Activity 7-8 - Actvities PDF

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Warning: TT: undefined function: 32MS. MICHELLE HSIAO1ACTIVITY #7: IDENTIFICATION OF CESTODES (TAPEWORMS)CESTODES Ribbon-like platyheminthes that live in the intestinal tract of vertebrates as adults and in tissues or body cavities of various intermediate larvae Adults are hermaphroditic Infection o...

Description

LAB

CLINICAL PARASITOLOGY

MS. MICHELLE HSIAO ORDER PSEUDOPHYLLIDEA

ACTIVITY #7: IDENTIFICATION OF CESTODES (TAPEWORMS) CESTODES • Ribbon-like platyheminthes that live in the intestinal tract of vertebrates as adults and in tissues or body cavities of various intermediate larvae • Adults are hermaphroditic • Infection of adult worm is generally acquired through consumption of intermediate hosts with encysted larvae.

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Characteristics: Segmented Possess scolex, neck and proglottids Hermaphroditic Reproduction  Oviparous  Sometimes multiplication in larval forms Infection is generally in encysted larvae • Scolex – anterior structure that serves as the worm’s main organ of attachment • Strobilla – body of worm ‫ﻫ‬ Neck ‫ﻫ‬ Proglottid (Segments)  Immature  Gravid  Mature

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Spatulate scolex with sucking grooves (bothria) Segements have uterine pore which allows release of eggs from gravid uterus No segments recovered for diagnosis Opperculated and immature eggs aquatic development of embryo (coracidium) Require two intermediate host in life cyle

Diphyllobothrium latum Spirometra spp.

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Taenia saginata Taenia solium Hymenolepis nana Hymenolepis diminuta Dipylidium caninum Raillietina garrisoni Echinococcus granulosus

Order Pseudophyllidea

Laying of eggs

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Globular sukers with four muscular suckers No uterine pore; undergoes apolysis (detachment of gravid proglottids from main body of worm) Both eggs and segments are recovered for diagnosis Non-opperculated eggs with hexacanth embryo Requires one intermediate host

SUMMARY

Scolex

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ORDER CYCLOPHYLLIDEA ‫ﻫ‬

live in the intestinal tract of vertebrates as adults and in the tissues or body cavities of various intermediate hosts as larvae no circulatory and digestive system; their food is absorbed from the host intestine the excretory system consists of protonephridial system draining into a main excretory canal nervous system contains sensory and peripheral motor nerves

Two order: 1. Order Pseudophyllidea 2. Order Cyclophyllidea

IH

Order Cyclophyllidea

Spatulate scolex with sucking grooves (bothria)

Globular scolex with four muscular suckers

Have uterine pore – allows release of eggs from gravid proglottids

No uterine pore. Undergoes apolysis – detachment of gravid proglottids from main body of worm) and eggs are released eventually

2

Eggs

Operculated and immature; requires aquatic development of embryo (coracidium)

Diagnosis

No segments recovered

1

Non- operculated with hexacanth embryo both eggs and segments are recovered

1 MLS 2B

MUYCO, Ma. Christy M.

LAB

MS. MICHELLE HSIAO

CLINICAL PARASITOLOGY SCIENTIFIC NAME

Diphyllobothrium latum Taenia solium Taenia saginata Taenia asiatica Hymenolepis nana Hymenolepis diminuta Dipylidium canicum

Echinococcus granulosus

COMMON NAME Fish tapeworm Broad tapeworm Pork tapeworm Pork tapeworm Asian tapeworm Dwarf tapeworm Rat tapeworm Dog tapeworm Double-pored dog tapeworm Cucumber tapeworm Dog tapeworm Hydatid worm Hyper tapeworm

CESTODES AND THEIR LARVA PSEUDOPHYLLIDEA GENUS Diphyllobothrium Spirometra

LARVA Procercoid (1st) Plerocercoid (2nd)

TAENIA SAGINATA Common Name Scolex

Proglottids

LARVA Cysticercus Hydatid Cysticercoid

ACCORDING TO HABITAT

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Ovum

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Adult Worm Habitat MOT Diagnostic Stage Infective Stage Host

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CYCLOPHYLLIDEA GENUS Taenia Echinococcus Dipylidium Hymenolepis Raillietina

