1. Medical Parasitology Lab.
Revision

2. Endoparasitic Helminthes
Parasites
Endoparasitic Helminthes
Platy helminthes
(Flat worm)
Trematoda
(Flukes)
Cestoda
(Tape worm)
Nematode
(Round worm)
Protozoa
R. Z. Ahmed, Medical Parasitology Lab., 2011

3. R. Z. Ahmed, Medical Parasitology Lab., 2011
Protozoa
Classification of protozoa according to final habitat in man:
Intestinal and urogenital parasites:
E.g.: Entamoeba histolytica, Giardia lambilia, Trichomonas vaginalis, Balantidium coli.
Blood and Tissue parasites:
E.g.: Toxoplasma gondii, Tryponasma spp., leishmania spp., Plasmodium spp..
R. Z. Ahmed, Medical Parasitology Lab., 2011

4. R. Z. Ahmed, Medical Parasitology Lab., 2011
Nematode
Classification of nematode according to the final habitat in the man:
Intestinal nematode:
E.g.: Ascaris lumbricoides, Enterobius vermicularis, Anclystoma duodenalae, Trichuris trichiura, and Strongyloides stercoralis.
Tissue nematode:
E.g.: Wucheraria bancrofti, Trichinella spiralis, and Loa loa.
R. Z. Ahmed, Medical Parasitology Lab., 2011

5. R. Z. Ahmed, Medical Parasitology Lab., 2011
Trematoda
Also name as Flukes.
Classification of Trematoda according to the final habitat in man:
Liver flukes ( liver or bile ducts ):
E.g.: Fasciola spp.
Intestinal flukes :
E.g.: Hetrophyes hetrophes.
Blood flukes:
E.g.: Schistosoma spp.
R. Z. Ahmed, Medical Parasitology Lab., 2011

6. R. Z. Ahmed, Medical Parasitology Lab., 2011
Intestinal Protozoa
Entamoeba histolytica/ dispar
E. histolytica inhabit large intestine and cause amoebic dysentery.
There is two diagnostic stages for E. histolytica/ dispar:
Cyst ( infective stage ).
Trophozoite ( motile form, motility by pseudopodia ).
Diagnosis:
Stool examination to see cyst stage, or trophozoite stage if the sample is fresh.
R. Z. Ahmed, Medical Parasitology Lab., 2011

7. R. Z. Ahmed, Medical Parasitology Lab., 2011
E. histolytica/dispar
Cyst
Iodine Wet mount
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8. R. Z. Ahmed, Medical Parasitology Lab., 2011
E. histolytica/dispar
Trophozoite
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9. R. Z. Ahmed, Medical Parasitology Lab., 2011
Intestinal Protozoa
Giardia Lamblia
It is the most common flagellate of the intestinal tract that cause giardiasis .
There is two diagnostic stages for Giardia lamblia :
Cyst ( infective stage ).
Trophozoite ( motile form, motility by flagella ).
Diagnosis:
Stool examination to see cyst stage, or trophozoite stage if the sample is fresh.
R. Z. Ahmed, Medical Parasitology Lab., 2011

10. R. Z. Ahmed, Medical Parasitology Lab., 2011
G. lamblia Cyst
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11. R. Z. Ahmed, Medical Parasitology Lab., 2011
G. lamblia Trophozoite
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12. R. Z. Ahmed, Medical Parasitology Lab., 2011
Urogenital Protozoa
Trichomonas vaginalis
Its pathogenic, inhabit the urogenital system.
There is no cyst stage but only have trophozoite stage:
Trophozoite is the infective and diagnostic stage and motile by flagella.
Diagnosis:
- Female: finding trophozoite in vaginal discharge.
- Male: finding organism in urethral prostatic discharge.
R. Z. Ahmed, Medical Parasitology Lab., 2011

13. T. Vaginalis trophozoite
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14. R. Z. Ahmed, Medical Parasitology Lab., 2011
Intestinal Protozoa
Cryptosporidium parvum
Infect human and most mammals.
There is one diagnostic stage for Cryptosporidium parvum:
Oocyst have 4 sporozoites.
Infective stage: Oocyst containing sporozoites.
Diagnosis:
Detecting oocyst in stool.
Staining with Acid – fast stain.
R. Z. Ahmed, Medical Parasitology Lab., 2011

