Amebae (class: sarcodinia) Species Entamoeba histolytica Entamoeba dispar &ae'leria spp( )canthamoeba spp Disease amebiasis Epidemiology

worldwide where people poop Europe *+) pools of water saline Diagnosis 4 nuclei cysts or trophs on O&P prep loo%s li%e histolytica trophozoites in brain ,+Infectious Stage cysts cysts trophozoites Pathologic Stage trophozoites trophozoites trophozoites Pathogenesis fecal-oral invade intestinal mucosa invade nose via cribiform to brain Pathology amebic dysentery ameboma ulcers NONPATHOGENI brain infection Treatment as! " iodo#uinol O$ paromyocin O$ dilo!anide furoate s! " metronidazole O$ tinidazole &ae': infusion of amphotericin . into ,+- brain +/)/ )can: pentamidine isethionate %etaconazole

menin'oencephalitis

Other Intestinal Proto!oa Species .alantidium coli (class: ciliata) 1iardia lamblia (class: masti'ophora) Disease balantidiasis Epidemiology worldwide in pi'raisin' societies ubi#uitous at campin' sites2s%i resorts (do's beavers) worldwide (insects vertebrates invertebrates) trichomoniasis worldwide Diagnosis trophs or cysts in stool Infectious Stage cysts Pathologic Stage trophozoites Pathogenesis fecal-oral invade colon (no deep penetration) fecal-oral emer'e in small intestine (does not invade tissue) confined to intestine or seed other or'ans Pathology ulceration 'an'renous colon death (rare) ulceration dysentery2fatty diarrhea frothy feces flatulence nausea wt loss a"itaminosis# fat malabsorption disseminated inf!n ocular or systemic inf!n watery diarrhea female: thic% dischar'e abnl epithelium male: as! Treatment tetracycline (0O,) iodo#uinol O$ metronidazole metronidazole or #uinacrine O$ tinidazole or furazolidone or paramomycin albendazole (0O,) fuma'illin " eyedrops %eratoplasty metronidazole O$ tinidazole (in both partners)

'iardiasis

fatty diarrhea trophs or cysts in stool strin' test (cysts #uadronucleate)

cysts

trophozoites

3icrosporidia

infective cyst

twirlin' cysts

/richomonas va'inalis (class: masti'ophora)

trophozoites only in *1 dischar'e scrapin'

trophozoites from se! no cysts

trophozoites

female: in va'ina male: in prostate

Plasmodium (class: sporozoa) Species )44 P( falciparum Disease mali'nant tertian malaria Epidemiology female Anopheles mos$uito tropics sub-+aharan )frica Diagnosis on blood smear: $.,s coarse dots5 not enlar'ed rin' sta'e small 'ametocyte crescent Infectious Stage sporozoites Pathologic Stage merozoites Pathogenesis sporozoites from mos#uito EE sta'e in blood and liver merozoites in liver (hypnozoites for ovale and viva!) eruption of liver cells rin' sta'e trophozoites schizont merozoites rupture $., 'ametocytes in blood mos#uito ta%es blood meal fusion to zy'ote in mos#uito invasion of stomach wall Pathology chills2fever %spi&ing temp) anemia splenome'aly .lac%water fever splenic rupture 06, cerebral malaria chills2fever (spi%in' temp) anemia splenome'aly chills2fever (spi%in' temp) anemia splenome'aly Treatment prophyla!is: chloro#uine symptomatic: chloro#uine prophyla!is (resistant): meflo#uine O$ pro'uanil2do!ycyline O$ malarone (atova#uone2pro'uanil) symptoms (resistant): fansidar 7 #uinine do!ycyline2tetracycline chloro#uine 7 prima#uine (for relapse %ills in liver)

P( viva!

beni'n tertian malaria

tropics not )frica where ovale is found

P( ovale

ovale malaria

tropics

$.,s +ch8ffer9s dots5 enlar'ed rin' sta'e lar'e 'ametocyte round $.,s small :a''ed dots5 enlar'ed rin' sta'e lar'e 'ametocyte round

