepr otect ioni sabsol ute
andaf f ordedonl yt ohomozy gotes.
• ( bet a)-thal assaemi at r
aital soappear st opr ot ectagai nstsev er e
falcipar um i nfection.
• Possessi onofcer tainhumanl euocy teant i
gens( HLA)ar eal so
thoughtt opr otectagai nstsev eremal aria,suchascl assIant igen
HLA- BW53andcl assI IantigenHLA- DRB11302.
• Newbor ni nfant shav epr otect ionagai nstmal ar i
ai nt hei rf i
rstf ew
mont hsofl ifewhent herei sahi ghconcent rat ionofHbFi nt hei rred
cells.Mal ariapar asitesdonotgr owwel l i
nr edcel lscont ai ningHbF.
Labor at or yDi agnosi s
1)Mal ar i
apar asi tesar edet ect edi nt hinort hickbl oodf i
lmsst ainedby
wr i
ght’sst ain, Giemsast ain,leishmanst ainorFi eldst ain.Takebl oodf i
l
ms
whent hepat i
entf eelsf ebrilebecauset hepar asitesar eusual lymost
numer ousi nt hebl oodt owar dstheendofanat t
ackoff ev er.
Alway scol lectt hebl oodbef oreant i
-mal ari
al dr ugsar et aken.
Fieldst aini sr ecommendedf orsmear sst ai nedst rai ghtawayandGi emsa
stainforsmear st obest ainedaf teraf ewday s.
2)Usingar api di mmunodi agnost i
ct est ssuchasPar aSi ghtF, ICTmal ari
a
Pf/Pvand, Opt iMALr .
Thesear er ecent lydiscov eredgr oupoft echni ques, whi chpr ov edt obe
valuabl eandhi ghl ysensi tive

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• 3)ELI SA
• 4)PCR
Otherlaboratoryt ests
• –Measur ementofhaemogl obi norpackedcel l
vol
umewhent herei smal ar
iawithheav ypar asi
taemiaparticularl
yiny oung
chil
drenandpr egnantwomen.
• Measur ementofbl oodglucoset odet ecthypogly
caemi a, part
icularl
y
inyoungchi ldrenandpr egnantwomenwi thseverefalciparum
malaria.
• Tot alwhi tecel lcountandpl atel
etcount( severefal
ciparum mal ar i
a),
• Coagul ationt estsi
fabnor mal bleedingissuspectedinf alci
parum
malaria.Measur ementofpl asmaf ibri
nogen,FDP’s(fi
br i
n/ f
ibr
inogen
degradat ionpr oducts)andot hercoagul at
iontests
• Test i
ngur inef orfr
eehaemogl obinwhenmal ari
ahaemogl obinuriais
suspect ed
• Bl oodur eaorser um creati
nine

Management
P.falciparum i snowr esi
stantt ochl oroqui neal mostwor l
dwi de.The
tr
eatmentofchoi cei sartemesi ni n-basedcombi nati
onther apy(ACT) .
Formi lduncompl icatedP.f alcipar um mal ar i
agiv e:
– Day1: Ar t
esunat etabl et4mg/kgpl usSP( 25mg/kg
sulfadoxi ne1.25mg/ kgpy ri
met hamine)asasi ngl edose.
– Day2and3: Artesunat et ablet4mg/kgoncedai ly
Treatmentofsev erecompl i
cat edmal aria
Givequi ninedi hy drochlori
deSt artwi thal oadi ngdoseof20mg/ kgdi l
uted
i
ngl ucosesol ution( preferably10%gl ucose) .Tobeadmi nisteredby
i
nfusionov er4hour s.
Thenmai ntenancedoseof10mg/ kgev ery8hour sbyinfusioningl ucose
10%ov er4hour s.
Adaptt hei nfusionv olumet ot hepat ient '
swei ght.
Moni torthepat i
entcl osely( ri
skofpul monar yedemaandhy poglycemi a)
Assoonast hepat i
enthasr ecei vedatl east3dosesofpar entralquini
ne
andcanswal l
ow.Changet oor al rout ewi thqui ninePOt ocompl ete7day s

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tr
eat ment ,f ollowedbyFansi dar(SP)asasi ngledoseordoxy cycline.
Prevent i
onandCont rol
Prevent i
onandcont rol ofmal ariabecomedi ff
icultasar esultofr esist
ance
ofthepar asi test othedr ugsandf ail
ur eofcont rolmeasur es.
Besidest hi spopul ationmov ement ,cli
mat icchangesandeconomi c
problemsar eal soconsi der edcur rentlyasf actorsthatr elatedwi thmal ari
a
spread.Howev er ,t
hef ollowi ngar esomeoft hemeasur est obet akenas
prevent ionandcont r
ol measur es; 7
1)Av oi dmosqui tobi tesby
-Select ingheal thysi tesf orhousesandscr eeni ngwi ndowsanddoor swith
mosqui tonet .
-Usingmosqui tobednet s
-Wear ingpr ot ect i
v ecl othessuchasl ongt routhers
-Usingmosqui tor epel lent s
2)Dest royadul tmosqui toesby
-Indoorr esi dual regul aref fecti
vespr aying
3)Pr ev entingbr eedi ngofmosqui toesby
-Alter i
ngt hehabi tatt odi scour agebr eedi ng
-Floodi ngorf lushi ngofbr eedingpl aces
-Drai naget or emov esur f acewat er,fil
li
ngi nponds, pothol es,etc.
-Spr ay i
ngbr eedi ngpl aceswi t
hef fect ivechemi cal
spar ticularlywi th
l
ar v
ici des
4)Usi ngdr ugst o
-Promptdi agnosi sandt r eatmentofmal ari
acases
-Prev enti nf ect ionsusi ngchemopr ophi l
axis,especi all
yinnoni mmune
personsv isitingorgoi ngt omal ariousar easori nper sonswi threduced
i
mmuni tysuchaspr egnantwomen.
5)Heal theducat ion.
6)Bloodscr eeni ngf ormal ariabef orepr ov i
dingf orthosewhoneedbl ood.

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MEDI CALHELMI NTHOLOGY

LEARNI NGOBJECTI VES
Att heendoft hissessi on,student sshoul dbeabl eto:
•Under standmedi call
yimpor tanthelmint hesi ncludi
ngt heirli
fecy cl
es,
modesoft ransmi ssions,cli
nical f
eatures, diagnosis,treatmentand
prev ention.
•Descr i
bebl ood,intesti
nal,li
verandl ungf l
ukes.
•Under standcommonr oundwor ms.
•Under standdifferentspeciesofCest odes.
INTRODUCTI ON
Medi calhelminthologyi sconcer nedwi tht hest udyofhel mi nt
hesor
parasi ti
c
wor ms.Hel minthesar et r
ophobl asti
cmet azoa( mult
i-
cel l
ularorganisms).
Helmi nthesareamongt hecommonpar asi t
iccausesofhumansuf f
eri
ng.
They
aret hecauseofhi ghmor bidit
yandmor talit
yofpeopl ewor ldwide.They
cause
differentdiseasesi nhumans, butfewhel mi nthicinfectionscausel i
fe-
threat ening
diseases.Theycauseanemi aandmal nut ri
ti
on.I nchildrentheycausea
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reducti
oni nacademi cper formance.
Hel minthesal socauseeconomi cl ossasar esul tofi nfect i
onsofdomest i
c
animals.Ther eisagedependentdi stribut i
onofi nf ect i
onsf rom geo-
helminthesandschi stosomes.Asar esultofpr edi sposi ngbehav ioraland
i
mmunol ogical status, childrendi spr opor tionat el ycar r yt heburdenof
schist
osomesandgeo- helmi nthes.
Thesour cesoft hepar asi tesar edi fferent .Exposur eofhumanst ot he
parasit
esmayoccuri noneoft hef ollowi ngway s:
1.Cont ami natedsoi l(Geo- hel mi nthes) , wat er( cer car iaeofbl oodf l
ukes)
and
food(Taeni ainr awmeat ).
2.Bloodsucki ngi nsectsorar t
hr opods( asi nf i
lar i
al wor ms) .
3.Domest icorwi ldani mal shar bor ingt hepar asi te( asi nechi nococcusi n
dogs).
4.Persont oper son( asi nEnt erobi usv er mi cul aris, Hy menol opisnana) .
5.Onesel f(aut o-infection)asi nEnt er obiusv er mi cul aris.
Theyent ert hebodyt hroughdi ffer entr out esi ncludi ng: mout h,skinandt he
respir
ator ytractbymeansofi nhal at i
onofai rbor neeggs.
Thehel mi nthesar eclassi fiedint ot hr eemaj orgr oups.Thesear e:
1.Tremat odes( Fl ukes)
2.Nemat odes( Roundwor ms)
3.Cestodes( Tapewor ms)
TheTr emat odesandCest odesar egr oupsoff latwor ms.Themaj or
objecti
v eoft hisl ecturenot eist opr ov idegoodunder st andingoft hemost
commonhel mint hespr ev alenti nt het r
opi csi ngener al andi nEthiopiain
parti
cular .