Beef tapeworm ‫ﻫ‬ quadrate scolex (1-2 mm diameter) with 4 acetabula (suckers), no hooks or rostellum

1000 – 4000 segments Mature: Broader than longer Gravid: narrower and longer (16-20 mm x 5-7 mm) Uterus is distended with ova and has 15 – 30 lateral branches Spherical or sub-spherical (30-45 um diameter) Brownish with thick embryophore (striated) Inside is oncosphere (embryo) with 3 pairs of hooklets (hexacanth embryo) 4-10 m Upper jejunum Ingestion of cysticercus larva (Cysticercus bovis) Egg or proglottids Cysticercus bovis IH: cattle DH: human

Intestinal cestodes: 1. 2. 3. 4. 5. 6.

Diphyllobothrium latum Taenia solium Taenia saginata saginata Taenia saginata asiatica Hymenolepis nana Dipylidium canicum

Extraintestinal cestodes: 1. 2.

Echinococcus spp. Spirometra spp.

2 MLS 2B

MUYCO, Ma. Christy M.

LAB

MS. MICHELLE HSIAO

CLINICAL PARASITOLOGY TAENIA SOLIUM

Common Name Scolex

HYMENOLEPIS NANA

Pork tapeworm ‫ﻫ‬ Spherical scolex with 4 acetabula and carries cushion-like rostellum with a double crown of 25-30 large and small hooks

Proglottids

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800 – 1000 segments Gravid: contains 7-13 lateral branches

Ovum

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Adult Worm Habitat MOT

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Diagnostic Stage Infective Stage Host

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Spherical or sub-spherical (30-45 um diameter) Brownish with thick embryophore (striated) Inside is oncosphere (embryo) with 3 pairs of hooklets (hexacanth embryo) 2-4 m Upper small intestine Ingestion of cysticercus larva (Cysticercus cellulosae) Eggs or proglottids Cysticercus cellulosae IH: cattle, pigs, and human DH: human

Common Name Scolex

Strobila

Ovum

Dwarf tapeworm ‫ﻫ‬ Scolex is subglobular with 4 cup-sahped suckers, a retractable rostellum with a single row of 20-30 Y shaped hooklets ‫ﻫ‬ 25-45 mm length and 1 mm width with no more than 175 – 220 segments ‫ﻫ‬ Proglottids (0.15 – 0.3 mm length and 0.8-1 mm width); anterior segemnts are short, posterior ones are broader than long ‫ﻫ‬ Spherical or subshperical (30-47 um diameter) ‫ﻫ‬ Brownish, with a thick embryophore (striated) ‫ﻫ‬ Thin oncosphere (embryo) with thin outer membrane and thick inner membrane with conspicuous bipolar thickenings from which arises 4-8 hair-like polar filaments embedded into the outer membrane

Adult Worm

Habitat MOT

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Diagnostic Stage Infective Stage Host

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Ileum Ingestion of cysticercoid larva, ingestion of embryonated egg Embryonated egg Embryonated egg, cysticercoid larva First IH: o Beetles: (Tribolium confusum and Tenebrio spp.) o Fleas: (Pulex irritans, Xenopsylla cheopis, and Ctenocephalides canis) o Moths: Second IH: Rodents DH: Human

3 MLS 2B

MUYCO, Ma. Christy M.

LAB

MS. MICHELLE HSIAO

CLINICAL PARASITOLOGY HYMENOLEPIS DIMINUTA

Common Name Scolex Proglottids

Ovum

Habitat MOT Diagnostic Stage Infective Stage Host

DIPYLIDIUM CANINUM

Rat tapeworm ‫ﻫ‬ Scolex is subglobular with 4 cup-sahped suckers, with rudimentary unarmed rostellum ‫ﻫ‬ Larger (0.75 mm length and 3.5 mm in width) ‫ﻫ‬ Mature: broader than longer; genital pore is unilateral ‫ﻫ‬ Gravid: contain sac-like uterus with eggs ‫ﻫ‬ Circular (60-80 um diameter) ‫ﻫ‬ Bile-stained, brownish with a thick embryophore (striated) ‫ﻫ‬ Onchosphere is enclosed in inner membrane with bipolar thickening but no polar filaments embedded into membrane ‫ﻫ‬ Hooklets have a fan-like arrangement ‫ﻫ‬ Small intestine ‫ﻫ‬ Ingestion of arthropod with cysticercoid larva ‫ﻫ‬ Egg ‫ﻫ‬ Cysticercoid larva ‫ﻫ‬ 1st IH: Arthropods o Lepidopterans o Earwigs o Myriapods o Larval fleas o Various beetles ‫ﻫ‬ 2nd IH: Rodents ‫ﻫ‬ DH human