P( malariae

#uartan malaria

tropics

$.,s no dots5 band across $., rin' sta'e lar'e 'ametocyte round

oocyst oocyst bursts sporozoites mi'rate to salivary 'land sporozoites in:ected

chills2fever (spi%in' temp) anemia splenome'aly nephrotic syndrome

To'oplasma# Pneumocystis# ryptosporidium Species /o!oplasma 'ondii Disease to!oplasmosis Epidemiology worldwide Diagnosis serolo'ic tests from mouse serum Infectious Stage oocysts in cat poop pseudocysts in meat Pathologic Stage tachyzoites Pathogenesis in'est cysts penetrate 'ut m in'est and distribute tachyzoites pseudocysts filled w2 bradyzoites in body air-borne inhalation of cysts trophs bloc% alveoli all sta'es in mucosa epithelia of sm( intestine ase!ual: includes merozoites se!ual: micro2macro 'ametocytes fuse to oocyst Pathology adult: flu-li%e brain lesions hepatitis con'enital inf!n in fetus: choreoretinitis hydrocephalus still birth interstitial pneumonitis preemies " plasma cell interstitial pneumonitis lifelon' intractable diarrhea Treatment pyrimethamine 7 sulfadiazine O$ spiramycin

Pneumocystis carinii ,ryptosporidium parvum (class: sporozoa)

pneumocystosis cryptosporidiosis

worldwide

cysts in sputum sample

cysts

trophozoites

/3P-+3;

*+ cattle-raisin' areas

oocyst in feces

sporozoites in oocysts

merozoites

)60+ " octreotide 6, " paromomycin (0O,) azithromycin nitazo!anide

Trypanosomes (class: masti'ophora) Species /rypanosoma brucei 'ambiense Disease <( )frican sleepin' sic%ness Epidemiology <( )frica tsetse fly on ve'etation near rivers Diagnosis blood ,+- lymph Infectious Stage metacyclic trypomasti'otes Pathologic Stage trypomasti'otes Pathogenesis tsetse fly w2 metacyclic trypomasti'ote trypomasti'ote enter chancre e!tracellular in blood ,&+ lymph Pathology = menin'itis cerebral edema perivascular cuffin' = e!haust )b supply b2c variable )' coat = cross ... sleepin' sic%ness = e!haust )b supply b2c variable )' coat = cross ... sleepin' sic%ness = inflammation = cardiome'aly aneurysm destroyed = me'acolon me'aesopha'us destruction of mesenteric ple!us Treatment hemolytic: suramin O$ pentamidine isethionate ,&+: melarsoprol

/rypanosoma brucei rhodesiense /rypanosoma cruzii

E( )frican sleepin' sic%ness ,ha'as9 disease %(OONOSIS)

E( )frica tsetse fly on bush bac% antelope 4atin )merica $hodnius spp /riatoma spp & cone-nosed bu's rodents armadillos

<inter9s bottom si'n blood cha'oma (swellin' > site) $oma?a9s si'n ,-shaped trypomasti'ote in blood

metacyclic trypomasti'otes trypomasti'otes in feces

trypomasti'otes

amasti'otes (intracellular)

bu' poops & person rubs trypomasti'otes into wound or mucosal membrane amasti'ote into tissue trypomasti'ote into blood

nifurtimo! O$ benznidazole

*eishmania %+ucocutaneous , -isceral) Species 4( braziliensis comple! Disease mucocutaneous leishmaniasis @espundiaA visceral leishmaniasis @Eala-azarA Epidemiology &< " )mazon .razil ,entral )merica Peru (arboreal mammals) (4utzomyia fly) O< " 6ndia $ussia ,hina Eenya Ethiopia +udan Diagnosis needle biopsy scrappin' Infectious Stage promasti'otes Pathologic Stage amasti'otes Pathogenesis promasti'otes in salivary 'land of sand fly in:ect amasti'otes in m penetrates 3, layers promasti'otes in salivary 'land of sand fly in:ect Pathology espundia (lesions B-CD yrs) destruction of nasal & pharyn! death by asphy!iation starvation drown Eala-azar (blac% fever) splenome'aly hepatome'aly Treatment stibo'luconate sodium O$ amphotericin .

4( donovani

biopsy spleen2liver no s%in test durin' inf!n

promasti'otes

amasti'otes

stibo'luconate sodium

(Phlebotomus fly) &< " .razil +( )m( (4utzomyia fly) *eishmania % utaneous) Species 4( tropica (@urbanA " slow) Disease cutaneous leishmaniasis Epidemiology O< " 3iddle East 6ndia )frica $ussia (Phlebotomus fly) Diagnosis needle biopsy scrapin' Infectious Stage promasti'otes Pathologic Stage amasti'otes

amasti'otes in m penetrates liver spleen bone marrow Pathogenesis promasti'otes in salivary 'land of sand fly in:ect amasti'otes in m stays nr wound or disseminated in cutaneous layers seed blood fly bites cycle in fly

leu%openia

4( ma:or (@ruralA " fast) 4( aethiopica 4( me!icano pifano 4( me!icana comple!