ClassNemat oda
Nemat odesarethemostcommonhel mi nthsparasi
ti
zinghumansand
i
ncludesintesti
nal
nemat odesaswell
asbl oodandt i
ssuenemat odes.The
mostcommonnemat odeofmedicali
mpor tancearethoseinhabit
ingthe
i
ntesti
nal t
ract.Mostofthesehaveadirectli
fecycl
eandt heir
presence
maybeconf i
rmedbydet ect
ingt
hecharacteri
sti
cseggsinf eces.
Thefil
ariaareamongt hemostimport
antofbl oodandt i
ssuenemat odes.

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Gener al Char acter istics

1.Nonsegment edcy li
ndr i
cal orroundwor ms
2.Possessashi nycut i
clewhi chmaybesmoot h, spined,orridged
3.Mout hi ssur roundedbyl ipsorpapi ll
ae
4.Sexesar esepar at ewi t
ht hemal ewor msbei ngsmal l
erthant hefemale
5.Int hemal et her ei sat estisatthedist alendofal ongtubewhi ch
termi nat esi ncopul ator yorgansconsi stingofoneort wopr ojecti
onscalled
spicul es
6.Copul at orybur sa, caudal alaeorgeni talpapill
ae
7.Femal esar eei therv ivi
parous( producel arvae)orov i
parous( layeggs)
8.Nemat odeswhi chi nfecthumansl iveint hetissuesori ntesti
nal t
ract
.
9.Ti ssuenemat odesar etransmi tt
edmai nlybyi nsectvectorsandmost
i
nt est i
nal nemat odesar efeco- or
al r
outeandsoi lt
ransmitted.
Thepar asiticnemat odesar edividedinto:
1.Int estinal nemat odes
1.1.Int est i
nal nemat odeswi tht i
ssuest age
A.Ascar i
sl umbr icoi des
B.Hookwor ms
C.St rongy loidesst er corali
s
1.2.Int est i
nal nemat odeswi thoutt i
ssuest age
A.Ent erobi usv er mi cul ari
s
B.Tr ichur ist ri
chui ra.
2.Ti ssueandbl ooddwel li
ngnemat odes
o .Fi larialwor ms
o .Dr acuncul usmedi nensi s
o .Tr i
chi nell
a
o .Lar vami grans.

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2.
1.INTESTI
NALNEMATODESWI
THTI
SSUESTAGE
Ascari
sIumbr
icoi
des

(Roundwor m)
Geogr aphicalDistribution:Cosmopol ians.A.l
t umbri
coi
desi soneofthe
commonestandmostwi despr eadofal lhumanparasi
tes.
Habi t
at:Adul t:I
nt hesmal li
nt esti
neEgg: Int
hefaeces
Mor phology :Adul
- t:colour :pinkish
Mal e:si
ze: about15cm cur vedt ailandt wocopulat
oryspicul
esofunequal
size
Femal e:size2- -
25cm , withast r
aighttail.
Eggs: -
Therear ef i
v etypesofAscar iseggs.
A.Fer t
ili
zedEgg
B.B.Unf ert
il
izedEgg
C.C.Semi -decor t
icatedFer t
ili
zedEgg
D.D.Semi -Decor t
icatedUnf erti
lizedEgg
E.E.Embr yonat edegg

I
nfect
ivest
ageandmodesofi
nfect
ion:
Theeggcont
aini
ngl
arv
awheni
ngest
edwi
thcont
ami
nat
edr
awv
eget
abl
es
Causesascar
iasi
s.
Lifecycl e:
Thei nfect i
vestagei
st heeggcontainingsecondst agerhabdi t
ifor
ml arva.
Infecti
onoccur sbyi ngest
ionoftheinf ecti
veeggi ncont aminatedf oodor
drink,f
r om contaminatedhand.Foll
owi ngingesti
ont helarvaehatchi nthe
smal li
nt esti
neandpenet r
atebloodv esselsint hesmal li
ntesti
nal wall
.The
l
ar vaefol l
owahear tlungmigratef
rom anddev el
op.Af t
ermi grati
ngupt he
trachea, thelar
vaear eswall
owed.Int hesmal lint
estine,theygrowi nto
mat urewor ms.
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Aft
ermat i
ngthefemal
eproduceslar
genumberofeggs( 200,
000
eggs/day/femal
e)whi
charepassedint
hef eces.I
nshadedsoil
.theegg
developandcont
aini
nfect
ivel
arv
a.Thelar
vadoesnothat chunt
iltheegg
i
sswal l
owed.
Epidemiol
ogy
Reservoirhostsoft
heparasi
tearehumans.Theexcret
edeggsremai
n
vi
abl
ef oryearsinamoistenv
ironment(
soil
),butar
esensi
ti
veto
desi
ccati
on.

Pat hol ogy : Dur i

ngt heirmi gration,Ascarislarvacancausei nfl
ammat ory
andhy per sensi tiv
er eactionsi ncludingpneumoni al i
kesy mptoms, att
acks
ofcoughi ng, andbr onchi alast hma.
-Dev elopi ngandmat urewor msi ntheintestinef
requent l
ycausepai n,
nausea, diar rheaandv omi ting.
-It
si nfect ioni nchildrenisknownt oaf f
ectgast r
ointesti
nalfuncti
on.
Infect edchi l
drenar eof tenVi t
ami nAdef i
cientandhav el
owser um albumi n
l
ev el
s. Fr equentexposur et oi nfecti
onmayr esul
tini mpairmentofphy sical
andi ntellect ual development .
Pr event ionandCont rol:
1.Pr ev entsoi lcontami nationbysani t
arydisposal offaecesinlatr
inesand
av oidt heuseofni ghtsoi lasaf erti
li
zerandwashi nghandsbef oreeating
2.Ar oundeat inguncookedf oodssuchasv eget
ables,greensaladsand
fruits
3.Tr eat mentandheal t
heducat i
on.
Labor ator yDi agnosi s
1.Fi ndi ngt heeggsi nfaeces
2.I dent if
y ingadul twor msexpel ledthrought heanusormout h.

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Treatment
Inf
ectionswi hA.
t lumbr i
coi
desareeasil
ytr
eatedwit
hanumberof
anthel
mi nti
cdrugs:
 pyrantelpamoat egiv
enasasi ngl
edoseof10mg/kg.
l evamisolegiv
enasasi ngl
edoseof2. 5mg/kg.
 mebendazol egivenasasingledoseof500mg.
 albendazolegivenasasingledoseof400mg.

Strongy l
oidesst er cor alis
(Thedwar ft hreadwor m)
Geogr aphi cal Distribut ion:
wor ldwi dedi stri
but i
oni nt hewar m moi stcli
mat esoft r
opical and
subt ropical count ries.Spor adicinthet emper ateandcool cli
mat es.
Habi tat:Hasbot hf reel ivingandpar asiticgener at
ionsPar asit
icAdults:
bur i
edi nt hemucosal epithel i
um oft hesmal l i
ntesti
neofman.
Rhabdi ti
for ml arvae: Passedi nt hefaecesandext ernalenv i
ronment s
Fil
ar iforml ar vae: soi landwat ert heinfecti
vestage
Mor phology :
Adul t
Mal e(f r
eel iv
ing) :-size=1. 7mm wi t
hr habidi
tiform esophagus.I thasno
par asiti
cmal e.
Femal e( par asiti
c)
-2.2mm i nl engthcy linder ical OesophagusFemal e(freeli
v i
ng)
-1mm i nlengt handr habi diti
form oesophagus
FirstSt ageRhabdi tiform Lar vae
Size: 200- 300μm l ong; 15μm t hick
Mot i
lity
: veryact ivel ymot i
leint hest ool
Tail: Moder atelytaper ed
Shor tbuccal cav i
tyandr habi dit
ifor
m esophagus
Fil
ar iforml Lar ave
-About600- 700μm
-Cy linderical esophagus
-Bif i
dt ailend
ModeofTr ansmi ssi on:
• Fi lariforml ar vaef oundi ninfectedsoi li
nt hetropicsandsubt ropics
penet ratehumanski n.
• Per son- to-per sont ransmi ssi
oni srare,buthasbeendocument ed.

