PARASITOLOGY

PRACTICAL HANDBOOK

Foundation Module 2
Infectious and Parasitic Diseases Module
DEPARTMENT OF PARASITOLOGY

FACULTY OF MEDICINE, COLOMBO

FOUNDATION MODULE 2/ INFECTIOUS AND PARASITIC DISEASES
MODULE

This manual has been designed to help you with your practical classes in Parasitology during the
Foundation Module 2 and Infectious and Parasitic Diseases Module. Keep this hand book during
all your practical sessions.

Brief descriptions of the medically important parasitic stages and gross specimens have been
provided. However, it is by no means complete and should be supplemented by further reading
of recommended textbooks in Parasitology.

Before starting any practical work:

Read the instructions
Listen to the demonstrator
Label all slides to be used
And if you have any doubts ask questions.

Prepared by:

Professor Deepika Fernando

Professor Sharmini Gunawardena
Dr. Sanath Senanayake

Technical Assistance
Ms. Himali Gunatilaka

10th February, 2020

Page 2 of 41
 Contents Page Number

PRACTICALS:

Use of the Microscope 4

Malaria 7

Filariasis, Leishmaniasis, Toxoplasmosis and Trypanosomiasis 15

Intestinal and Urogenital Protozoa 17

Intestinal Nematodes, Cestodes and Trematodes 24

Medically important Arthropods 31

Snakes 37

Page 3 of 41
01. PRACTICAL: USE OF THE MICROSCOPE

Introduction
The microscope is one of the most important instruments in a biology laboratory. There are many
small objects such as the malaria parasites which cannot be seen by the unaided human eye. The
microscope magnifies the images of such objects thus making them visible.

Microscopes used in clinical practice use a beam of light to view specimens and thus they are
called light microscopes. As these use two lens systems they are termed compound light
microscopes. A compound light microscope with a single eyepiece is called monocular; one with
two eyepieces, binocular.

(2) (1)

(4)
(3)
(5)

(6)

(6 a)
(10)
Condenser (7)
(8)

(&) (11)
(9)

(12)

Parts of the microscope

Practical Exercise : Identify the parts of the microscope given below:

1. Eye-piece (the ocular lens)

• It is the uppermost series of lenses through which an object is viewed.
• The lens magnifies the image formed by the objective. The magnifying power of the
eyepiece is in the range 5x-20x.
• A movable pointer may be attached to the inside of the eyepiece.
• In binocular microscopes, the two eye-pieces can be moved closer or farther apart to
adjust for the distance between the eyes by pulling–pushing motion or by turning a
knurled ring.

2. Microscope tube
• Holds the nosepiece at one end and the eyepiece at the other end.
• It can be of the monocular or the binocular type.
• Conducts light rays.

3. Arm
• Supports the upper parts and provides a carrying handle.

Page 4 of 41
 4. Nose-piece
• The nosepiece is attached beneath the arm of the microscope tube.
• It carries the objectives and rotates with them.
• The objectives are arranged in sequential order of their magnifying power from lower to
higher. This helps to prevent the immersion oil from getting on to the intermediate
objectives.

5. Objectives (objective lenses)

a. Low-power objective: holds the low power lens used to view the object (10x).
b. High-power objective: holds the high power lens used to view the object in even greater
detail (40x).
c. Oil immersion objective: holds the oil immersion lens and is used in conjunction with
immersion oil to view objects with the highest magnification (100x).
• The image of the specimen first passes through the objective.
• The magnifying power is marked on the lens and is usually colour-coded for easy
identification.

6. Mechanical stage
• A movable stage that aids in the accurate and steady positioning of the slide.
• The mechanical stage allows the slide to be moved to the left, right, forward or backward
by rotating the knobs.
• It is fitted with fine vernier graduations as on a ruler. This helps in relocating a specific
field of examination.

7. Condenser
• Focuses the light onto the specimen and illuminates it.
• It controls the amount of light and contrast.

8. Diaphragm
• Controls the amount of illumination used to view the object.

9. Light source/ Illumination

• A mirror or a built-in light source is used for illumination in the microscope.
• It directs a beam of light up through the object.

10. Coarse-adjustment knob

• Knob used to bring the object into approximate focus.
• Used only with the low-power objectives.

11. Fine-adjustment knob

• Knob used to bring the object into final focus.
• The fine focusing knob changes the distance between the specimen slide and objective
very slowly and is used to view objects with high power objectives.

12. Base
• The flat surface of the microscope that rests on the table.

The magnification

The objective forms an enlarged image of the object. The eyepiece enlarges this image still more.
The total enlargement or magnification is the product of the magnifying powers of the objective
and the eyepiece.

For example, if the magnifying power of the eyepiece is 10x and that of the objective is 100x, the
total magnification is 10x100 = 1000.

Page 5 of 41
Practical exercise: Use of the light microscope

1. Ensure that the light intensity control is set to low, turn on the light and increase the
brightness to give a bright light output.

2. Raise the sub-stage condenser fully and adjust the iris of the diaphragm for minimum light.
(In most new models the condenser is fixed and the need to adjust it does not arise).