15. R. Z. Ahmed, Medical Parasitology Lab., 2011
C. parvum oocyst
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16. R. Z. Ahmed, Medical Parasitology Lab., 2011
Tissue Protozoa
Toxoplasma gnodii
Habitat: reticulo-endothelial system, monocyte, and muscle fiber and cause toxoplasmosis.
There are two diagnostic stages for Toxoplasma gondii:
Cyst
Oocyst have 4 tachyzoites .
Infective stage: Oocyst.
Intermediate host: Human.
Definitive host: Cat.
R. Z. Ahmed, Medical Parasitology Lab., 2011

17. R. Z. Ahmed, Medical Parasitology Lab., 2011
T. gondii tachyzoites
R. Z. Ahmed, Medical Parasitology Lab., 2011

18. Plasmodium falciparum
Blood Parasites
Blood Parasite
Plasmodium
Plasmodium falciparum
Plasmodium vivax
ovale
Plasmodium malariae
Microfilariae
Trypanosoma
Leishmania
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19. R. Z. Ahmed, Medical Parasitology Lab., 2011
Blood Protozoa
Trypanosoma spp.
T. cruci (Americans) cause Chaga’s disease.
T. bruci (Africans) cause sleeping sickness disease.
have many stages:
Amastigote, Promastigote, Trypomastigote, and Epimastigote.
Intermediate host: Tse tse fly.
Definitive host: Human.
Infective stage: Metacyclic trypomastigote.
Diagnostic stage: Trypomastigote.
Diagnosis:
Blood smear within 21 days from the bite, it will show the parasites.
R. Z. Ahmed, Medical Parasitology Lab., 2011

20. R. Z. Ahmed, Medical Parasitology Lab., 2011
Trypanosoma
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21. R. Z. Ahmed, Medical Parasitology Lab., 2011
Blood protozoa
Leishmania spp.
There is many species affect man:
L. tropica : cause skin lesion ( cutaneous )
L. braziliense : cause muco-cutaneous lesion.
L. donovani : cause visceral lesion.
Have two stages:
Amastigote ( Leishmania stage ), in man (reticuloendothelial cell).
Promastigote ( Leptomonas stage ), the infective stage and present in the lumen gut of the sand fly.
Intermediate host: Sand fly.
Definitive host: Human.
Diagnosis:
- Thick and thin blood film.
- Skin scraping.
R. Z. Ahmed, Medical Parasitology Lab., 2011

22. Leishmania promastigote
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23. R. Z. Ahmed, Medical Parasitology Lab., 2011
Blood Protozoa
Plasmodium spp.
Four species of Plasmodium are the causative agent of malaria, these are:
P. vivax, P. malariae, P. falciparum, and P. ovale.
Intermediate host: Human.
Definitive host: Anopheles mosquitoes.
Plasmodium spp. have 4 stages:
Ring form (young trophozoite.), Late ( old ) trophozoite, Schizonts, and Gametocyte.
Infective stage: Sporozoites.
Diagnosis:
Thick and stained thin blood film to detect parasites.
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27. R. Z. Ahmed, Medical Parasitology Lab., 2011

28. Ring form
P. ovale
P. vivax
P. malariae
P. falciparum

29. Trophozoite form
P. ovale
P. vivax
P. malariae
P. falciparum

30. Schizonts form
P. ovale
P. vivax
P. malariae
P. falciparum

31. Gametocyte form
P. ovale
P. vivax
P. malariae
P. falciparum

32. R. Z. Ahmed, Medical Parasitology Lab., 2011
Comparison
Thick smear
Thin smear
Lysed RBCs, many layer
Fixed RBCs, single layer
0.25 μl blood/100 fields ( large volume )
0.005 μl blood/100 fields ( small volume )
Good screening test
( positive or negative )
Good species differentiation
Save time
Requires more time to read
Low density infection can be detected as blood elements more concentrate ( more sensitive )
Low density infections can be missed
More difficult to diagnose species
R. Z. Ahmed, Medical Parasitology Lab., 2011