cutaneous leishmaniasis cutaneous leishmaniasis cutaneous leishmaniasis O< " Ethiopia (Phlebotomus fly) &< " Henezuela (4utzomyia fly) &< " 3e!ico 4atin )merica Henezuela (4utzomyia fly)

Pathology recidivans in brain 'ranulomas w2 satellites dry-rolled lesion (self-cure F-C yrs 'et immunity only to tropica) wet-rolled lesion (selfcure G-FC mo 'et immunity to tropica & ma:or) non-ulceratin' nonhealin' lesion ANE.G/ rolled-ed'e lesion ('et immunity)

Treatment 4 tropica: hot compress or sulfuric acid for the recidivans arsenic for the brain inf!n )44: stibo'luconate sodium O$ me'lumine antimonate O$ amphotericin .

estodes (phylum: platyhelminthes) Species /aenia sa'inata /aenia solium Disease taeniasis taeniasis cystercercosis Epidemiology beef eatin' societies por%-eatin' societies Diagnosis pro'lottids in stool IFC uterine br2side pro'lottids in stool J-FD uterine br2side Infectious Stage cystercerci in beef cysterci in por% e''s in pro'lottids Pathologic Stage adult adult cysticercus Pathogenesis in'est cysterceri hatch in stomach mature in small intestine pro'lottids shed people eat people poop or reverse peristalsis e'' larvae encyst in muscle do' eats infected sheep people eat do' poop larva in stomach to small intestine encyst in brain muscle liver fo! eats infected mice people eat fo! poop larva in stomach to small intestine encyst in brain muscle liver direct: e''s fr poop larva oncospheres cysticercoids (villi) adult worms pro'lottids indirect: e''s fr insects cysticercoids adult worms pro'lottids Pathology anore!ia wt nausea anore!ia wt nausea brain lesions sz eye problems muscle wea%ness hepatitis seizure anaphyla!is death Treatment prazi#uantel (0O,) niclosamide prazi#uantel (0O,) niclosamide sur'ery

Echinococcus 'ranulosis

unilocular hydatid dz %(OONOSIS)

3iddle East Europe ,anada *+ (do')

ima'in' ultrasound hydatid has multisheath membrane colonies 'row w2in membrane impression h! serolo'y no membranous linin' colonies 'row all over cyst @lea%yA e''s in stool

e''

hydatid unilocular cyst

mebendazole before sur'ery to cyst sur'ery abendazole after sur'ery

Echinococcus multilocularis

multilocular hydatid dz %(OONOSIS)

,anada &( *+ +iberia (fo!)

e''

hydatid multilocular cyst

destruction necrosis death

nothin' unless cau'ht early then mebendazole before sur'ery sur'ery prazi#uantel (0O,) niclosamide

Kymenolepsis nana

mouse tapeworm direct: mouse2human indirect: beetles insects

anywhere mice live

direct: embryonated e''s in poop or insects indirect: cystercercoid

oncospheres adult attach to 'ut via scole!

mild s!s: intestinal distress diarrhea colic pain delayed immune response for indirect response due to decreased tissue e!posure

Kymenolepsis diminuta 0ipylidium caninum estodes Species 0iphyllobothrium latum

rat tapeworm (rat flea) do' tapeworm (do' flea)

anywhere rats live anywhere w2 rats or do's

e''s in stool e''s in stool

cystercercoid in body of insect cystercercoid in body of insect

similar to indirect cycle of K( nana similar to indirect cycle of K( nana

mild s!s mild s!s

niclosamide niclosamide

Disease broad fish tapeworm dz (copepod) spar'anosis (copepod) %(OONOSIS)

+pirometra mansonoides

Epidemiology fish fr +candinavia +witzerland Kun'ary 1reat 4a%es *++$ +E )sia Lapan ,hina )frica

Diagnosis e''s in stool

Infectious Stage pleurocercoid in fish flesh

Pathologic Stage adult

biopsy

pleurocercoid

spar'anum

Pathogenesis in'est pleurocercoid fr fish adult in small intestine pro'lottids pass out pro'lottids cycle from cats to rodents2amphibians humans accidentally eat infected amphibians 'et pleurocercoids mi'rate to +, layers (spar'anum) irre'ular nodules