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LifeCy cl
e:
Egg→Lar vae→Adul t
Thef reelivi
nggener ati
oni st hebasi cl ifecycleoft hepar asiteandal most
const antlypr esenti nt hewar m moi stcl imat es.Itresultsconsi der abl
e
mul tipli
cationofpot ential i
nf ection.
Inpar asiti
cwayofl if
e, usual lymanacqui resinfectionbyf i
lari
for ml arva
penet rati
ngt heski n.Fol lowi ngpenet rat i
on,thel arvaeent erbl oodv essels
andunder goahear tlungmi grationt odev el
op.Af termi gratingupt he
trachea, thelar vaear eswal l
owedandt heymat ureint heintest inal t
ract.
Femal ewor msbecomeembeddedi nt hewal lofthesmal lintest ine
andl ayeggs.Ther habdi tiforml arvehat chouti nthei ntestineandei t
her
dev elopint hei ntest i
nei nt oi nfect i
vel ar v
aecausi ngaut oinfect i
onort hey
arepassedouti nt hef aeces.
Ther habdi t
if
orml ar vaewhi char eexpel ledint hef aecescanf ol lowf ree
l
iv i
ngwayofl ifeift heext ernal env i
ronmenti ssui tableori tdev el opint o
thei nfectivestagecal l
edf i
lar i
forml arv ae.

Cl
ini
calfeatur
eandPat hology:
Causesstrongyl
oidiasi
s,t
hediseaseisal
soknownascochinchi
na
di
arnheabecausei nthefecesofFrenchcol
olni
alt
roopwhohadbeen
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sufferi
nginuncont r
olleddi arrheainCochi nChi na.
Thef emaleadultwor m byt hei ri
nvasionoft heint est
inecause
i
nflammat orychangesi nt hemucosaofsmal lintesti
nel eadingtothe
developmentofgast rointestinal sy
mpt oms.I tisusual l
yasy mptomatic,
in
sympt omaticcasesshowst hef oll
owingphases:
1.Cutaneousphase: I
nf ectioncausedbyl argenumberofl arvaproduce
i
tchingander yt
hemaatt hesi teofinfecti
onwi thin24hour sofinvasi
on.
2.Pul monaryphase:Themi gratorylarvai
nt hel ungpr oducesa
considerabl
edegr eeofhostdamageandi njuryt otheal v
eoliandbronchi
al
epitheli
um t
herebypr oducingbr onchopneumoni aandf ul
lblown
pneumoni ti
s.

3.Intestinal phase: Invasi onbyadul twor msmaypr oduceabdomi nalpai

n
andmucusdi ar rheawhi chal l
eviateconst i
pation.I ndigesti
on,nausea
vomi ti
ngandanemi amayal sooccur .
Heav yinf ectionespeci allyi nchildrenmayr esul tinmal absorbti
on,
steatorrheaanddehy dr ation.
Auto-andhy per -inf
ect i
onsy ndr omesoccur swhent hei mmunest atusof
thehostsuppr essedbyei therdr ugs, malnutri
tionort heconcurrent
diseases:
Inthesecondi tions, l
ar vai nv adeandar efoundi nmanyoft hetissuesand
serouscav iti
esoft hebodypr oduci ngaser iousi nfect i
on,whichisf at
al.I
n
auto-andhy per -i
nfect iont hemucosal inf
lammat ioni ssevere.The
sigmoi dal colonandr ect um becomef r
equent l
yt hickenedandedemat ous
Labor atoryDi agnosi s
Findingt hel arv aeinf aecesori nduodenal aspiratesusi ngdirector
concent rationmet hod.I nhy per-i
nfectionsy ndromet helar
vamaybef ound
i
nsput um andi not herspeci mens.
Stool culture: usingchar coal cultur
emet hod, fi
lariforml ar
vaedev elopin5-
7day s
i
nposi t
ivecases.

Tr
eatment
I v
ermectin200μg/ kgasasi ngl
edose,ortwodosesof200μg/kgon
successi
veday s,iseffecti
ve.
 Alt
ernati
vely,
albendazol eisgi
venoral
lyi
nadoseof15mg/ kgbody
weight12-hourl
yf or3day s.Asecondcoursemayberequir
ed.Fort
he
Str
ongyloi
deshy per i
nfecti
onsyndrome,i
vermect
ini
sgivenat200
μg/kgonday s1, 2,15and16.

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PreventionandCont rol
1.Sanitarydi
sposal off aecesinl
atri
ne
2.avoiduseofni ghtsoi lasaferti
l
izer
3.Wear ingprot
ectiv
ef ootwear
4.Treatmentofinfect edindivi
dualsandHeal
theducat
ion.

HOOKWORMS
Ancy lomst omaduodenal eandNecat oramer i
canus
(oldwor ldhookwor m) (Newwor ldhookwor m)
Exceptsomedi fferenceswhi chdescr i
bedbel owbot hspeci esar esimilarin
manyaspect s.
Geogr aphi calDist ri
bution:( N.amer i
canus)- Widespr eadint he
west ernhemi spher e.Itist hepr edomi nantspeci esinal l
par tsoft hetropics.
ForEast ,Sout hAsi a,paci f
icIslands, TropicalAfrica,Central andSout h
Amer i
ca.
Geogr aphi calDist ri
bution:( A.duodenal e)
Wor l
dwi de; I
tisessent iall
ynor thernspeci esoccur ri
ngi nNor t
hernpar tsof
Chi na, Japan, Eur ope, NorthAf rica,southernEur ope, MiddleEast .Iti
sl ess
commoni nEthiopi athanN. amer i
canus.
Habi tat :
Adul t: Jej unum andl essof tenint heduodenum ofmanEggs: Inthefaeces;
noti nf ect ivetoman
Infect ivel arvae: freeinsoi l andwat er
Mor phol ogy :
A.duodenal e:-
Adul t-l onger&t hickert hanN. amer icanus
 Cr eamywhi t
eappear ance
 Lar gemount hcav it
y( Buccal capsule);broadert hanl ong
- Twopai rsoft eet h,t
wopl ates&t wosubv ent r
allancet s
- Clubshapedesopagus
- Femal elay s20, 000eggs/ day
Size-mal eandf emal emeasur es8mmand10- 13mm r espect ivel
y
N.amer icanus: -
Adul t-shor t&t hinnert hanA.dudenal e
-Buccal capsul el ongert hanbr oad
-2cut ti
ngpl ates, 2pl ates&2-subdor sallancets
-cl
ubshapedOesophagus
Size- mal eandf emal emeasur es7- 9mm and9t o11mm r espect i
vely

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Egg:-Si
ze: 65-40μm
Shape:ov al
Shell
:veryt hinandappear sasbl ackl ine
Colour:thecel l
sinsi dear epalegr ay
Content:v ari
esaccor dingt othedegr eeofmat ur i
ty.Itcontainsanov um
whichappear ssegment edusual l
y4- 8st age.
Lif
eCy cle
Egg→Lar ve→Adul t
Thewor msr equiresonehostt ocompl etethei rlif
ecy cl
eandt hedefinit
ive
hostisman.I nfectionmayoccuri nt woway s: (1)throughpenet r
ati
onof
theskinand( 2)ingest ingfil
ariforml arvae.Thel arvaepenet rat
etheski n
andent ersmal lbloodv esselsandf ollowingahear tlungmi grati
on.Af t
er
migrati
ngupt het rachea, t
helar v
aear eswal lowed.
Inthesmal li
ntestinet heydev elopandmat e. Thewor m attacht othewal lof
thesmal lintesti
nebysucki ngpar toft hemucusandbl oodf rom thehost.
Femalewor msl ayeggswhi char epassedi nt hef aeces.I nt heexternal
envir
onmentt heeggdev el
opandhat cht her habdi ti
for mlarv ae.I
tfeeds
andmoul ttwicet obecomei nfecti
vel ar v
ae.

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Pathology :
causeshookwor mi nf ecti
on.Maj orsympt omsar esevereit
chingatt hesi
te
ofskinpenet rati
onknownas" gr
oundi tch",
mi l
dpneumoni awithcough,
sorethroat,bloodysput um, headache, weakness, bl
oodydi ar
rheaand
anemia.
Adulthookwor m causechr onicbloodl oss.Ithasbeenest i
mat edthata
si
ngleA. duodenal ewor mi ngestsabout0. 15ml ofblood/dayanda
N.amer i
canuswor m about0. 03ml.
Diagnosis:Exami nationofst oolbydirectsalinesmeart odetecttheeggs.
Treatment
Mebendazol e: 1tab2xdai lyfor3day s.
Preventionandcont r ol:
-
1.Sanitarydisposal off aeces
2.Avoidt heuseofni ghtasf erti
li
zer
3.Wear ingadequat epr otectivefootwar e
4.Treatmentandheal theducat i
on.