3. Rotate the nosepiece to get the low power objective (x10) into position i.e. above the
condenser.

4. Take the stage down using the coarse adjustment control and place the specimen slide on
the stage using the retaining mechanisms to hold it in place.

5. While looking carefully from a side, take the stage up close to the objective lens (do not
knock the lens on the slide; this cannot normally occur when a low power objective is
chosen).

6. Set the eyepieces to the correct width for your eyes so that you can look down through both
comfortably.

7. Focusing: look into the eyepieces (with both eyes open) slowly lower the stage to bring the
specimen into focus. Use the coarse adjustment control first and then the fine one. Slight
movements of the specimen while focusing by using the mechanical stage controls, may
aid you to find the object.

8. Proceed and examine the specimen under higher magnification. Depending on the
specimen and the magnification used, you will need to:
• Adjust the condenser if necessary
If adjustable it should be at a low position when low power objectives are used.
When changing to higher magnifications, slowly raise it up to get a sharp and crisp
image (this must be done only after a specimen has been focused on the stage).
• Set the Iris Diaphragm
When the iris-diaphragm is fully opened, the image is flooded with light and
definition is lost due to “white-out”. As the diaphragm is closed, controlling the
amount of light passing through the condenser, the image becomes clearer and
sharper as the contrast improves.

9. Using the oil immersion lens:

Once you have focused the specimen under low power, centre it in your field of view, place
a drop of oil (on the illuminated spot of the slide) and bring the oil immersion lens into
position. Once you have changed to the oil immersion lens, use only the fine focus knob
(fine focus adjustment) to focus.
When light passes through glass into air it bends from the original direction. Thereby, in
the microscope, the light rays bend as it is passing through the glass slide on the microscope
stage into the layer of air between it and the objective lens. This limits the amount of light
entering the objective and also affects its resolving power resulting in the production of a
poor image. The bending effect of light is avoided by the use of immersion oil which has
the same optical properties as glass. The commercially available immersion oil for
microscopes has the same refractive index as glass. Thus replacing the layer of air between
the lens and the slide with immersion oil gives a well defined image of the specimen.

10. Once you have finished examining:

Move the stage down and remove the slide. Change to a low power objective, reduce the
light intensity to minimum and switch off the lamp.

Page 6 of 41
02. PRACTICAL : MALARIA

PRECAUTIONS IN HANDLING A BLOOD SAMPLE

The principal blood borne diseases are:

• Hepatitis
• Acquired Immunodeficiency Syndrome (AIDS)
• Malaria

The collection and handling of blood samples present a potential risk of infection. This risk can be
reduced by taking the following precautions:

• Wear protective gloves when handling blood or taking blood samples.

• Avoid getting blood, including that from unstained slides, on your fingers or hands.
• Cover any cuts or abrasions on your hands with adhesive dressings.
• Take care not to prick yourself or others with any sharp instrument that has been in
contact with blood.
• Never use disposable lancets more than once.
• Always wash your hands with soap and water after completing any task that involves the
handling of blood.
• If blood does get on to your skin, wipe it off quickly with cotton wool dampened with
alcohol and wash the affected area with soap and water as soon as possible.
• Any materials contaminated with blood, such as lancets, cotton swabs and discarded slides,
should be boiled for 20 minutes, or placed in a solution of bleach or sodium hypochlorite
(available chlorine level 10 000 parts per million), then disposed of safely by burial or
incineration.

TYPE OF SAMPLE REQUIRED FOR MALARIA DIAGNOSIS

The blood for malaria parasite detection can be taken by finger prick method or by venipuncture.
If venous blood is collected by venipuncture the blood is transferred to EDTA (Ethylene Diamine
Tetra Acetate) tubes.

Collection of blood by finger-prick

Collection of blood by finger–
method
prick method

Collection of blood by
venepuncture

Page 7 of 41
METHOD OF CAPILLARY BLOOD COLLECTION FOR MICROSCOPY

Whenever possible the specimen should be collected before treatment. Malaria is excluded with
3 negative smears taken 12 hours apart. Further films are needed if clinical suspicion is high.

Labeling the slide

Label the slide with a wax pencil by writing at one end

of the slide. The label should contain the patient’
name/reference number and date

Disinfecting the finger & Stimulation of blood circulation

Clean and disinfect the finger with a cotton wool soaked

in 70% isopropyl alcohol.

Puncturing the finger

Puncture the ball of the finger with a sterile lancet.

Collection of blood for the thin smear

Apply gentle pressure on the finger and collect a single

small drop of blood, about this size •, on the middle of
the slide. This is for preparation of the thin smear.

Page 8 of 41
Collection of blood for the thick smear

Apply further pressure to express more blood and

collect two or three larger drops, about this size
•, on the slide about 1cm inner to label.

Thin smear preparation

Wipe the remaining blood away from the finger with a

piece of cotton wool.

Preparation of the thin smear: use a second clean slide as

a “spreader”. Touch the small drop (in the middle of the
slide) with the spreader and allow the blood to run along
its edge. Firmly push the spreader along the slide, keeping
the spreader at an angle of 45. Make sure that the spreader
is in even contact with the surface of the slide all the time
the blood is being spread.