Common Name Scolex Proglottids

Ovum

Habitat MOT Diagnostic Stage Infective Stage Host

Dog tapeworm, Double-pored dog tapeworm, Cucumber tapeworm ‫ﻫ‬ Has 4 suckers and armed rostellum ‫ﻫ‬ Narrow with 2 sets of male and female reproductive organs and bilateral genital pore ‫ﻫ‬ Gravid: size and shape of pumpkin/cucumber seed and are filled with 8-15 eggs enclosed in an embryonic membrane (egg packets or capsules) ‫ﻫ‬ Spherical, thin shelled with hexacanth embryo ‫ﻫ‬ 25-40 um ‫ﻫ‬ ‫ﻫ‬ ‫ﻫ‬ ‫ﻫ‬ ‫ﻫ‬

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Small intestine Ingestion of vector with cysticercoid larva Proglottid Cysticercoid larva 1st IH: larval stages of o Ctenocephalides canis (dog flea) o Ctenoscephalides felis (cat flea) o Pulex irritans (human flea) o Trichodectes canis (dog louse) 2nd IH: cats and dogs DH: Human

4 MLS 2B

MUYCO, Ma. Christy M.

LAB

MS. MICHELLE HSIAO

CLINICAL PARASITOLOGY DIPHYLLOBOTHRIUM LATUM

Common Name Scolex

Proglottids

Ovum

Habitat MOT Diagnostic Stage Infective Stage Host

ECHINOCOCCUS GRANULOSUS

Fish tapeworm, Broad tapeworm ‫ﻫ‬ Spatulate and measures 2-3 mm in length by 1 mm in diameter; has 2 bothria (sucking grooves) which are located dorsally and ventrally ‫ﻫ‬ Mature: 2-4 mm in length by 10-12 mm in width contains 1 set of reproductive organs ‫ﻫ‬ Gravid: dark, rosette-like, coiled uterus located in middle that extends from ootype and opens through a uterine pore ‫ﻫ‬ Yellowish brown, with a moderately thick shell and an inconspicuous operculum ‫ﻫ‬ 66x44 um (range of 58-76 um in length and 40-51 um width) ‫ﻫ‬ Small intestine ‫ﻫ‬ Ingestion of plerocercoid larva from raw or improperly cooked fish ‫ﻫ‬ Operculated eggs or proglottids ‫ﻫ‬ Plerocercoid larva ‫ﻫ‬ 1st IH: crustaceans ‫ﻫ‬ 2nd IH: small freshwater fish ‫ﻫ‬ 3rd IH: predator fish ‫ﻫ‬ DH: Human

Common Name Scolex

Dog tapeworm, Hydatid worm, Hyper tapeworm ‫ﻫ‬ Pyrifrom scolex typically taeniid; has 4 acetabula and armed with 30-36 hooks

Proglottids

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Ovum Habitat MOT

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Diagnostic Stage Infective Stage Host

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Gravid: widest and longest Uterus is midline, with lateral evaginations and filled with eggs that resembles those of taeniid worms Resembles other Taeniid worms Small intestine of canines Ingestion of embryonated egg from dog feces (fecaloral) Hydatid cysts Embryonated egg 1st IH: sheep, goat, swine DH: dogs and other Canidae, Human

5 MLS 2B

MUYCO, Ma. Christy M.