Pathology abs0 "it 123 rare: pernicious anemia edema pain

Treatment prazi#uantel (0O,) niclosamide

sur'ery

Trematodes %34host) (phylum: platyhelminthes order: di'enea) Species +chistosoma mansoni +chistosoma haematobium +chistosoma :aponicum +( me%on'i +( malayensis Disease schistosomiasis (freshwater snail) Epidemiology )frica +( )m ,aribbean )frica 3iddle East Diagnosis e''s w2 lar'e lateral spine in stool e''s w2terminal spine in stool e''s w2 small lateral spine in stool Infectious Stage cercariae cercariae Pathologic Stage e''s are the patholo'ic sta'e and where they end up determines what patholo'y you see Pathogenesis cercariae fr snail burrows into human s%in to liver liver2lun' adults mate F( mansoni & :aponicum to mesenteric venules e''s in small intestine & passed out in colon C( haematobium to bladder mesenteric venules e''s in bladder passed out in urine Pathology liver fibrosis portal K/& cor pulmonale polyposis bladder fibrosis 2 calcification hydroureter hydronephrosis ,&+ lesions hepatosplenome'aly thic% 'ut cor pulmonale polyposis Treatment prazi#uantel (0O,) o!amni#uine prazi#uantel (0O,) metrifonate prazi#uantel

E( )sia

cercariae

Trematodes %54host) Species ,lonorchis sinensis Para'onimus westermani Disease clonorchiasis para'onimiasis Epidemiology Lapan Eorea Hietnam ,hina )sia 6ndia Pacific +( )m Diagnosis e''s in stool e''s in stool or sputum Infectious Stage metacercariae in fish muscle metacercariae in crab or crayfish Pathologic Stage adult adult Pathogenesis cercariae in snail fish2crab2water plant 'ets & encyst in fish2crab2waterplant human in'ests Pathology mild inflammation if bile duct lun' fibrosis hemoptysis dyspnea pleural pain rare to brain Treatment prazi#uantel prazi#uantel

-asciola hepatica

fascioliasis

)mericas Europe ,hina

e''s in stool

metacercariae on 6atercress

adult

-asciolopsis bus%i Keterophyes heterophyes

fasciolopsiasis heterophyiasis

)sia 6ndia )sia 3iddle East E'ypt

e''s in stool e''s in stool

metacercariae on 6ater chestnut metacercariae in fish muscle

adult adult

metacercariae hatch in small intestine F( ,( sinensis to bile ducts (adult) C( P( westermani to lun's (adult) B( -( hepatica to bile ducts (adult) then e''s out in feces not as important similar to above not as important similar to above

inflammation of bile duct fibrotic liver colic Co abscess to brain

prazi#uantel

obstruction of ampula of vater ,.0 small intestine heart & neuro dz mild intestinal problems

prazi#uantel prazi#uantel

Nematodes %intestinal) (phylum: nematoda) Species Enterobius vermicularis (pinworm) Disease enterobiasis Epidemiology urban centers Diagnosis scotch tape across anus pm or early am Infectious Stage embryonated e''s Pathologic Stage adults Pathogenesis e''s in'ested from thumb larvae hatch in small intestine (4 molts) adults mature in colon (mate) 'ravid adults mi'rate out of anus female lays e''s on perianum e''s embryonate e''s in'ested from soil larvae hatch in small intestine adults mature in colon (@sewnA into mucosa female passes e''s in colon e''s passed out in colon to soil e''s in'ested from soil larvae hatch in small intestine to liver to heart to lun's into alveolar spaces up trachea & swallowed mature in small intestine may 'o to bile ducts or out in feces to soil (up to 4-G wee%s) similar to )scaris but incomplete adults live in small intestine of cats2do's in'est e''s from cats2do's hatch in small intestine Brd sta'e larvae wander over or'ans Pathology anal itchin' aller'ic response lose sleep appendicitis P60 neurolo'ic s!s Treatment mebendazole

/richuris trichiura (whipworm)

trichuriasis

tropics +( *+ worldwide

e''s in stool ,harcot-4eyde crystals

embryonated e''s

adults

bleedin' diarrhea prolapsed rectum

mebendazole

)scaris lumbricoides ('iant roundworm)

ascariasis

worldwide

e''s in stool

embryonated e''s

adults larvae

larvae: hypersensitivity to moltin' in lun' pneumonitis adult: perforated bowel obstructed ducts eosinophilia: larvae die 'ranuloma children: fever hepatosplenome'aly bronchospasm myocarditis nephritis serious: retinal 'ranuloma 'ranuloma (loo%s li%e stomach ,)) colic%y pain nausea anemia mucosal scars eosinophilia

mebendazole

/o!ocara spp(

visceral larva mi'rans %(OONOSIS)

where cats and do's roam free

immunolo'ic tests h! eosinophilia

e''s

larvae

albendazole (0O,) mebendazole (0O,) thiabendazole diethyl carbamazine

)nisa%is Porocaecum ,ontracaecum (@+ushiA worm) &ecator americanis (&ew <orld) )ncylostoma duodenale (Old <orld) )ncylostoma brasiliensis