Thick smear preparation

Preparation of a thick smear: Using the corner of the

spreader, quickly join the drops of blood and spread
them to make an even, thick smear. The circular thick
smear should be about 1 cm (1/3 inch) in diameter.
Allow the thick smear to dry.

The smears for staining and examination looks as given below:

Page 9 of 41
IMPORTANCE OF PREPARING THICK AND THIN SMEARS

• About 20 times more blood can be examined in a thick smear than in a thin smear in the
same period of time. A thick blood smear is therefore more suitable for the rapid detection
of malaria parasites. The detection of malaria parasites may not be successful by examining
only a thin smear if the parasitaemia is low. Therefore, examining a thick smear is of utmost
importance. In a stained thick smear, as the red cells are lysed, the intact stained parasites
are readily made out against a clear background. Thick smears are also used for the
estimation of parasite density.

• Thin smears are required to confirm the species and stage of the malaria parasite present.
As the thin film is fixed the red cells are intact and so are the parasites within them and as
such their morphology can be studied. Thin films are also suitable to calculate parasitaemia
as individual cells can be easily counted.

PRACTICAL EXERCISE: USE THE MICROSCOPE AND EXAMINE THE STAINED

BLOOD SMEAR PROVIDED

1. Switch on the light source.

2. Adjust the eyepieces by sliding them horizontally until they fit both eyes comfortably and
the two fields merge.
3. Place the dry stained slide on the stage. Make sure that the slide is not upside down. Secure
the slide to the slide holder of the mechanical stage.
4. Rotate the nose-piece to bring the 10x objective into position and raise the stage to its
maximum.
5. Move the slide with the adjustment knobs to bring the tail end of the blood smear into the
field of view.
6. Focus the “tail end” of the blood smear under the 10x objective using the coarse focusing
knob and lowering the stage. Obtain sufficient illumination by closing or opening the iris
diaphragm. For low power objectives light has to be reduced and for higher power
objectives it has to be increased.

Examine the tail end of the thin

blood smear where the red cells do
not overlap with each other.

‘Tail end’ of the thin smear

7. Shift the 10x objective away and add a drop of immersion oil on to the illuminated spot of
the smear and bring the 100x objective into position.
8. Open the iris diaphragm fully. Focus the cells using only the fine adjustment (fine focusing)
knob. (Do not use the coarse adjustment knob to focus. This is to prevent any possible
damage to the lens).
9. Identify the species and stage of any parasite on the smear.
10. After examination, lower the stage and swing the lowest power objective into position
before removing the slide (Never attempt to remove the slide when 40x or 100x objectives
are in position as this may scratch and damage the lenses).
11. Wipe off any oil from the lenses and the microscope stage using lens tissue that has been
provided.
12. Switch off the microscope.

Page 10 of 41
DEMONSTRATIONS

STAGES OF Plasmodium vivax

a) Ring stage – Blood smear x 1000

- Red cell enlarged

- Red cell surface may show very fine pink dots- stippling or
Schuffner’s dots
- With the standard stains (Giemsa’s or Leishmann’s) the
cytoplasm stains blue and the nucleus red
- Parasite shows a coarse (thick) cytoplasm with a single nucleus
(Lasts about 10-12 hours in the blood)

b) Amoeboid stage – Blood smear x 1000

- Red cell enlarged

- Stippling marked
- Amoeboid trophozoite with irregular cytoplasm with scattered
yellow brown malarial pigment and a single nucleus
(Lasts about 24 hours)

c) Mature schizont – Blood smear x 1000

- Red cell enlarged

- Stippling marked
- Pink nuclei 14-24
- Malarial pigment clumped in center

d) Female gametocyte – Blood smear x 1000

- Enlarged red cell

- Schuffner’s dots
- Parasite occupies almost entire cell
- Compact nucleus usually eccentric
- Evenly scattered malarial pigment

e) Male gametocyte – Blood smear x 1000

- First three points as above

- Diffuse nucleus usually central
- Evenly scattered malarial pigment

Page 11 of 41
STAGES OF Plasmodium falciparum

a) Ring stage – Blood smear x 1000

- Red cell not enlarged

- Clefts may be seen in the red cell: Maurer’s clefts
- Small delicate thin hair like ring of cytoplasm stains blue with standard stains (Giemsa’s
or leishmann’s) single nucleus stains red in color
- Multiple parasites may be seen inside a single red cell – Polyparasitism
- May have two nuclei in a ring - Double nuclear phenomenon
- "Accole" forms may be found closely applied to the edge of the red cell
(Ring stage lasts about 24 hours in the blood)
The late trophozoites and schizonts of P. falciparum are not usually seen in peripheral blood.

b) Female gametocyte - Blood smear x 1000

- Crescent shaped, longer and more pointed than the male gametocyte
- Compact pink nucleus in center
- Surrounded by a halo of jet black malarial pigment

c) Male gametocyte - Blood smear x 1000

- Sausage shaped
- Rounded ends
- Diffused nucleus
- Scattered pigment

Page 12 of 41
THE FOLLOWING ARE THE STAGES OF THE PARASITE THAT MAY BE SEEN
WHEN EXAMINING UNDER OIL IMMERSION (X100) OBJECTIVE.

