INTESTINAL HELMINTHS &INTESTINAL PROTOZOA                  Submitted By :-                 Dr.Laximan Sawant              ...
IntestInal helmInths
Ascaris
• Ascaris is a genus of parasitic nematode worms known as the   "giant intestinal roundworms". • One species, A. suum, typ...
•  A. lumbricoides is the largest intestinal roundworm   and is the most common helminth infection of   humans worldwide, ...
MorphologyFertile egg• mammillated • thick external layer 
Morphology Cont.Infertile egg• elongated and larger than    fertile egg • thin shelled 
Morphology Cont. Infertile     Fertile
Adult worm:   tapered ends; length    15 to 35 cm   Female are larger in    size and have a    genital girdle
Adult worm of A. lumbricoides
The 3 prominent “lips”
TRANSMISSION   Ascariasis is not spread directly from one person to    another.   By the FAECAL-ORAL route, i.e., by ing...
•    There is increasing evidence that dust may    play an important role in the dissemination of    ascaris in arid areas.
Pre-patency:2 monthsPneumonitis:4 – 16 days afterinfection,short duration(~3 wks)
Symptoms1. Symptoms associated with larvae migration• eosinophilic pneumonia, cough (Loefflers Syndrome)• Breathing diffic...
Löeffler Syndrome (Pneumonitis)                       Transverse sections of                       Ascaris larvae in      ...
Symptoms Cont.2. Symptoms associated with adult parasite in the intestine• Usually asymptomatic• Abdominal discomfort, nau...
Adult Ascarisworms migrating inliver
Ascaris causingintestinalobstruction.
Ascaris(roundworm):The onlynematode evercoughed orvomited up
Diagnosis• Stool microscopy :• Eosinophilia:  eosinophilia can be found, particularly during   larval migration through th...
Treatment• Mebendazole• Albendazole
Prevention • Proper washing of the vegetables. • Health education. • Washing hands before meals. • Mass treatment for the ...
The Human HookwormsNecator americanusAncylostoma duodenale
   Morphology1. Adults: They look like an odd piece   thread and are about 1cm.2.    They are white or light pinkish when ...
2. Eggs: oval in shape, shell is thin and colorless.  Content is 2-8cells.
Acylostoma duodenale & Necatoramericanus -- human hookworms               • Small nematodes (1-1.5 cm)               • Hea...
• note the presence of four "teeth," two on each   side. 
Necator americanus• Note the presence of two cutting "teeth“.
Pathogenesis and Clinical     Manifestations                •   Skin penetration and                     associated second...
Hookworms  • The main concern with hook     worm disease is blood loss  •  0.03 ml to 0.26 ml (A.d) per     worm, up to 20...
Adults in intestinal mucosa
Diagnosis       Criterion:    1. Hemoglobin is lower than 120g/L in man, 110g/L in       woman.    2. find hookworm egg   ...
TREATMENT1.   Albendazole2.   Mebedazole
Prevention1. sanitary disposal of night soil2. individual protection3. health education4. cultivate hygienic habits5. trea...
 Entamoeba histolytica(amoebiasis)
Transmission• Amoebiasis is usually transmitted by the   fecal-oral route,•  but it can also be transmitted indirectly thr...
Pathology and        Clinical Manifestation• Pinpoint lesion on mucous membrane• Flask-shaped ulcers
A. Intestinal amoebiasis•   a. dysentery: dysenteric stools (pus and blood        dysentery:     without feces). fever, de...
Histopathology of a typical flask-shaped     ulcer of intestinal amebiasis
B. Extra-intestinal amoebiasis•     a. Hepatic •       (1) acute non-suppurative•       (2) liver abscess:•     b. Pulmonary
Amoebic Liver Abscess
Gross pathology of liver containing amebic               abscess
Gross pathology of amebic abscess of liver. Tube of         "chocolate" pus from abscess. 
   Note the reddish    brown colour of    the pus . This    colour is due to the    breakdown of liver    cells.
Diagnosis1. Stool examination2. Serologic studies: indirect hemagglutination, skin   tests, ELISA and latex agglutination....
Treatment and Prevention• Treatment:• Diodoquin-carriers• Metronidazole-dysentery, liver abscess
Preventing Amoebiasis• Drink only bottled or boiled (for 1 minute) water.•  Fountain drinks and any drinks with ice cubes ...
Food safety• Thoroughly cook all raw foods. • * Thoroughly wash raw   vegetables and fruits before   eating. • * Reheat fo...
Trophozoites   Cysts
Epidemiology    DistributionWorldwide distribution, endemic and epidemic.Traveler diarrheaPatients with variable immunodef...