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Int
est inal nemat odeswi thoutt issuest age
Entrobi usv ermi culari
s
(PinWor m)
Enterobi usv ermi cularisi sasmal lwhi t
ewor m wi tht hread- likeappear ance.
The
wor m causesent erobi asis.I nfect i
oni scommoni nchi l
dr en.
Cosmopol itantmor ecommoni nt emper ateandcol dcl imat est hani nwar m
cli
mat es.mor ecommonl yi nfect edt hanadul t
s.
Habi tat:
Adul t
: smal li
nt estine( termi nal il
eum)Gr av i
df emal e: Caecum andr ectum
Eggs: Inf aecesordeposi tedonper ianal skin
Mor phol ogy :
Adul t
s:Col or: yell
owwhi te
Mal e:Si ze2- 5mm Coi ledt ailedwi thasi ngl espi cul e.
Femal e:8- 13mm, thinpoi nt edt ailwi nglikeexpansi onofcer v
ical alae
Egg:Si ze: 50- 60μm Shape: ov al butf latt
enedononesi de, r oundedont he
othersi de
Smoot handt hinbutwi thdoubl eshel l
Cont ent : eitherasmal l granul armassorasmal lcur v edupl arvae.
-Theeggi susual l
ymor eeasi lyf oundont hef oldsofski nr ound
theanus.
Modeofi nf ection
 Bydi recti nfecti
onf r om apat ient(Fecal -
oral rout e) .
 Aut oinf ection: t
heeggsar ei nfect i
v eassoonast heyar epassedby
thef emal ewor m.I ft hehandsoft hepat ientgetcont ami nat edwi th
theseeggs, he/shewi lli
nf ecthi m/ her selfagai nandagai n.
 Aer osol i
nhal ationf r om cont ami natedsheet sanddust .
Lif
eCy cle
Manget si nfect i
onwi theggcont ainingi nfect i
vel arv af rom cont ami nated
handf oodordr ink.Fol lowi ngi ngest ionofi nfectiveeggs, thel arv aehatchi n
theint est ineanddev elopi nt oadul twor msi nthel argei nt est i
ne.
Aftermat ing, t
hef emal ewor msmi gratet ot her ect um.t hegr av idfemal es

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passoutoftheanusandl aythei
reggsont heper
ianal
skin,wi
thinabout
si
xhour seacheggcontainsi
nfecti
velarv
a.
Manal soacqui
resi
nfecti
onfrom clot
hing,beddi
ng,ai
rborneeggs
autoi
nfect
ionorret
roi
nfecti
on.

Epi
demi
ology
Amoi
st,
war
m cl
i
mat
eandunhy
gieni
cpr
act
icesf
avori
nfect
ions,
whi
char
e
cont
ract
edasdescr
ibedf
orAscar
is.
Themi
grat
ionoft
hewor
mscausesal
l
ergi
creact
ionsar
oundt
heanusand
dur
ing
Ni
ghti
tcausesnoct
urnal
itchi
ng(
prur
it
usani
)andenur
esi
s.Thewor
ms
may
Obst
ructt
heappendi
xcausi
ngappendi
cit
is.

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Di
agnosi
s
♦ Eggsi
nst
ool
:Exami
nat
ionoft
hest
ool
bydi
rectsal
i
nesmeart
odet
ect
t
heegg:
thi
sisposi
ti
vei
nabout5%ofcasesbecauset
heeggsar
egl
uedt
o
t
he
per
i-
anal
ski
n.
♦ Per
i-
anal
swab:
Theper
i-
anal
regi
oni
sswabbedwi
thapi
eceofadhesi
ve
t
ape(
cel
l
otape)hol
dov
erat
onguedepr
essor
.Theadhesi
vet
apei
spl
aced
onagl
asssl
i
deandexami
nedf
oreggs.Theswabshoul
dbedonei
nthe
ear
lymor
ningbef
orebat
hinganddef
ecat
ion.

Tr
eat
ment
Mebendazol
e;Pi
per
azi
ne.
Pr
event
ivemeasur
es
 Tr
eat
mentofal
lfami
l
ymember
s
 pr
eventeggdi
ssemi
nat
ion:

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 washi
ngt
heper
ianal
ski
n(especi
all
yint
hemor
ning)
,cov
eri
ngi
twi
th
oi
ntment
s,
 washi
ngt
hehands,
hotl
aunder
ingofunder
wear
,andcl
eani
ng
cont
ami
nat
edobj
ect
swi
thhotwat
er
Trichur ist richiura
(TheWhi pwor m)
Geogr aphi calDi stribution:-Cosmopol itan:mor ecommoni nmoi stwar m
cli
mat es.I ti srar elyf oundi nar idar easandathi ghal tit
udes.
Habi t at
Adul t: lar gei ntest ine( caecum)andv ermi form appendi x
Eggs: Int hef aeces, notinfect i
vewhenpassed
Mor phol ogy
Adul ts:whi p- l
i
keshape, anter i
or3/ 5t hoft hewar mr esembl esawhi p&
hencet henamet hepost eri
or2/ 5t
har ethick.
Mal e:Si ze30- 45mm , coiledt ailwithasi ngl espi cule
Femal e:35- 50mm, straightt hi
ckt ail.
Egg:
Size: 50- 54μm
Shape: bar rel-
shapedwi thacol orl
esspr ot rudingmucoi dplugat
eachendShel l:fai rl
yt hickandsmoot h,wi thtwol ay ers;&bi l
estained
Col or :y ellowbr own
Cont ent : acent ral granul armasswhi chi sunsegment edov um
Infectivest ageandmodeofi nf ection
Infectioni sbyi ngest ionofeggscont ai ningl arvaewi thcont aminatedr aw
veget abl es.
LifeCy cle
Aper sonbecomesi nf ectedbyi ngest i
ngeggscont aininginfectivelar
v ae
from cont ami natedhands, foodordr ink.Thei nfectiveeggsar eingest ed
andt hel ar vahat chandpenet ratethev il
laoft hesmal lintesti
ne.Thel arvae
mi gratet ot hel argei nt esti
neanddev elopi ntoadul twor m.Af termat ingthe
femal ewor msl ayeggswhi char epassedi nt hef aeces.I nadampwar m
soilthel ar vaedev elopandeacheggcont ainsani nfectivelarva.

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Cli
nicalf eaturesandPat hology:
Li
ghti nfect i
onproducesf ewsy mpt oms.I ny oungchildren,severe
i
nfect i
oncancausechr onicdi arr
hea, intestinalulcer
ationwithbloodand
mucusbei ngpassedi nt hef eces, i
rondef iciencyanemi a,
fai
luretodevel
op
atthenor mal rat
e,weightl ossandpr olapseoft herectum.
Labor atoryDiagnosis:-Findingt hechar acteristi
ceggsi nthefaeces.
Treatment
Mebendazol e: 1tabl
ett wicedai l
yfor2day s.
PreventionandCont rol
1.Sani t
ar ydisposaloff aecesi nlat
rine
2.Av oidt heuseofni ghtsoi l asaf erti
lizer
3.Treatmentofi nfectedi ndividualsandheal theducation.