Stages of Plasmodium vivax

Page 13 of 41
Stages of Plasmodium falciparum

Page 14 of 41
03. PRACTICAL : FILARIASIS, LEISHMANIASIS, TOXOPLASMOSIS
& TRYPANOSOMIASIS
FILARIASIS

Wuchereria bancrofti – microfilaria x 1000

- Smooth graceful curves

- Cephalic space square
- Body nuclei regularly arranged, discrete,
countable, similar in size and shape
- Tail devoid of nuclei
- Sheath visible

Dirofilaria repens adult – filarial worm of dog which can cause a zoonotic infection
in humans.

TOXOPLASMOSIS

Toxoplasma gondii

a) Pseudocysts with tachyzoites x 1000

- Nuclei of macrophages stain purple

- Free cresentic shaped tachyzoites with
one end rounded and other end
pointed

b) True cyst in brain tissue x 1000

- Thick walled cyst

- Elongated bradyzoites with a single
terminal nucleus enclosed within

Page 15 of 41
TRYPANOSOMIASIS

Trypanosoma species – Trypomastigote form in blood smear x 1000

Trypanosoma gambiense and T.rhodesiense cause African trypanosomiasis or sleeping
sickness, while T.cruzi is the causative agent of Chagas disease.

- Found extra-cellularly
- Spindle shaped
- Blunt posterior end and narrow anterior end
- Nucleus oval large centrally placed
- Flagellum arises from the posterior end

LEISHMANIASIS

Leishmania species - The causative agent of Visceral leishmaniasis and Cutaneous

leishmaniasis belong to the genus Leishmania. The Leishmania parasite exists in two
morphological forms an amastigote and a promastigote. The amastigote is the only form of
parasite found in man while the promastigote is found in the sand fly gut and when
Leishmania are cultured.

Amastigote form x 1000

- Round to oval body
- Nucleus and rod shaped kinetoplast together gives it a
“dot and dash” appearance
- Found within the phagocytic vacuoles of the macrophages

Page 16 of 41
04. PRACTICAL : INTESTINAL AND UROGENITAL PROTOZOA
COLLECTION OF FAECAL SAMPLES

Collection of appropriate faecal samples must take into account the various parasitic forms
that can occur within the human gastrointestinal tract, particular attention being paid to the most
convenient stage that will confirm the presence of parasites and identify species.
The irregular release of helminth ova and protozoan cysts (especially in chronic infections)
makes it necessary to examine three samples routinely from each patient, on alternate days. On
occasion up to six samples may be necessary in a clinically suspect case. Confirmation of
successful treatment can be made by further examination of a single sample after completion of
treatment.

METHOD OF COLLECTION
• Collect approximately 10g of fresh faeces uncontaminated by urine or water, using a
wooden spatula, into a clean, leak-proof, wide-mouthed container with a screw cap
e.g. yogurt cup.
• The container should be free from antiseptics and disinfectants.
• Label the samples clearly with the patient’s name, reference number, date and time of
collection. All samples should be accompanied by a request form, from the physician
giving the relevant clinical details and recent travel history.
• Samples and forms from patients with confirmed or suspected diagnosis of certain
infectious diseases such as AIDS or hepatitis should be clearly labeled with a ‘risk of
infection’ “Biohazard” vinyl tape.
• Most viable parasites are susceptible to desiccation or temperature variation. If the time
lapse between collection and observation is considerable, depending on the parasite, it
may be necessary to add some form of preservative to the faeces to retain the
morphology as near to the original as possible. Formed samples can be kept in a
refrigerator at + 4 C for a short while, but not in an incubator. Whole worms or
segments passed should be placed in a separate container.

DELIVERY AND TRANSPORTATION

• Formed faecal samples without evidence of blood or mucus should be examined during
the day of passage. It is possible to store these samples for up to 4 hours at +4 C.
• Soft, unformed or liquid faecal samples and those containing blood or mucus may
contain vegetative, trophozoite forms of protozoa. These samples should be delivered
to the laboratory with the minimum of delay, preferably within 30 minutes to 1 hour
of collection. (Amoebic trophozoites may still be active in unformed faeces up to
several hours after passage but the time depends on the external temperature and is
unpredictable).

MACROSCOPIC EXAMINATION OF STOOLS

a) Consistency
Faecal consistency varies with diet but certain clinical conditions associated with parasite
presence may be suggested by particular consistencies. The presence of protozoal trophozoites in
the stools will depend on the consistency and the frequency of passage of faeces. Trophozoites are
more likely to be found in (ii) or (iii) and cysts in (i).

Stools should be recorded as:

(i) Formed : Normal shape and consistency. Formed stools from which the water content
has been reabsorbed will contain few trophozoites and principally the cyst
stage of protozoa.
(ii) Semi-formed or unformed : Soft faeces with no regular shape.
(iii) Liquid : Note colour and any flakes of mucus or blood present.

Page 17 of 41
b) Composition

The stool may contain blood and mucus as evidence of ulceration or colitis due to invasive
amoebae, bacillary dysentery or inflammatory bowel conditions. It may also indicate occult blood
from gastric ulcers or conditions such as giardiasis. It may also have pus, froth, undigested food,
vegetable fibres, fat etc.