33. Species differentiation on thin films
Species differentiation on thin films
Feature
P. falciparum
P. vivax
P. ovale
P. malariae
Enlarged infected RBC +
Infected RBC shape
round
round, distorted
oval, fimbriated
Stippling infected RBC
Mauer clefts
Schuffner's spots
Schuffner's dots
none
Trophozoite shape
small ring, applique
large ring, amoeboid
large ring, compact
small ring, compact
Chromatin dot
often double
single
large
Mature schizont
rare, merozoites
12-24 merozoites
4-12 merozoites
( scattered )
6-12 merozoites
( rosette )
Gametocyte
crescent shape
large, round
compact, round

34. R. Z. Ahmed, Medical Parasitology Lab., 2011
Nematode
Ascaris lumbricoides
Ascaris lumbricoides is the giant roundworm of human, inhabit small intestine and cause Ascariasis .
There are three diagnostic stages for Ascaris lumbricoides :
Eggs (embryonated, fertilized, and unfertilized).
Larvae.
Adult:
Male: have 2 minute spicules and copulatory bursa.
Female: pointed tail and have no spicules.
Infective stage: Embryonated eggs.
Diagnosis: Stool analysis to detect egg or larvae.
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35. R. Z. Ahmed, Medical Parasitology Lab., 2011
Adult Stage
50 cm
30 cm
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Ova or eggs
There are 3 shapes of ova:
Embryonated egg:
Corticated.
Decorticated.
Fertilized egg:
Unfertilized egg:
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37. R. Z. Ahmed, Medical Parasitology Lab., 2011
Embryonated egg
Corticated
Decorticated
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38. R. Z. Ahmed, Medical Parasitology Lab., 2011
Fertilized eggs
Corticated
Decorticated
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39. R. Z. Ahmed, Medical Parasitology Lab., 2011
Unfertilized eggs
Corticated
Decorticated
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40. R. Z. Ahmed, Medical Parasitology Lab., 2011
Larvae stage
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41. R. Z. Ahmed, Medical Parasitology Lab., 2011
Nematode
Enterobius vermicularis
Other names: human pin worm and seat worm.
Young and mature worms are present in small intestine (at terminal ileum till fertilization).
Gravid females are present at lower rectum where they lay ova at perianal region around anus.
Infective stage: Eggs.
Diagnosis:
- Egg in stool is rarely detected but adults present after purgative.
- Egg can be detected at perianal area by using scotch tape test.
R. Z. Ahmed, Medical Parasitology Lab., 2011

42. R. Z. Ahmed, Medical Parasitology Lab., 2011
E. vermicularis adult
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43. R. Z. Ahmed, Medical Parasitology Lab., 2011
E. vermicularis eggs
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44. R. Z. Ahmed, Medical Parasitology Lab., 2011
Nematode
Anclystoma duodenalae ( Hook worm )
Inhabit human intestine ( jejunum, ileum, and rarely duodenum ) and cause Anclystomiasis.
Male shorter than female and have copulatory bursa and two spicules.
Female is long and has pointed end.
Both sexes have long buccal cavity with two pairs of teeth.
Infective stage: Filariform larvae.
Diagnosis:
Based on finding ova in fresh stool sample.
In old sample, larvae present and must be differentiated from larvae of Strongyloides stercoralis .
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45. R. Z. Ahmed, Medical Parasitology Lab., 2011
Anclystoma Egg
Hook worm eggs like insects or mites egg, therefore must be differentiated.
Mites egg
Plant material
Hook worm egg
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46. R. Z. Ahmed, Medical Parasitology Lab., 2011
Anclystoma adult
Female
Male
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47. R. Z. Ahmed, Medical Parasitology Lab., 2011
Anclystoma larvae
Filariform
Rhabditiform
R. Z. Ahmed, Medical Parasitology Lab., 2011

48. Anclystoma male copulatory bursa
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49. Anclystoma buccal capsule
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50. R. Z. Ahmed, Medical Parasitology Lab., 2011
Nematode
Strongyloides stercoralis
Adults lives in the small intestine ( duodenum and jejunum ).
Male have a pointed curved tail associated with two spicules.
Female have strait tail without spicules.
In contrast to the Anclystoma spp., both sexes have short buccal cavity.
Infective stage: Filariform larvae.
Diagnosis:
Based on recovery of the rhabditiform larvae passed in stool.
If diarrhea is present, eggs may also be recovered.
R. Z. Ahmed, Medical Parasitology Lab., 2011