LAB

MS. MICHELLE HSIAO

CLINICAL PARASITOLOGY

ACTIVITY #8: IDENTIFICATION OF TREMATODES (FLUKES) TREMATODES • Infections occur worldwide • Cause various clinical infections in humans • Parasite are named cause of their conspicuous suckers, the organs of attachment • Trematodes means “pierced with holes” • Flukes parasitize are members of all vertebrate class but most commonly parasitize fish, frogs, and turtles, they also parasitize humans, domestic animals, and invertebrates such as mollusks and crustaceans

BLOOD FLUKES Schistosoma is a genus of parasitic blood flukes that infects birds and mammals, including humans. FIVE SPECIES OF MEDICALLY IMPORTANT Schistosoma 1. Schistosoma japonicum: Oriental blood fluke 2. Schistosoma mansoni: Manson’s blood fluke 3. Schistosoma haematobium: Vesical blood fluke 4. Schistosoma mekongi 5. Schistosoma intercalatum •

SPOROCYSTS AND CERCARIA • Miracidium develops into sporocysts within the infected snail • Daughter sporocyst develop from mother sporocyst Cercariae (Infective stage) • Emerges from sporocysts, released by snail into water and freeswimming • Has a body and forked-liked tail • Infects man by skin penetration • Cercarial penetration is mediated by lytic enzymes and by muscular activity • Limiting factor for the number of cerciae that develop from one miracidium is the size of the snail host ‫ﻫ‬ In S. mansoni and S. haematobium, thousands of cerciae are produced since their sanil host are much larger. ‫ﻫ‬ The cercaria has an oral sucker which occupies the anterior end of the body and a small ventral sucker

LIFE STAGES OF SCHISTOSOMA SPP.

MIRACIDIUM • Hatches from the egg • Eggs hatch only in fresh water with sufficient oxygen and will not hatch in salinity greater than 0.7% or at mammalian temperatures • Free swimming ciliated embryo liberated from the egg • Infects snails e.g Oncomelania (as IH)

SCHISTOSOMULES • After the skin penetration, cercaria loses its tail and tranforms into schistosomule • Adapted to survive in serum or physiologic saline at 37°C • Enters the pleural cavity on the 2nd day of infection. Parenchyma of diaphragm on the 3rd day, liver parenchyma on the 4th day, and in the intrahepatic branches of portal vein after wards on the 6th day.

6 MLS 2B

MUYCO, Ma. Christy M.

LAB

ADULT WORMS OF SCHISTOSOME SPP. • Dioecious • Live up to 30 years but mean life span is much shorter (3-8 years) • Adults have large sucker capping the anterior end, a ventral sucker, and gonophore, located slightly posterior to the ventral sucker • Suckers aid in movement and enable the flukes to maintain their position inside the veins •

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MS. MICHELLE HSIAO

CLINICAL PARASITOLOGY

MALES: shorter but sturdier - 12 – 20 mm length x 0.4 – 0.5 mm diameter - Gynecophoral canal about 0.3 mm, where the female is held - testes are arranged in one row above the ventral sucker FEMALES: slender - 15 – 26 mm x 0.3 mm - Single pyramidal ovary located in the midline

SCHISTOSOMA JAPONICUM • Oriental blood fluke • Parasite of portal vein and its branches • First describe in Japan but has been eliminated with the last human case reported in 1977 • Causes Schistosoma japonica • Endemic in China, Philippines, Indonesia IH

Onchomelania hupensis quadrasi

DH

Dogs, pigs, cats and cows, along with sylvan reservoirs such as rodents, and mice, humans • Ovoid, round or pear-shaped • Pale yellow in color • Longer diameter: 46-110 um, shorter diameter: 37-90 um • Thin shell, residual tissue or red cells may be adherent • Curved hook or spine/knob may be observed near one of the [polar ends • Laid in multicellular stage and embryonate within 10-12 days

OVA

SCHISTOSOMA MANSONI • Manson’s blood fluke • Sub-Saharan Africa and some South American countries and the Caribbean, with sporadic reports in Arabian Peninsula • Causes intestinal schistosomiasis • Occurs often in inferior mesenteric veins draining the large intestine • Paired adult worms migrate to mesenteric venules of bowel/rectum (laying eggs that circulate to the liver shed in stool) IH

Biomphelaria (Biomphalaria) and Australorbis

DH

Humans

7 MLS 2B

MUYCO, Ma. Christy M.