TISSUENEMATODES
Thisgroupi ncl
udest hefi
l
arial
wor ms,t
hegui neaworm( Drancul
ucul
us
medinensis)andTr ichi
nel
laspiral
i
s.
Wucher eri
abancr of
ti
GeographicalDistri
buti
on:-
Theperiodi
cformi sthemostwi del
ydist
ri
buted
ofthefilar
ialwormsi nsubtr
opicsandtropics,Asi
a,Af
rica,
Amer i
ca,Middl
e
East,FarEast ,
Incl
udingEthi
opia.Thesub-periodi
cfor
mi sfoundinEaster
n
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Paci fic, Thai landandVi etnam

Habi t at
Adul ts:Coi l
edi nlymphat icgl ands, orl yingi nl ymphat icv essels,super fi
cial
abscesses, orwonder ingi nr etroper itoneal tissues.Foundusual lyin
l
y mphat icoft hel owerl i
mb.
Mi crof ilar i
ae:I nlymphat i
cv essels, andi nt heper ipher al bloodnor mal l
yat
nightbutdur ingdayi nl ungandot heri nt ernal organs.I nf ectivelarvae: I
n
thegutandmuscl esi ncl udi ngmout hpar t
sofcer tainspeci esof
mosqui toes
Mor phol ogy :
Adul ts:- Cr eamywhi t ewi thsmoot hsur f
ace
Mal e: -23- 40mm by0. 1mm
`Taper edandr oundedswol lenheadShar pl ycur vedt ai lwitht wospi cules.
Unequal spi cules
Femal e:-50- 65mm by0. 16mm Cur v edt ail,t aper edf rontendandVul vaat
cer vical area
Mi crof ilar i
a:-Size: 275- 300μm by8- 10μm
-Hasasheat hwhi chst ainspi nkwi thGi emsaandpal elywi thHaemat oxylin
stain
-Bodynucl ei aref ewerandmor edi st inctt hani not herspeci es
-Ther ear enonucl ei int heendoft hepoi nt edt ail
-Bodycur vesar esmoot handf ewwi t hSmoot hcut icle
-Blunt lyr oundedant eriorlyandpoi nt edcaudal ly
LifeCy cle:
Infect ivef i
lariforml ar vae→Adul twor m→mi cr ofi
lariaeI tr equirest wohost s
tocompl et eitsl i
fecy cl e:
1)Def i
ni tivehost :man
2)I nter medi at ehost s: speci esoff emal ecul ex, Anophel esandAedes
mosqui toes
Thei nf ect i
v ef i
lari
f or ml ar vasar edeposi tedonhumanski nwhenan
i
nf ect edf emal emosqui tov ect ortakesabl oodmeal .Thel ar vaepenet rate
theski nt hrought hebi teandent erint ot hebl oodv essel sandl y
mphnodes.
Dev el opmentt akespl acei nt hel ymphat icsandt headul twor m mat eto
producemanymi cr ofilari
aet hatent ert hebl oodst ream.
Themi crof i
lar i
aear et akenupbyamosqui tov ectorwheni ttakesabl ood
meal .Int hest omachoft hei nsectv ect or ,themi crofilariael oset heir
sheat handmi gratef rom t hemi d-gutt ot het horaxoft hev ect orwher ethey
dev elopi ntoi nfectiv el arvaeanddev elopi nt oi nfectivef orm.Thel arvaear e
readyt obet r
ansmi ttedwhent heinsectnextt akesabl oodmeal .

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Epidemi ology :
W.bancr of t
iinfectionisnotr epor t
edi nhigheral t
itudesofEt hiopia,but
l
imi t
edt ol owl andsofGambel la.Theepi demi careacov ersal ongdi stance
al
ongt heBar oRi ver.
Pathol ogy:Causesl y
mphat i
cf i
lari
asi sorel ephantiasisofusual lytheupper
l
imbs, genital organsandbr easts.
Maj orsy mpt omsar ef everwi t
hpai nful i
nflamedl y
mphat i
cs,thickeningand
bl
ocki ngofl ymphat i
cv essels,swelling, f
ibrosis,el
ephant i
asisand
hydrocoel eofl i
mbs, geni t
alorgansandbr eastsduet oobst ructionoft he
fl
owofl y mph.
Treat ment-Di ethylcar bamazine( DEC) :2mg/ kg3xdai lyfor2weeks.
Prev enti
onandCont rol:
1.Cont r
olli
ngmosqui toesv ector
2.Av oidmosqui toesbi te
3.Tr eati
ngi nf ectedper son
4.Gi vi
ngheal theducat i
on.
Labor atoryDi agnosi s
1.Mi crofil
ariaeinwetorst ainedbl oodf i
lms
2.Mi crofilari
aei naspi r
atesofhy drocel eandl ymphgl andf luid.
3.Occasi onallyMi crofi
lari
aei nchy lousur ineorhy drocoelef l
uidIn
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chr oni cbanchr of tianf i

lariasi s,acondi ti
oncal ledchy luriawi l
loccur, i.
e.,
passi ngofchy lei nur i
ne.I nsuchur i
nemi crofi
lar i
acanof tenbf ound.
4.Ser ologi cal diagnosi s
Col lect i
onTi meofBl oodf orW. bancr of timi crofil
ar i
ae
Per iodi cW. bancr of timi crof i
lariae: Col lect i
ngbl oodbet ween22. 00-04.00
hour s( timeofpeakdensi tyi s24. 00hour )Noct urnal subper i
odi c
W. bancr of timi crof i
lar i
ae: Col lect ingbl oodbet ween
20. 00- 22. 00hour s( timeofpeakdensi tyis21. 00hour )
Diur nal subper i
odi cW. bancr of timi cr ofilari
ae: Collectingbl oodbet ween
14. 00- 18. 00hour s( timeofpeakdensi tyis16. 00hour )Thedi urnal
subper i
odi cv ar antW.
i bancr of t
i isf oundmai nlyinEast er n
paci fic.Thenoct ur nal subper iodi cv arianti sf oundespeci allyi nThi l
andand
Viet nam.
W.bamcr of tiisf oundwi thB. mal ay iinpar tsofsout hEastAsi a&Sout h
India
Brugi amal ay i
Geogr aphi calDi str i
but ion:-Itisdi stribut edi ncount riessuchasAsi a,
Mal ay sia,Indi a, Phi lippines, Viet nam, Chi na,andKor ea.Thenoct urnal
per iodi cf or mi sthemostwi del yspr eadi nswampsandr i
cegr owi ngar eas
wher east henoct urnal subper iodi cf ormi sf oundi nf r
eshwat erswamps
andf or est sal ongmaj orr i
v ers.
Habi tat
Adul t:Indi lat edl ymphat i
cVessel sofman; usual lyi ntheupperl i
mb.
Mi cr ofil
ar iae: Ly mphandper i
pher al bloodatni ght ,andi nthel ungand
i
nt er nal or gansdur ingdayt imeI nfect ivef il
ar i
forml arvae: Int hegutof
mosqui toes.
Mor phol ogy
Adul ts:-Mal e:13- 23mm
Femal e:43- 55mm
Mi cr ofil
ar iae: -Si ze: 200- 275μm by5- 6μm
-Bodyi susual lycoi ledandki nked( hassmal l angul arcur ves)
-Hasasheat hwhi chst ainsdar kpi nkwi thGi emsaandpi nkmauv ewi th
haemat oxy li
n.
-Bodynucl ei ar edenseandst aindar kly .
-Ther ear et wodi scr et enucl ei i
nt heendoft het ail whi cht aper si r
regularly.
Lifecy cle
Thel ifecy cleofB. mal ay ii
ssi mi lart ot hel ifecy cleofW. bancr ofti
.Mani s
thedef i
ni ti
v ehost .Femal eanophel esandMansoni mosqui toesar ethe
i
nt er medi at ehost s.Manget si nf ect i
onbyt hebi t
eofi nfect edi nsectv ector

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wheni tt akesabl oodmeal .

Pat hol ogy :Causesmal ay anf i
lariasi sorel ephanti
asisoft helowerl i
mbs.
Sympt omsdev elopr apidlyandchi ldrenar emor eaffected.
Prev ent i
onandCont rol: -simi larmet hodl ikeW. bancrofti
.
Labor at oryDi agnosi s
Findi ngt hechar act er i
st i
cMi crof i
lar i
aei nwetorst ainedbl oodf i
lms
Col l
ect i
onTi mef orB. mal ay i Micr ofil
ar iae
Per iodi cB. mal ayiMi cr ofil
ar iae:
Col l
ectbl oodbet ween22. 00- 04.00hour s( t
imeofpeakdensi t
yis24.00
hour )
Subper iodi cB. mal ayiMi crof i
lariae:
Col l
ectbl oodbet ween20. 00- 22.00hour s( t
imeofpeakdensi t
yis21.00
hour )
-Per oidi cB. mal ayiiscommonl yf oundi nopenswampsandr i
cegrowi ng
areasofcoast alregi ons.Thesubper iodicv ari
antisfoundmost l
yinfresh
wat erswampi nfor est sal ongmaj orr ivers.
-B.t umor i showsnoct urnal periodi city.Itisfoundonl yint helesserSunda
ofI ndonesi at hespeci est akesi t snamef rom theisl
andofTi morwhi ch
formspar toft hegr oup.i tisf oundi nl ow
l
y i
ngr i
v erineandcoast alar eas.
Loal oa( Ey ewor m)
Geogr aphi calDi stribut i
on:
TheDi st ri
but ionofL. loai sr est r
ict edt ot heequat ori
al r
ainf orestareaof
westandcent ralAf rica.
Habi tat:
Adul t s:Inconnect ivet i
ssuesundert heski n,inthemesent eryandthe
par i
et al per itoneum.Theycommonl ymi graterapi
dlyinthebodyandmay
beseeni nt hesubconj unct ival t
issueoft heey eorin
thinski nnedar eas.
Mi crof ilariae: Inper ipher al bloodofmandur i
ngdayt ime.
Infect ivel ar vae:Int hegut ,mout hpar tsandmuscl esoft abani defl
i
esoft he
genusChr ysops.
Mor phol ogy
Adul t s:-Cy l
inderical andt ranspar ent
Mal e:30- 34mm
Femal e:60mm
Mi crof ilariae:
-Size: 250- 300μm l ongand8- 10μm t hi ck
-Hassev eral curvesandki nks