51. R. Z. Ahmed, Medical Parasitology Lab., 2011
S. stercoralis larvae
Rhabditiform
Filariform
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52. S. stercoralis adult male
spicules
spicules
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53. S. stercoralis adult female
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54. Anclystoma spp. (Hook worm) Strongyloides stercoralis
Comparison
Aspect
Anclystoma spp. (Hook worm)
Strongyloides stercoralis
Rhabditiform larvae
Buccal cavity
Long
Short
Esophagus
One – third of the body
Genital permordium
Absence
Prominent
Filariform larvae
Half of the body
Tail
Pointed
Notched
larvae
Striated sheath
Unsheathed
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55. R. Z. Ahmed, Medical Parasitology Lab., 2011
Nematode
Trichuris trichiura ( whip worm )
Adult inhabit the large intestine and cause trichuriasis.
Adult male is smaller than female.
Trichuris trichiura eggs have distinct shape.
Because of the shape of this worm ( anterior thin and posterior thick ) called whip worm.
Infective stage: Eggs.
Diagnosis:
Detection of eggs in the stool.
R. Z. Ahmed, Medical Parasitology Lab., 2011

56. R. Z. Ahmed, Medical Parasitology Lab., 2011
T. trichiura egg
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57. R. Z. Ahmed, Medical Parasitology Lab., 2011
T. trichiura adult
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58. R. Z. Ahmed, Medical Parasitology Lab., 2011
Nematode
Trichinella spiralis
Adult inhabit the small intestine of the rats and pigs. Both males and females lie freely in the lumen of the intestine of pigs and rats.
Fertilized female only penetrate the mucosa where the larviposit, they do not lay eggs.
Larvae is the infective stage, live encysted in the flesh of the host, and they represent the infective stage.
Diagnosis:
By finding the adult parasites in early days of infection.
Finding larvae in the blood during migration or in muscle after encystation.
R. Z. Ahmed, Medical Parasitology Lab., 2011

59. T. spiralis larvae encysted in muscle
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60. R. Z. Ahmed, Medical Parasitology Lab., 2011
Cestoda
Hymenolepis nana ( Dwarf tape worm )
Larvae inhabit the small intestine so, there is no intermediate host.
This is the smallest tape worm in man.
Eggs have double membrane and contain six hooked oncosphere.
Infective stage: Eggs.
Diagnosis:
Stool examination to detect the eggs.
R. Z. Ahmed, Medical Parasitology Lab., 2011

61. R. Z. Ahmed, Medical Parasitology Lab., 2011
H. nana adult
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62. R. Z. Ahmed, Medical Parasitology Lab., 2011
H. nana eggs
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63. R. Z. Ahmed, Medical Parasitology Lab., 2011
H. nana scolex
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Cestoda
Taenia spp.
There are two species that infect man and cause Taeniasis.
Taenia saginata ( Beef tape worm ).
Taenia solium ( Pork tape worm ).
Both have mature, immature and gravid segments.
Both have scolex provided with four cup- shaped suckers.
In both species the infective stage is the cysticercus.
Intermediate host:
T. saginata: Cows.
T. solium: Pigs.
Definitive host: Human.
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65. R. Z. Ahmed, Medical Parasitology Lab., 2011
Taenia spp.
Taenia saginata and Taenia solium must be differentiated from each other by the following:
Mature segment, gravid proglotid and adult worm.
Diagnosis:
By finding gravid proglotid or eggs in stool.
Direct fecal smear.
Brine flotation technique.
Cellophane - tape technique.
R. Z. Ahmed, Medical Parasitology Lab., 2011