Faeces may contain adult helminthes such as Ascaris lumbricoides, Enterobius vermicularis or
segments of Taenia sp. Gravid Taenia segments are frequently motile for several days and may
migrate to the top of the container.

c) Colour
Pale yellowish stool are passed in steatorrhoeac conditions such as giardiasis or tropical sprue.
Dark or black stools occur when iron or bismuth is taken or when there is intestinal haemorrhage.

d) Smell

e) Amount

MICROSCOPIC EXAMINATION OF STOOLS

DIRECT MICROSCOPY OF STOOLS

Direct microscopy is used to observe cellular exudate and motile protozoan trophozoites, as they
are killed or distorted during concentration techniques. The presence of other parasitic stages,
undigested food, bacteria, yeasts, crystals or fat globules are also noted. All fresh stools (less than
4 hours old) which are semi formed, unformed, liquid or show the presence of blood and / or mucus
should be examined by direct microscopy. Routine direct microscopy on formed stools is
unnecessary unless there is external blood or mucus. Any blood or mucus present should be
examined separately as it is more likely to contain trophozoites. Trophozoites die rapidly, so
unformed stools should be looked at as soon as possible after voiding, preferably within 30 minutes
of being passed.

Preparation of saline and iodine wet mounts for direct microscopy of stools

Materials and reagents

1. Wooden applicator sticks or matches

2. Microscope slides (75x25 mm)

3. Cover slips

4. Pens or markers for indelible labeling

5. Dropping bottles containing:

isotonic saline solution (0.85%; 8.5 g/l)
Lugol’s iodine (1% solution)

Procedure

1. With a wax pencil or marker, write the patient’s name or identification number and the date
at the left-hand end of the slide.

2. Place a drop of saline in the center of the left half of the slide and place a drop of iodine
solution in the center of the right half of the slide (Note: iodine wet mount preparations are
most useful for protozoa, less so for helminths).

Page 18 of 41
3. With an applicator stick or match, pick up a small portion of faeces (approximately 2 mg which
is about the size of a match head) and add it to the drop of saline: add a similar portion to the
drop of iodine. Mix the faeces in each drop until a suspension is formed.

4. Cover each drop with a cover slip by holding the cover slip at an angle, touching the edge of
the drop, and gently lowering the cover slip onto the slide so that air bubbles are not produced
(Note: ideal preparations containing 2 mg of faeces are uniform – not so thick that faecal debris
can obscure organisms, nor so thin that blank spaces are present)

5. Examine the preparations with the 10x objective or, if needed for identification, the high power
objective of the microscope (40x), in a systematic manner (either up and down or laterally) so
that the entire cover slip area is observed. When organisms or suspicious objects are seen,
switch to higher magnification for more detailed morphology of the object in question.

DISPOSAL

1. Discard slides, coverslips and ekel applicators into 1% aqueous lysol in a wide mouthed
container. Slides and coverslips are cleaned and reused as given in the following step while the
applicators are thrown away. Since coverslips are fragile these are collected and cleaned
separately.
2. Keep overnight.
3. Wash in running tap-water for 1 hour.
4. Boil in soap water (65g of soap in a gallon of water) and let cool to room temperature.
5. Wash in running tap-water for 1 hour.
6. Wipe dry with clean cloth and use.

Page 19 of 41
DEMONSTRATIONS

1: ENTAMOEBA HISTOLYTICA X 1000

a) Trophozoite in iron haematoxylin stain x 1000

- Outer ectoplasm wide and clear, inner endoplasm is finely granular and “ground glass”
like in appearance.
- Pseudopodia visible
- Ingested red blood cells present
- Nucleus with uniform peripheral chromatin and centrally located karyosome

b) Trophozoite in a tissue section x 1000

- Trophozoites with ingested RBC
- Nuclei of intestinal epithelial cells

c) Cyst in Trichrome stain x 1000

- Sausage shaped chromatoidal bodies stain red
- Cytoplasm stains bluish green to purple.
- Nuclei < 4
- Glycogen vacuoles

d) Cyst in Iron Haematoxylin stain x 1000

Page 20 of 41
2. ENTAMOEBA COLI X 1000

a) Trophozoite in iron haematoxylin stain x 1000

- Ectoplasm is granular and less well differentiated from endoplasm
- Endoplasm is more granular and more vacuolated
- May contain bacteria, yeast (rarely red blood cells)
- Pseudopodia have more sluggish movements
- Nucleus has heavier peripheral chromatin and a larger eccentric karyosome

b) Cyst in lodine x 400

- Generally larger than E.histolytica
- Chromatoidal bodies if present are splinter like with pointed ends
- Glycogen vacuole in immature cyst may be more heavily stained brown
- Contains 1-8 nuclei

c) Cyst in Saline x 400

d) Cyst in Iron Haematoxylin stain x 1000

Page 21 of 41
3. BLASTOCYSTIS HOMINIS - Iron Haemotoxylin x 1000

- Central vacuole
- Nuclei darkly stained
- Cytoplasm visible
- Outer cell membrane