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-Hasasheat hwhi chst ainsbestwi thhaemat oxy l

in.
-Bodynucl ei arenotdi st i
nctandappearmor edenset hant hoseof
W. bancr ofti
-Nucl ei extendt ot heendoft het ai lwhi chi sr ounded.
Lifecy cle
Nat ur al Definitivehost sar e-Man&Monkey s.Reser v oirhostar esi mi an
host s.
Simi lart ot hel ifecy eofW.bancr
cl oftibutt hehabi tatoft headul twor msis
i
nt hesubcut aneoust issuesandt heyar ef r
eel ymov ingi nt heset issues.
Thei nter medi at ehost sar especi esofchr ysops( hor sef l
y).
Pat hol ogy :Char act erizedbyt hef ormat ionofswel l
ingknownascal abar
swel lings.Thear msmostf requent lyaf fected.Adul twor msal somi grate
i
nsub- conj unct ivat issues.Theycancausei nf lammat ionandi rri
tat ionbut
Prev ent ionandCont r
ol : Similarwi ththepr ev iousf i
lar i
awor ms.
Labor ator yDi agnosi s
1.Fi ndi ngt hechar act er isticmi cr ofil
ariaei nst ainedbl oodf i
lmst aken
dur i
ngt hedayt ime.
2.Occasi onal lyt hemi cr of il
ariaecanbef oundi nj ointf luid.
Onchocer cav olv ulus
Geogr aphi calDi stribut ion: -occur smostwi del yalongt hecour sesoff ast
runni ngr i
versi nt hef or est sandSav annahar easofwestandcent ral Afr
ica.
Itisendemi cf rom Senegal int hewestt oUgandaandEt hiopiaint heEast
andasf arassout hasZambi a.I talsooccur sint heYemenAr ab
Republ ic.Saudi Ar abiaandi ncent ralAmer i
ca( Mexi coandGuat imal a).I
tis
alsof oundi nSout hAmer ica.
Habi tat :
Adul ts:-Subcut aneousnodul esandi nski nMi cr ofil
ar iae:-Skin,eyeand
otheror gansoft hebody .Infect ivel arvae: Int hegut , mout hpar tsand
muscl esofSi mul i
um bl ackf ly .
Mor phol ogy :
Adul ts:- mal e:25- 40mm, curvedandbul boust ail
-Femal e; 33-55cm i nlengt h
Mi crof i
lariae:-Si ze240- 360μm l ongand5- 9μm t hick
-Hasnosheat handheadendi ssl i
ght lyenl arged
-Ant eriornucl ei areposi tionedsi debysi de
-Ther ear enonucl eiint heendoft het ai lwhi chi sl ongandpoi nt ed.
LifeCy cle
Itrequi rest wohost smanasdef initi
veandSi mul um asi ntermedi atehost .
Infect ivelar vaear edeposi tedont heski nwhenani nfect edv ectort akes

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bloodmeal .I
tentersthr ought hebi tewoundanddev elopintomal eand
femal ewor msinsubcut aneoust issue.Theymat eandv ivi
parousfemal e
producesmanyunsheat hedmi crofil
ariathatcanbef oundj ustbelowt he
sur faceoftheskini nthel ymphspacesandi ntheconnect iveti
ssues.
Theycanal sobef oundi nt hefluidofnodul es.Themi crofi
lar
iaalsomi grat
e
tot heey e.Themicr of
ilariaearei ngestedbyi tsmostcommonestv ector
Simul ium damnosum compl exasi ttakesabl oodmeal anddev el
opi nto
i
nf ectivelar
vaethatmi gr atetot hemout hpar t
soft heblackflyr
eadyt obe
transmi tt
edwhent heflynextt akesabl oodmeal .

Pathogeni cit
y :
-I
tcausesOnchocer ciasisorr i
verblindnessThecl ini
cal
featureofonchocer ciasisarecausedmai nlybyt heinflammat oryreacti
ons
arounddamaged&deadmi cr
ofil
aria.Inchr onic
onchocer ciasistheski nlosesitsel asti
city&becomeswr inkledwhi ch
makespeopl emor eagedt hantheyar e(knownasel ephantski n).When
theskinar oundt hegr oinbecomeaf fectedhangi nggr oindev elops.The
term Leopar dskinref erstoaspot t eddepi gment aionoft heski n.Themai n
cli
nicalfeaturesaret hef ormationofnodul es, dermatiti
s&i nf l
ammat ory
reacti
onsi nt heeyel eadingt obli
ndness.
PreventionandCont r
ol
1.Dest r
uct i
onofsi mul imincluding
-Selecti
v euseofi nsect i
cidesIntroduci ngot hermet hodt or educet he

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breedi ngofbl ackf il

esi nr i
ver s&st reams.
2.Av oidi ngsi mul ium bi tesbycov eringusi ngasf araspossi bl et hosepar t
s
ofthebodymostatr i
sk.
3.Ident ificat i
onofi nfect edcommuni tiesf ollowedbyt r
eat mentof
communi tiesby
Labor ator yDi agnosi s-Findi ngt hechar acteristicMi cr
of i
lariaei nski nsni ps.
Not e:I nheav yInfect ionandf ollowi ngt r
eat ment , t
hemi crof i
lar iaecanal so
bef oundi nur ine, blood, andmostbodyf l
uids.Unl ikeW. bancr of tiwhich
mayal sobef oundi nur ine
TRICHI NOSI S
Eti
ol ogi cagent-Tr ichi nellaspi ralis
Thisi st heonl yimpor tantspeci esi nt hisgr oup.I tcausest richi nosi s–a
cosmopol i
tani nfect i
on.Mor et han100di fferentani mal speci escanbe
i
nfect edwi thTr i
chi nellaspeci es, butt hemaj orreserv oirhostf orhuman
i
nfect i
onsi sswi ne.
Habi tat
Adul ts:Embeddedbyi t sant er i
orpar ti nmucosaofmuscul arepi thelium of
duodenum andJej unum ofMan, Dog, Rate, Cat ,
Pigsandmanywi l
d
Carni v ores.v ivipar ous
Larv ae:ency stedi nt hest r
aitedmuscl eoft hebodyofmeateat i
ngani mals
i
ncl udi ngman.
Egg:Noeggspassedi nt hef aeces, femal egi vesbi r
tht ol arv ae.
Mor phol ogy
Adul tf emal ewor m measur es3- 4mm i nlengt handt headul tmal ewor m
measur es1. 4- 2.6mm i nlengt h.Theency stedl arvaemeasur e800- 1300μm
i
nl engt h.
Thesameani mal (andman)act sasf i
nal andi ntermedi atehost
harbour ingt headul tpar asitet hel arv a.
Li
fecy cle
Wheni nf ect edf l
eshofani mal scont ainingi nf ectiv
elar vaei seat enbyman,
pi
gorot hercar nivor eani mal s, thel ar vaear ef reedandbecomemat ure
normsi nt hesmal l i
nt est i
ne.Fol lowi ngf erti
li
zat i
on, t
hev ivipar ousf emal es
producemanyl arv aewhi char ecar riedi nt hebodyci rcul ationt ost riated
muscl est of orm cy st.Thenat ur al cy cleiscompl etedwhent hef leshofan
i
nfect edcar nivor ei seat enbyanot hercar nivor e.