66. Comparison Taenia saginata Taenia solium Adult size
Aspect
Taenia saginata
Taenia solium
Adult size
Longer ( 4 – 8 meters )
Smaller ( meters )
Number of segment
1000 – 2000
Mature segment
Pass singly by their own activity
Pass in chain
Gravid proglotid
With 15 – 30 uterine branches
With 7 – 13 uterine branches
Scolex
Devoid rostellum and hooks
With rostellum and 2 rows of hooks
Larvae
Cysticercus bovis in cattle only
Cysticercus cellulosae in pig as well as in man
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67. R. Z. Ahmed, Medical Parasitology Lab., 2011
Eggs
We can’t use egg to differentiate to species for each other
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68. R. Z. Ahmed, Medical Parasitology Lab., 2011
Scolex
Taenia saginata
Taenia solium
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69. R. Z. Ahmed, Medical Parasitology Lab., 2011
Mature segment
Taenia saginata
Taenia solium
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70. R. Z. Ahmed, Medical Parasitology Lab., 2011
Gravid proglotid
Taenia saginata
Taenia solium
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71. R. Z. Ahmed, Medical Parasitology Lab., 2011
Adult worm
Taenia saginata
Taenia solium
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Trematoda
Also name as Flukes.
Classification of Trematoda according to the final habitat in man:
Liver flukes ( liver or bile ducts ):
E.g.: Fasciola hepatica.
Intestinal flukes :
E.g.: Hetrophyes hetrophes.
Blood flukes:
E.g.: Schistosoma spp.
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73. R. Z. Ahmed, Medical Parasitology Lab., 2011
Blood flukes
Schistosoma spp.
Eggs are non operculated, but spined.
Cercaria has a bifid tail and penetrate intact skin.
Cause human bilharziasis.
There are three species:
Schistosoma mansoni, cause intestinal bilharziasis.
Schistosoma jabonicum, cause intestinal bilharziasis.
Schistosoma haematobium, cause schistosomal hematuria or urinary bilharziasis.
Infective stage in three species is the Cercaria.
Intermediate host: Snail.
Definitive host: Human
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74. R. Z. Ahmed, Medical Parasitology Lab., 2011
Schistosoma spp.
Habitat:
S. mansoni lives in the mesenteric venules of large intestine and produce eggs in stool.
S. jabonicum lives in the mesenteric venules of small intestine and produce eggs in stool.
S. haematobium lives in the venous plexus of the urinary bladder and produce eggs in urine.
Diagnosis:
Stool analysis should be performed to find eggs when infection with S. mansoni or S. jabonicum is suspected.
Urine analysis should be performed to find eggs when infection with S. haematobium is suspected.
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75. R. Z. Ahmed, Medical Parasitology Lab., 2011
Snail
Snails
Schistosome species
Bulinus spp.
S.haematobium
Biomphalaria spp.
S.mansoni
Oncomelania spp.
S.japonicum
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76. R. Z. Ahmed, Medical Parasitology Lab., 2011
Schistosoma egg
S. mansoni
S. haematobium
S. jabonicum
Lateral spine
Terminal spine
Rounded spine
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77. R. Z. Ahmed, Medical Parasitology Lab., 2011
Schistosoma Cercaria
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78. Schistosoma adult male
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79. Schistosoma adult female
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80. Schistosomal miracidium
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81. R. Z. Ahmed, Medical Parasitology Lab., 2011
Snail
Biomphalaria spp.
Oncomelania spp.
Bulinus spp.
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Liver flukes
Fasciola spp.
Fasciola hepatica lives in the liver of man.
Fasciola spp. have many stages:
Oval eggs have miracidium, cercaria, metcercaria, larvae and adult stage.
Intermediate host: Snail.
Definitive host: Sheep.
Infective stage (human): Metacercaria.
Human infected by ingestion metacercaria from infected sheep.
Diagnosis:
Stool analysis to find Fasciola egg.
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83. R. Z. Ahmed, Medical Parasitology Lab., 2011
F. hepatica egg
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84. R. Z. Ahmed, Medical Parasitology Lab., 2011
F. hepatica miracidium
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85. R. Z. Ahmed, Medical Parasitology Lab., 2011
F. hepatica larvae
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Medical entomology
Lice
Flea
Bed bug
Ticks
Hard ticks
Soft ticks
Mite
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Lice
Lice egg
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88. R. Z. Ahmed, Medical Parasitology Lab., 2011
Flea
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89. R. Z. Ahmed, Medical Parasitology Lab., 2011
Ticks
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90. R. Z. Ahmed, Medical Parasitology Lab., 2011
Ticks
Soft ticks
Hard ticks
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Tick mouth part
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92. R. Z. Ahmed, Medical Parasitology Lab., 2011
Mite
Mite egg
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Bed bug
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THE END
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