4. BALANTIDIUM COLI

a) Trophozoite x 1000 b) Cyst x 1000

- Cilia visible - Round in shape
- Kidney shaped macronucleus - Large macronucleus
- Rounded micronucleus - Smaller micronucleus
- Cilia may be faintly visible

5. TRICHOMONAS VAGINALIS

Trophozoite x 1000
- Oval in shape
- 3-5 anterior flagellae
- Undulating membrane extends more than half of the body length
- An axostyle
- Nucleus in anterior part of body

No cyst stage

Page 22 of 41
6. GIARDIA INTESTINALIS

a) Trophozoite x 1000
- Pear shaped
- Bilaterally symmetrical
- Ventral surface has a sucking disc
- 4 pairs of flagella present
- Nuclei visible

b) Cyst in wet mount x 1000

- Cyst wall present
- 2-4 nuclei
- Contains the remains of axonemes and parabasal bodies

7. Cryptosporidium oocyst - Ziehl-Neelsen stain x 1000

- Small, round in shape about 4 in diameter.

- A mature oocyst contains 4 sporozoites.

Page 23 of 41
05. PRACTICAL - INTESTINAL NEMATODES

CLASSIFICATION

Helminths

Nematodes Cestodes Trematodes

Taenia solium Fasciola hepatica

T.saginata Clonorchis sinensis
Echinococcus granulosus Fasiolopsis buski
Hymenolepis diminuta Paragonimus westermani
Hymenolepis nana Schistosoma sp.

Small Intestinal Large Intestinal

Nematodes Nematodes
Ascaris lumbricoides Enterobius vermicularis
Necator americanus Trichuris trichiura
Strongyloides stercoralis
Trichinella spiralis

NEMATODES

1. ASCARIS LUMBRICOIDES (ROUND WORM)

a) Adult male and female worm (gross)

- Posterior end curved in males 10-30 cm in length
- Females are 20-40 cm in length

b) Fertilized egg x 400

- Round or oval in shape
- Outer albuminoid layer is coarsely mammillated
- Thick transparent glycogen middle layer (hyaline shell)
- Unsegmented ovum

Page 24 of 41
c) Unfertilized egg x 400
- Longer and narrower than the fertilized egg (barrel shaped)
- Thinner mammillated outer coat
- Thinner shell
- Amorphous mass of disorganized granules inside
- No clear demarcation of layers

Unfertilized egg

Fertilized egg

2. NECATOR AMERICANUS (HOOKWORM)

a) Adult male or female (universal low power)

- Head curvature opposite to body curvature
- Small cylindrical worm
- Tapering anteriorly
- Approximately 1cm long

b) Hookworm egg x 400

- Broadly oval with bluntly rounded ends
- Colourless
- Thin walled
- Segmented ovum

Page 25 of 41
3. TRICHURIS TRICHIURA (WHIP WORM)

a) Adult male and female worms (gross specimen)

- Posterior end bluntly rounded in the female and curved in the male

b) Whipworm egg x 400

- Like a paddy seed
- Outer coat is bile stained and appears brown in colour
- At either end there are transparent polar prominences (mucoid plug)

4. ENTEROBIUS VERMICULARIS (PINWORM)

a) Adult male and female (gross specimen)

- Spindle shaped

b) Pinworm egg x 400

- Plano-convex
- Thick double wall colourless
- Rhabditiform larva present inside

Page 26 of 41
CESTODES

Adult worm: genital pore

situated laterally, no uterine pore
Taenid egg: Spherical, very thin,
TAENIA hyaline outer membrane,
SOLIUM
embroyphore with six hooklets
insite

Scolex: globular, 4 cup shaped

suckers, projection like a beak
(rostellum), 2 rows of hooks at
the base of the rostellum.

Cysticercus cellulosae: thin

walled cyst, invaginated scolex
with suckers and chitinized
hooks

Gravid proglottid: central

uterus, <12 lateral branches

Mature segments: square

shaped, lateral pore.

Page 27 of 41
 Adult worm: genital
pore situated laterally,
no uterine pore
TAENIA Taenid egg: Spherical,
SAGINATA
very thin, hyaline outer
membrane,
embroyphore with six
hooklets inside

Scolex: quadrate, 4
suckers, no rostellum,
no hooks

Cysticercus bovis: cyst

like structure,
protoscolices visible.
thin walled cyst,
invaginated scolex with
suckers and chitinized
hooks

Gravid proglottid:
contains uterus with
eggs, >12 lateral
branches, lateral
genital pore

Mature segments:
square shaped, lateral
pore, Similar to
T.solium mature
proglottids.