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Pathol ogy :causest r chi nell

osi s.Majorsympt omsar enausea, v
omiti
ng,
abdomi nal pain,diar rhea, headache, fever,blurredv i
sion,edemaofface
andey e,cough, pleur al pain, eosi
nophili
a,acut elocal i
nfl
ammat i
on,wit
h
edemaoft hemuscul atur e.
Ther ear et wocl i
ni cal phases.
1.Thei ntestinalphase: lasting1-7day s-asy mpt omat ic;someti
mescause
nausea, vomi ti
ng, di ar rhea, constipati
on,pain, etc, and
2.Themuscl ephase: whi chcausesmy al
gia, palpabr aledema,eosi
nophil
i
a,
fever,my ocarditis,meni ngitis,bronchopneumoni aet c.
Diagnosi s:
♦ Muscl eBi opsy
♦ Det ect i
onofl ar vaei nbl oodorCSF
♦ Det ect i
onofl ar vaeandadul twormsi nst ool (rare).
♦ ELI SA
Treat ment-Thi abendazol
Prev ention
♦ Cooki ngofal l meatbef oreconsumpt i
on
♦ I nspect ionofpi gs
♦ Por kmustbest or edat- 150Cf or20day s.
Dracuncul usMedi nensi s
(GuineaorMedi nawor m)
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Geogr aphicalDi stribut i

on:-Since1986, t
heglobal prev al
enceof
drancuncul iasishasbeenr educedby97%andi ti
sexpect edthatthe
diseasewi l
lbeer adicat einthenearf eat
ure.Itissti
llendemicin18
count r
ies,1.e.,India, Yemenand16count r
iesinsub- SaharaAsfr
icawith
77%ofi nfectionsbei ngf oundi nSudan.
Habi t
at:
Adul t
s:threadl ike
Femal eint hesubcut aneoust i
ssuesandintermusularconnect i
vet i
ssues
theoft hel owerext ri
mi tes;especiall
yaroundt heankl e.
Mal eresidesi nt her et r
oper i
tonealconnecti
vet i
ssuesanddi esshor t
lyafter
copulation
Firststagel arvae: I
nt heulcer sorbli
ster
s.Infecti
veFi l
ari
formlar
v ae:Inthe
hemoceol eofCy clops.

Mor phol ogy

Adul ts:Whi t
ewi thsmoot hsur f
ace
Mal e:12- 29mm , coil
edpost eri
orend.
Femal e:70- 120cm ( average100cm)Thel ongestnemat odeofmanHas
cylinder icaloesophagus
Vivipar ous
Lar va:Si ze:500- 700μm
Roundedant eri
orendLongandpoi nt edt ail HasRhabi dit
iform
Oesophagus
Lifecy cle
Mani st hemosti mpor t
antdef i
nitiv
ehost .Ithasal sobeenf oundi ndogs
andcat s.Cyclopsorr elatedcr ustaceansar et heintermediatehost s.When
Per sonswal lowswat ercont ainingcy clopst hatareinfectedwi ththel arvae.
Thel arv aearefreedandpenet rat
et hr ought heduodenal wall.After
dev elopmentandf ertil
izati
oni ntheconnect iv
et i
ssues, t
hef emal ewor m
mi grat est otheconnect i
vet issuesoft hel owerl i
mbswher ewi t
hinabouta
yeari tbecomesf ul
lymat ure.
Thef emal eworm bur iesitsant er
iorendi nt heder misformingabl istert hat
ulcer ates.whent hebl i
ster( ulcer)isbat hedi nt hewat ertheut erusoft he
femal epr otr
udest hrought heul cerandr upt ures.lar
genumberoff irst
stagel ar v
aear er el
easedi nt ot hewat er.Thel arvaeareunabl et oswi m but
areact ivelymot il
e, coili
nganduncoi l
ing.Fort hel i
fecy cl
etobecont inued
thel arv aemustbei ngest edbyaCy clops.I nthebodycav it
yoft heCy cl ops,
thel arv aedev elopi nt oinfect i
v elarvae.

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Pathogeni cityi nMan

-DiseaseGui neawor m ulcerdi sease
-toxichi stami nel ikesubst ancesar eliberat edbyt hef emaleguineaworm
assoonasshest artsmi gration, cousingpr ofoundellergi
csy mptoms
-Thisi sf ollowedbyt heappear anceofwor m undert heskinassoci at
ed
withbl ist erf ormat ionwhi chbur sts&t hel arv aearedischargedaf t
er
comi ngi ncont actwi t
hwat er.
-Premat urel iberat ionofembr oy sinthet issuecausei rr
it
ati
onand
i
nf l
ammat iont hishappenspar t
icular
lywhent hei
tsext r
acti
onpr ematur
ely
-Secondar yinf ectionmayal sooccur sl eadi ngt ocel
lulit
isandoccasionall
y
septicaemi a
-Ifajoi nti si nv olved, arthri
tismaydev elop
Prevent i
onandCont rol:
Theeasi estpar asi tet obePr ev entedcont rolled
1.Prev entwat ercont ami nati
onwi ththel arv ae
2.Av oiddr i
nki ngi nf ectedwat erbyboi l
ing
3.Dest royt heCy clopsbyusi ngchemi calsexampl e,organophosphorusor
chlorine
4.Cov eringt hebl ist erwithawat erproofdr essing
Labor at or yDi agnosi s:-

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Findingt hegr avidwormi nthebli

ster.
Adi agnosi sisusual l
ymadewhent hebl i
sterhasr uptured&t heanterior
endoft hef emal eworm canbeseen.I frequired,l
abor atoryconfi
rmationof
thedi agnosi scanbemadeasf oll
ows:
1.Placef ewdr opsofwat erontheulcert oencour agedi schargeofl
ar vae
from t heuter usofthewor m.
2.Af terandl eftforafewmi nut
escol l
ectt hewat erinapi petteandprepare
awetmount .
3.Tr ansfert hewat ert
oasl i
de&exami nemi croscopicallyforthemot i
le
l
ar v
aeusi ngt he10xobj ecti
vewiththei r
isdiaphragm cl osedsuffi
cientlyt
o
givegoodcont rast
.

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ClassTr emat oda( Fl ukes)

Tr emat odesorf l
ukesar emember soft hepl at yhelmi nt hsandar egener all
y
fl
at ,f l
eshyf l
at ,l
eafshapedwor ms.Tr emat odsv aryi nsi zefrom speci es
j
ustv isiblet ot henakedey e, likeH. het er ophy esandM. yokogawit ol arge
fl
eshyspeci es, l
ikeFasci ol
aandFasci olopsi s.ThemostChar acter isti
c
ext ernal struct uresar et heaccept able( i
.e. ,sucker s)whi chcausedt heear l
y
wor ker si nt hi
sgr oupt ocal lt hem t remat oda, i
.e."bodywi thhol es. "They
possest womuscul arsucker s: oneor al ,
sur roundi ngt heopeni ngt ot hepr imi tivedi gest ivet ract ,andonev ent r
al
suckerf orat t
achment .Thedi gest ivesy st em consi stsofamuscul ar
phar ynxandesophagusandbi lateral cecat hatendbl indlyneart he
post erioraspectoft hewor m.
Thef l
ukesmaydi v i
dei ntot womaj orcat egor iesbasedont heir
repr oduct ivesy stems.Themaj or it
yoff l
ukesar eher maphr odites.Theadul t
her maphr odi tescont ai nsbot hmal eandf emal esexgonadsandpr oduce
oper cul atedeggs.TheSchi st osomesconst itutet hesecondmaj orcat egory
andi ncl udeor gani sm wi thsepar at esexes.
Thef emal eSchi stosomesdeposi t
sonl ynon- oper cul at edeggs.Bot h
Schi st osomesandher maphr odi t
icf lukeshav esi mi larl if
ecyclest hat
i
ncl udeoneormor ei ntermedi at ehost s.Anot hermeansofcl assi fy i
ngt he
tremat odest hatcausehumani nfect ioni sbyt heanat omi clocat ionoft he
par asi tei nt hehumanhost .Thuswehav et hei ntest inal tr
emat odes, t
he
l
iv erandl ungt remat odesandt hebl oodt remat odes.
Gener al Char act eri
st ics
1.At tachedt ot heirhostbymeansofsucker s.Theyhav eoralsuckerwhi ch
sur roundst hemout handv ent ral suckeront hev ent ral surf
ace
2.Thedi gest i
v esy st em consi stsofamout handanesophaguswhi ch
div i
dest of ormt woi ntest i
nal caeca.I nsomespeci est hecaecaar e
branched.Ther eisnoanus.
3.Fort hedev elopment ,eggsmustr eachwat er.
4.Adul tf l
ukesl iveint hebi l
educt( l
iv erf lukes)i ntest inal t
ract(int est i
nal
fl
ukes) ,por tal veins( bl oodf lukes)andl ung( lungf lukes)accor dingt o
speci es.
5.Repr oduct i
v est ruct ureissi mi lart ot het apewor m' s
6.Requi r
easexual andsexual gener at ionst ocompl etet heirli
fecy clei n
twoormor ehost s.
Accor dingt ot hesi test heyi nhabi t,ther ear ef ourgr oupsoff l
ukes.
 Thesear e:
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 Bloodf l
ukes,
I ntest
inalf
lukes,
 Liverfl
ukes,andLungf
lukes