LAB OVA

MS. MICHELLE HSIAO

CLINICAL PARASITOLOGY • • •

144 – 180 um long x 45 – 70 um wide Prominent lateral spine near posterior end Anterior end is tapered and slightly curved

SCHISTOSOMA INTERCALATUM • Inhabits inferior mesenteric plexus but lower in bowel than S. mansoni • Eggs are moved progressively toward the lumen of the intestine and are eliminated in feces • IH are snails of genera Bulinus • Found in Democratic Republic of the Congo

SCHISTOSOMA HAEMATOBIUM • Vesical blood fluke • Africa and pockets of Middle East • Inhabits in the vesicular and pelvic venous plexus of the bladder • Eggs are moved progressively toward the bladder and uterus, and are eliminated in the urine IH

Bulinus (Physopsis)

DH OVA

Humans • 110-170 um long x 40-70 um wide • Conspicuous terminal spine • Eggs contain a mature miracidium when shed in urine

SCHISTOSOMA MEKONGI • Only known IH for S. mekongi is Neotricula aperta • Eggs are moved progressively toward the lumen of intestine and are eliminated in feces • Found in Mekong river basin region, form Kratie province, Cambodia, to Khong Island • Much like Schistosoma japonicum in that thet are found as adults more frequently found in superior mesenteric veins, but can be found in CNS.

PATHOGENESIS AND CLINICAL MANIFESTATION • Cercarial penetration of skin usually accompanied by dermatitis with pruritus and localized reaction – swimmers itch •

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2-12 weeks following cercarial penetration schistosomule migration can give rise to syndromes characterized by: - Easy fatigability - Respiratory syndrome - Arthralgias - Myalgias - Malaise - Eosinophilia - Fever - Abdominal pain Occurring syndrome can be termed “Snail Fever”, “Katayama Fever”, or “Katayama syndrome”

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Katayama fever is currently preferred since not all patients may present with fever

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Colonic schistosomiasis – usually asymptomatic

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Celebral schistosomiasis – manifestations may present as motor or sensory disturbances depending of egg disposition a granuloma formation

8 MLS 2B

MUYCO, Ma. Christy M.

LAB

MS. MICHELLE HSIAO

CLINICAL PARASITOLOGY

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Hepatosplenic disease is the most serious consequence of chronic schistosomiasis

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Pulmonary involvement may initially occur during period of larval migration, which result in coughing, wheezing and other respiratory sysmptoms

LIFE CYCLE OF SCHISTOSOMA SPP.

DIAGNOSIS • Eggs are not immediately demonstrable in feces unless they are deposited in terminal vein or capillaries of intestinal mucosa or subsequently escape to the intestinal lumen •

Schistosome eggs can be recovered be rectal or liver biopsy

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Merthiolate iodine-formalin concentration (MIFC) technique has sufficient sensitivity for moderate and heavy infections, but not adequate for very light infections (< 10 eggs per gram of feces)

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Kato-katz technique preferred egg-counting technique

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Immunodiagnostic tests: a) Intradermal test for immediate cutaneous hypersensitivity  Sensitive but nonspecific for infection  Cannot reliably distinguish active from old infection b)

Indirect hemaggluination using adult worm and egg antigens  Highly sensitive but requires specialized reagents and training

c)

COPT (Circulation preciptin test)  Currently regarded as the method of choice for definitive diagnosis of this infection in the Philippines

d)

ELISA (enzyme linked immunosorbent assay)

9 MLS 2B

MUYCO, Ma. Christy M.

LAB LUNG FLUKES • • •

MS. MICHELLE HSIAO

CLINICAL PARASITOLOGY Paragonimiasis an infection of humans and other mammals by trematodes of genus Paragonimus Paragonimus westermani or Oriental lung fluke causes 90% of paragonimiasis in Asia Species in Philippines is P. siamensis, which has only been identified in cats

PARAGONIMUS WESTERMANI OVA • Yellowish-brown • Thick shelled, 80-188 um x 48-60 um • Flattened but prominent operculum • Opposite the operculum is a thickened aborpercular portion

PARAGONIMIASIS • Cough • Hemoptysis • Symptoms consistent with pulmonary tuberculosis • Misdiagnosed as PTB ADULT • Reddish-brown and measures 7-12 mm in length, 4-6 mm in width, 2.5-5mm in thickness, resembles a coffee bean shape • Rounded anteriorly and slightly tapered posteriorly • Found in pairs or threes in fibrotic capsules or cysts in lungs.

MIRACIDIA-SPOROCYST-CERCARIAE • 1st IH: Brotia asperata » Where miracidium develops into sporocyst and 2 radi...