Page 28 of 41
HYMENOLEPIS Egg: spherical,
DIMINUTA onchosphere with 6
Rat Tape Worm hooklets

Scolex: club shaped,

retractable, rostellum, 4
small suckers, no hooks

Cysticercoid larvae:
tailed larvae

Mature proglottid:
Rhomboid shaped 3
round testes, bi-lobed
ovary and lateral genital
pore

Gravid segment:
contains uterus with
eggs, 4mm in length,
broad

HYMENOLEPIS NANA Egg: oval shaped, hyaline

Dwarf Tape Worm outer shell, inner
membrane, polar
filaments, hexacanth
embryo

Scolex: globular,
retractable rostellum with
single row of small hooks,
4 suckers

Mature Proglottid: broad,

bilobed ovary, 3 round
testicles in each segment,
lateral genital pore

Gravid proglottid: long,

0.6 mm in length, filled
with eggs
Page 29 of 41
 ECHINOCOCCUS Adult worm: scolex
GRANULOSUS has a rostellum
Dog Tape Worm armed with hooks
arranged in two
rows, 1-2 immature
segments, a single
gravid segment half
the body length
containing a
branched uterus
Hydatid cyst in
section: with 3
coverings (pericyst,
ectocyst, endocyst),
a brood capsule and
protoscolices

Protoscolices: cyst
with invaginated
scolex, scolex with
double crown of
hooklets and four
suckers

TREMATODES

FASCIOLA HEPATICA
Leaf like caecae heavily
branched
Testis in tandem position
Ovary to the right of the midline
Coiled uterus

FASCIOLOPSIS BUSKI
Intestinal caeca not branched
with two characteristic lateral
indentations
Testis in tandem position, ovary
at the centre to the right of the
midline

CLONORCHIS SINENSIS
Narrow anterior end, round
posterior end
Unbranched caeca
Testis in tandem position, ovary
anterior to the testis in midline

Page 30 of 41
06. PRACTICAL – ARTHROPODS
CLASSIFICATION

Phylum Arthropods

Class Insecta Arachnida

Order Anoplura Diptera Siphonaptera Hemiptera Acarina

(lice) (flies) (fleas) (bugs) (ticks and mites)

1. LICE

a) Pediculus humanus capitis (head louse)

b) Pediculus humanus corporis (body louse)

Adult x 100
- Flattened dorsoventrally
- Tip of abdomen bifurcated – “w” shaped in females
- Tip of abdomen not bifurcated in the male
- Abdomen has 7 segments

Egg (Nit) x 100

- Operculated
- Cemented to fibers of clothing (or hairs)
- Whitish in colour

Medical importance
1) Are vectors of
- Louse borne epidemic typhus due to Rickettsia prowazeki
- Trench fever due to Bartonella quintana
- Louse borne relapsing fever due to Borrelia recurrentis
2) Causes pruritus

c) Phthirus pubis (crab louse/ public louse)

Adult x 100
- Smaller than the body louse
- Less differentiation between the thorax and abdomen
- 3 pairs of legs
- 1st pair of legs more slender with smaller claws
- In the female the tip of the abdomen is bifurcated – “w” shaped

Page 31 of 41
2. FLIES

a) Musca domestica (house fly)

Adult

- 6-9 mm in length
- Four broad dark longitudinal stripes on thorax on dorsal aspect
- Wings- 4th vein bends sharply to join the costa near the 3rd vein.
Egg
- Creamy white
- 1mm in length
- Banana shaped
- Two rib like thickenings along its dorsal surface
Larva

- 12 segments
- Tapers gradually towards the anterior end
- First segment has a pair of mouth hooks

Medical importance
- House fly adult acts as a mechanical vector and transmits disease
- House fly larvae have occasionally caused urogenital and traumatic myiasis

b) Glossina (tsetse fly)

Wing- There is a closed cell “hatchet cell” between the 4th and 5th veins
Medical importance
- Transmits African Trypanosomiasis (sleeping sickness)

c) Phlebotomus (sand fly)

- Hairy
- Three very long pairs of legs
- Head bent acutely down
- Large black eyes
- wings kept erect “V”- shaped when at rest
- 2nd vein divided
- Found in Sri Lanka
Medical importance: Transmits
- Leishmaniasis
- Sand fly fever (viral)
- Oroya fever (Bartonella species)

Page 32 of 41
3. BUGS

a) Cimex lectularius (bed bug)

- Pyramidal shaped flattened head
- Head has prominent compound eyes
- Oval dorsoventrally flattened body
- Tip of abdomen bifurcated in female – “w” shaped
- Tip of abdomen not bifurcated in males – “v” shaped
- Each of the 3 thoracic segments bear a pair of legs that terminate as claws

b) Reduviid bug
- Long narrow head
- Prominent compound eyes
- Long antenna
- 3 segmented proboscis
- Dark brown in colour
Medical importance
- Transmits Chagas disease (American trypanosomiasis)

4. FLEAS

Medical importance
Acts as a vector of disease
- Bubonic plague - caused by the bacillus Yersinia pestis
- Endemic typhus - caused by Rickettsia typhi
- Cestode infections - H.diminuta, Dipylidium caninum

Page 33 of 41
5. TICKS

Hard ticks & Soft ticks

Medical importance
1) Acts as a vector for diseases
a) Rickettsial diseases
- Rocky mountain spotted fever by R.rickettsiae
- Tick borne typhus
- Q fever- Coxiella burnetti
b) Viral diseases
- Colorado tick fever
- Kyasanur forest disease
c) Bacterial and spirochaete disease
- Tick borne relapsing fever
- Lyme disease - Borrelia burgdorferi
- Tularemia - Francisella tularensis
d) Protozoal disease- Babesiosis