BLOODFLUKES
Thesear ef lukest hatr esi
demai nlyinthebl oodv esselsofv ariousor gans
andt heschi stosomesar ethepr ototypeandt hecommonestf lukesi nour
count ry.
Itisest i
mat edt hatabout600mi ll
ionpeopl ei n79count ri
essuf ferfrom
schistosomi asis( Bilharzi
asis).Theschi stosomescausei nt estinal,
hepat ospl enic,
pulmonar y ,
ur ogenital,cerebralandot herf ormsofschi stosomi asis.
Schistosomei st heonl yflukewi thsepar atesexes.Thef emal ewor mli
esin
thegy necophor al canal ofthemal e.Thiscondi tioni si
mpor tantf or
transpor tati
on.
Therear ef i
v emedi cal l
yimpor tantspeci es:
1.Schi stosomamansoni :causesi ntestinalschistosomi asis.
2.Schi stosomahaemat obium:causesv esical(urinary)schi stosomi asis.
3.Schi stosomaj aponi cum:causesi ntesti
nal schistosomi asis.
4.Schi stosomai ntercalat
um:causesi ntestinalschistosomi asis.
5.Schi stosomamekongi :causesi ntestinalschistosomi asis.Thi sseemst o
causemi lderdi seasei nman.I tcausesdi seasei not herv ertebr atehosts.
Thef irsttwoschi stosomes( S.mansoniandS.haemat obium)ar e
prevalenti n
Somal i
a.

SCHI
STOSOMAJAPONI
CUM
Thef
emal
eadul
twor
mlay
sabout500-
3500eggsdai
l
y.Theeggsar
eov
oid,
bear
ingonl
yami
nut
elat
eral
spi
neorasmal
lknobpost
ero-
lat
eral
l
y.I
tis
f
oundi
n
Japan,
Chi
na,
andPhi
l
ippi
nes,
etc.
SCHI
STOSOMAI
NTERCALATUM
Thi
sist
her
arestandl
eastpat
hogeni
cschi
stosomet
hatmat
uresi
nman.I
t
i
s

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f
oundi
nWest
ernandCent
ral
Afr
ica.Thedai
l
yeggout
puti
sabout300.The
eggs
hav
eat
ermi
nal
spi
ne.
LI
FECYCLEOFSCHI
STOSOMES
Adul
twor
msr
esi
dei
npai
rs:
thef
emal
ely
ingi
nthegy
necophor
alcanal
of
t
he
mal
e.Af
terf
ert
il
izat
ion,
eggsar
epassedi
ntot
hev
enul
es.Al
arv
alf
orm–
t
he
mi
raci
dium -dev
elopswi
thi
ntheegg.I
tsl
yti
cenzy
mesandt
hecont
ract
ion
oft
he
v
enul
erupt
uret
hewal
loft
hev
enul
eli
ber
ati
ngt
heeggi
ntot
heper
ivascul
ar
t
issuesoft
hei
ntest
i S.mansoni
ne( )orur
inar
ybl S.haemat
adder( obi
um)
.
The
eggspassi
ntot
hel
umensandor
gansandar
eev
acuat
edi
nthef S.
eces(
mansoni
)ort
heur
i S.haemat
ne( obi
um)
.Oncont
actwi
thf
reshwat
ert
he
mi
raci
diahat
chf
rom t
heeggsandswi
m aboutunt
ilt
heyf
indt
he
appr
opr
iat
e
snai
l
,whi
cht
heypenet
rat
e.Af
tert
wogener
ati
onsofspor
ocy
st
dev
elopmentand
mul
ti
pli
cat
ionwi
thi
nthesnai
l
,thef
ork-
tai
l
edcer
car
iaeemer
ge.I
nfect
iont
o
man
t
akespl
acedur
ingbat
hingorswi
mmi
ng.Thecer
car
iaepenet
rat
etheski
n,
ar
e
car
ri
edi
ntot
hesy
stemi
cci
rcul
ati
onandpasst
hrought
othepor
tal
vessel
s.
Wi
thi
nthei
ntr
ahepat
icpor
ti
onoft
hepor
tal
syst
em,
thewor
msf
eedand
gr
owt
omat
uri
ty.

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Sy
mpt
omsandcompl
i
cat
ions
Pat
ient
sinf
ect
edwi
thS.haemat
obi
um suf
ferf
rom t
ermi
nal
haemat
uri
a
and
pai
nful
mict
uri
ti
on.Ther
eisi
nfl
ammat
ionoft
heur
inar
ybl
adder(
cyst
it
is)
,
and
enl
argementofspl
eenandl
i
ver
.
Pat
ient
sinf
ect
edwi
thS.mansoni
suf
ferf
rom cer
car
ial
der
mat
it
is
(
swi
mmer
sit
ch)
anddy
sent
ery(
mucusandbl
oodi
nst
ool
wit
htenesmus)aswel
las
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enl
argement
s
oft
hespl
eenandl
i
ver
.
S.haemat
obi
um causessquamouscel
lcar
cinomai
nthebl
adder
.
Labor
ator
yDi
agnosi
s
S.mansoni
 Mi
croscopi
cexami
nat
ionoft
hest
ool
foreggsaf
terconcent
rat
ionby
sedi
ment
ati
onmet
hod.Theegghaschar
act
eri
sti
clat
eral
spi
ne.
 Rect
alsni
p
S.haemat
obi
um:
 Exami
nat
ionoft
heur
ineaf
teral
l
owi
ngi
ttosedi
menti
naconi
cal
ur
inal
ysi
s
gl
ass.Adr
opf
rom t
hesedi
menti
stakenandexami
nedf
oreggs.Egg
has
t
ermi
nal
spi
ne.
 Bi
opsyf
rom bl
adder
Tr
eat
ment
:
Pr
azi
quant
el:
singl
eor
aldoseof40mg/
kgdi
vi
dedi
ntot
wodoses.
Pr
event
ionAndCont
rol
1.Heal
theducat
ion
A.Onuseofcl
eanl
atr
inesandsaf
ewat
ersuppl
y
B.Av
oidur
inat
ionanddef
ecat
ioni
ncanal
s,av
oidcont
actwi
thcanal
wat
er
2.Snai
lcont
rol
:
A.Phy
sical
met
hods:
i
.Per
iodi
ccl
ear
anceofcanal
sfr
om v
eget
ati
ons.
i
i
.Manual
remov
alofsnai
l
sandt
hei
rdest
ruct
ion.
B.Bi
ologi
cal
met
hods:
Useofnat
ural
enemi
est
othesnai
l
ssuchasMar
isa.

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C.Chemi
cal
met
hods:
Mol
l
usci
desar
eappl
i
edi
nthecanal
stoki
l
lthe
snai
l
s.e.
g.Endod
I
NTESTI
NALFLUKES
Fasci
olopsi
sbuski
:Thesegi
anti
ntest
inal
flukes(
2-7.
5cm i
nlengt
h)ar
e
f
oundi
nsomeAsi
ancount
ri
es.
Het
erophy
ids:
Minut
efl
ukesacqui
redbyi
ngest
ionofr
awf
reshwat
erf
ish.
Theyar
efoundi
nAsi
ancount
ri
es.
LI
VERFLUKES
 Cl
onor
chi
ssi
nensi
s:Chi
nesel
i
verf
luke-adul
twor
msl
i
vei
nbi
l
e
duct
s.
 Faci
olahepat
ica:Sheepl
i
verf
luke-i
sacommonpar
asi
te,
cosmopol
i
tani
n
di
str
ibut
ion.I
tisl
arge(
3cm i
nlengt
h).Adul
twor
msr
esi
dei
nthe
l
argebi
l
iar
y
passagesandgal
lbl
adder
.
 Faci
olagi
gant
ica:l
i
vesi
nthel
i
verofcat
tl
e.Humani
nfect
ionsar
e
v
eryr
are.
LUNGFLUKES
Atl
eastei
ghtdi
ff
erentspeci
esofl
ungf
lukes,
all
bel
ongi
ngt
othegenus
Par
agoni
mus,
areknownt
oi ectman.Par
nf agoni
muswest
ermani
,best
known
speci
es,
aff
ect
smancausi
ngpar
agoni
miasi
s(l
ungdi
sease)
.Iti
sfoundi
n
Asi
a
(
Chi
na,
Indi
a,I
ndonesi
a,Mal
ayaet
c)andsomeAf
ri
cancount
ri
es.

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