anisa%iasis

Pacific

'astroscopy biopsy unembryonated e''s in stool (4cell)

larvae

penetratin' larvae adults w2 cuttin' plates adults w2 da''erli%e teeth larvae

in'estion of larvae fr undercoo%ed salt water fish larvae hatch burrow into 16 tract filariform penetrate s%in to heart lun's throu'h alveoli up trachea & swallowed adults in small intestine umbreyonated e''s out in feces to soil

sur'ery 'astroscopic removal mebendazole

hoo%worm disease

&< tropics O< &( temperate

filariform

cutaneous larva mi'rans

where cats and do's roam free

eosinophilia

larvae

creepin' eruption

albendazole (0O,) mebendazole

)ncylostoma caninum +tron'yloides stercoralis (small human roundworm)

%(OONOSIS) stron'yloidiasis tropics & subtropics rhabditiform larvae in stool filariform larvae adult larvae

/richinella spiralis

trichinosis %(OONOSIS)

worldwide in pi'eatin' societies

hi'h por% consumption eosinophilia after C w%s immunolo'ic tests

larvae

larvae mi'ration & penetration

larvae from do'2cat feces penetrate s%in live about BD days 4B (filariform) larvae penetrate s%in mi'rate to heart to lun's penetrate alveoli larvae swallowed adults live in small intestine 4C larvae passed out F( autoreinf!n cycle 4B in colon penetrate bloodstream mi'rate to C( in favorable conditions out in soil & cycle throu'h 4 larval sta'es to matin' adults 4B larvae s%in in less favorable conditions larvae in'ested w2 por% larvae in stomach to small intestine mature female shed larvae to lymph2blood larvae penetrate muscle form comple! calcified larvae in muscle

thiabendazole can last a lifetime adult: diarrhea malabsorption larvae: eosinophilia pneumonitis autoreinf!n (CD-BD yrs) thiabendazole

heart failure ,&+ dama'e Co inf!n fr enteric flora petechial hemorrha'es eosinophilia

thiabendazole steroids for severe cases

Nematodes %tissue) Species <uchereria bancrofti .ru'ia malaya .ru'ia timori Disease filariasis elephantiasis female aedes anopheles mos#uitoes Epidemiology tropics Pacific mos#uitoes: aedes anopheles cule! 3alay 6ndia )sia mos#uitoes: mansonia anopheles armi'eres Diagnosis microfilariae in peripheral blood at ni'ht (nocturnal periodicity) Infectious Stage larvae (mi'rate to lymph mate & produce microfilariae F year later) Pathologic Stage adult Pathogenesis infected mos#uito ta%es blood meal larvae deposited into s%in enter lymphatics adults mature in lymphatics microfilariae in blood mos#uito ta%es blood meal & ta%es up microfilariae infected fly ta%es blood meal larvae deposited into wound develop in +, tissue to adult fly ta%es blood meal & becomes infected infected blac%fly ta%es blood meal larvae crawl into wound develop to adults in +, tissue microfilariae mi'rate throu'hout +, tissue (patholo'y) another fly ta%es blood meal & is infected larvae swallowed w2 infected copepods freed in small intestine penetrate small intestine enter abd wall enter +, tissue mi'rate to lower Pathology lymphan'ina (painful lymph vessels) lymphadenitis (elephantiasis) (painful swellin' of lymphatics in 'roin periphery breasts) massive fibrosis Treatment diethylcarbamazine (0E,) ivermectin

4oa loa (eye worm)

loiasis crysops (man'o or deer fly)

)frica

microfilariae in blood at day (diurnal periodicity)

larvae (adults mature in F year)

adult

calabar swellin's in eye and e!tremities

diethylcarbamazine (0E,)

Onchocera volvulus

onchochorciasis (river blindness) blac%fly (blac%fly simulium damnosum)

fast-runnin' streams in ,entral )m tropical )frica &< upper body O< lower body

s%in snip shows microfilariae

larvae crawl into fly bite and mature in F year

microfilariae

0racunculus medinensis

dracunculiasis cyclops (copepods water fleas)

e#uatorial )frica (rain pools in <( )frica) 3iddle East 6ndia (wells) +( )m

head of worm in s%in of blister

larvae

adult female

s%in: elephant2leopard s%in due to microfilariae destroy elastic fibers partial depi'mentation ophthalmic: iritis Co 'laucoma corneal2retinal dama'e blindness blisters ulcers aller'ic r!n

ivermectin

metronidazole (0O,) niridazole

e!tremities worms develop in +, tissue to adults larvae pass out to water (female faces head down blister brea%s & spits out larvae into water) copepods in'est