6. MITES

a) Sarcoptes scabiei
Adult x 100
- Whitish, disc shaped and dorso-ventrally flattened
- 4 pairs of short stumpy legs

Medical importance
e) Lesions appear as itchy papules at sites of each mite and later develop into pustules due
to secondary infections.
f) Secondary infection of lesions by B.haemolytic Streptococci can result in
glomerulonephritis.

b) Trombiculid mite
Larva x 100
- Reddish orange
- 3 pairs of legs
- On dorsal surface a rectangular plate / scutum bearing feathered septae together
with 2 flagelliform sensillae
Medical importance
- Vector for Rickettsia tsutsugamushi which causes scrub typhus(only larval stage is
responsible for disease transmission)

Page 34 of 41
MOSQUITOES
1. Anopheles culicifacies (transmits malaria)
Adult x 40
- Anterior border of wing has 4 sharply defined pale areas and a 5th at the wing tip

2. Culex spp.
Adult x 40
Culex quinquefasciatus (transmits bancroftian filariasis)
Culex gelidus (transmits Japanese Encephalitis)

- Absence of any positive markings characteristic of Culex species

3. Mansonia species (vector of Brugia malayi in South and South East Asia,
transmits Dirofilaria repens to humans)
Adult x 40

- Wings covered with flat, broad, light and dark scales giving the wings a
speckled (salt and pepper) appearance

Page 35 of 41
4. Aedes species (transmits yellow fever, dengue , Chickunguniya, ZIKA)
Adult
- Black in colour
- Silvery scales on body
- Legs show a banded appearance

Aedes aegypti- thorax shows a silvery

lyre shaped marking on the dorsal
surface.

Aedes albopictus – shows a “ | ”

shaped mark on thorax.

Culicine species adult mosquitoes

lie horizontal to the surface

Anopheles adult mosquito lies at a

45 degree angle

Page 36 of 41
07. PRACTICAL : SNAKES

1. ELAPIDS

Ceylon cobra Special Features

Naja naja naja

Largest elapid up to 6 feet

Light and dark brown or blackish in colour with a

white speckled appearance along the length of the
body.

The vertebrals are not enlarged.

Sub-caudals are divided (biserial).

Only hooded snake found in Sri Lanka (hood found

between head and body).

Characteristic spectacle shaped marking on dorsal

surface just below head.

Page 37 of 41
Ceylon krait Special Features
Bungarus ceylonicus
Brownish black or black with broad white bands
on the dorsum which are continued on the belly
(on the ventral aspect)

Oval head

Vertebrals enlarged

Subcaudals undivided

Common krait (Bun garus caeruleus) Special Features

Black glossy snake oily appearance
Vertebrals enlarged
Sub-caudals undivided
Thin white bands in pairs on the dorsum only. No
bands on the belly. Belly is whitish.

Page 38 of 41
 2. VIPERS

Russell’s viper (Vipera russelli) Special features

3 longitudinal rows of characteristic oval/round
markings along the length of the body. One row
runs along the median dorsal line and other two on
either side. Each spot is dark brown with an inner
black and outer white margin.

Saw scaled viper (Echis carinatus)

Characteristic dagger shape or “Bird’s foot”
marking on the head
Serrated costal scales on both sides of the body
Dorsally the colour is brown with dark blotches
and a wavy line on the side of the body.

Hump nosed viper (Hypnale spp)

Large head scales which is an exception from the
other vipers.
The snout ends in a hump like prominence.
Typical brown mottled appearance with a series of
brown oval spots on either side of the spine.

Green pit viper (Trimeresurus

trigonocephalus) A black stripe runs from the eye to the angle of
jaw on each side.

*Pit vipers
The hump nosed viper and Green pit viper are referred to as the pit vipers due to the presence of
the Loreal pit on the head between the nostrils and the eye on either side. These are sensitive
thermal receptors which help to locate warm blooded prey.

Page 39 of 41
 3. COLUBRIDES

Cat snake Special features

Boiga spp
Conspicuous neck which makes the head
look triangular.
Brown mottled appearance with a series of
brown oval spots on either side of spine,
similar to the body markings of the Hump
nosed viper.
A long thin tail.

No hump on the head

The Ceylon Wolf snake (Cercaspis carinatus)

Looks morphologically similar to the Sri
Lankan Krait.

Subcaudals undivided

Vertebrals are not enlarged.

Rat snake (Ptyas mucosa)

Large snake.
Grows up to 6 feet.
Belly is whitish yellow
Subcaudals biserial

Page 40 of 41
 4. OTHER IMPORTANT SNAKES

Python (Python molurus)

Quadrangular patches on body
Non venomous
Can kill the victim by constriction.

Earth snake
Earth worm like.
Non venomous

Sea snake (Hydrophis ornatus ornatus)

Its head is small with a slender
neck.
The body is flattened from side to
side
Have a paddle like (laterally
compressed) tail with a rounded
end

Fresh water snakes (Cerberus rhynchops rhynchops)

Body and tail are cylindrical

Page 41 of 41