Epidemiology  Transmission sourcePersons whose feces containing cystsMonkeys and pigs can also be infected, the infectedpi...
DiagnosisPathogenic examination  (1) Fecal examination  (2) Duodenal fluid or bile examination  (3) Intestinal examination...
Diagnosis Immunological diagnosisELISA: enzyme-linked immunosoebent assayIFA: indirect fluorescent antibody
Cysts have strong resistanceCysts can keep alive 10 or more days in feces      Cysts are often waterborne, either by takin...
Prevention and controlTreat the patients and cyst carriers Metronidazole TinidazoleTreatment of the drinking water  Suspec...
CRYPTOSPORIDIUM
   fecal-oral   Animal to human   Contamination of    water supplies (result    of waste runoff)   *WATER-BORNE    MOS...
SYMPTOMS• Immunocompetent              • Immunocompromised   – Mild self-limiting           – 50 or more stools per     en...
LAB DIAGNOSIS                 Microscopic    exam                   Acid                       fast stain of stool      ...
Cryptosporidium oocysts with acid-fast stain
LAB DIAGNOSIS                 Immunodiagnosis                     Immunofluorescence                      assay (IFA)   ...
• Infectious agents are the OOCYSTS• In immunocompromised patients ID50 is about 10     to 30 oocysts      
TREATMENT• Immunocompetent            • Immunocompromised   – Self-limiting              – Cocktail therapy -used         ...
PREVENTION• Wash hands• Wash fruits and  vegetables• Avoid untreated water• Treat contaminated  water• MAINTAIN PROPER  HY...
WATER PREVENTION          • Ozone          • UV light          • boiling          •   “Chlorine not               effectiv...
CONTROL OF PROTOZOA INDRINKING WATER     Multiple barrier approach:       Filtration       Chemical  inactivation- ozon...
INTESTINAL HELMINTHS  & INTESTINAL PROTOZOA
INTESTINAL HELMINTHS  & INTESTINAL PROTOZOA
INTESTINAL HELMINTHS  & INTESTINAL PROTOZOA
INTESTINAL HELMINTHS  & INTESTINAL PROTOZOA
INTESTINAL HELMINTHS  & INTESTINAL PROTOZOA
INTESTINAL HELMINTHS  & INTESTINAL PROTOZOA
INTESTINAL HELMINTHS  & INTESTINAL PROTOZOA
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INTESTINAL HELMINTHS & INTESTINAL PROTOZOA

  1. 1. INTESTINAL HELMINTHS &INTESTINAL PROTOZOA Submitted By :- Dr.Laximan Sawant (L-2011-V-91-M)
  2. 2. IntestInal helmInths
  3. 3. Ascaris
  4. 4. • Ascaris is a genus of parasitic nematode worms known as the  "giant intestinal roundworms". • One species, A. suum, typically infects pigs, • while another, A. lumbricoides, affects human populations,  typically in sub-tropical and tropical areas with poor  sanitation.
  5. 5. •  A. lumbricoides is the largest intestinal roundworm  and is the most common helminth infection of  humans worldwide, an infection known as ascariasis.
  6. 6. MorphologyFertile egg• mammillated • thick external layer 
  7. 7. Morphology Cont.Infertile egg• elongated and larger than  fertile egg • thin shelled 
  8. 8. Morphology Cont. Infertile  Fertile
  9. 9. Adult worm: tapered ends; length 15 to 35 cm Female are larger in size and have a genital girdle
  10. 10. Adult worm of A. lumbricoides
  11. 11. The 3 prominent “lips”
  12. 12. TRANSMISSION Ascariasis is not spread directly from one person to another. By the FAECAL-ORAL route, i.e., by ingestion of infective eggs with food or drink. Foods that are eaten raw such as salads and vegetables readily convey the infection, and so is polluted water.
  13. 13. • There is increasing evidence that dust may play an important role in the dissemination of ascaris in arid areas.
  14. 14. Pre-patency:2 monthsPneumonitis:4 – 16 days afterinfection,short duration(~3 wks)
  15. 15. Symptoms1. Symptoms associated with larvae migration• eosinophilic pneumonia, cough (Loefflers Syndrome)• Breathing difficulties and fever• Complications - asthmatic attacks, pulmonary infiltration 
  16. 16. Löeffler Syndrome (Pneumonitis) Transverse sections of Ascaris larvae in pulmonary alveoli
  17. 17. Symptoms Cont.2. Symptoms associated with adult parasite in the intestine• Usually asymptomatic• Abdominal discomfort, nausea in mild cases• Malnutrition• Sometimes fatality may occur when mass of worm blocks the  intestine
  18. 18. Adult Ascarisworms migrating inliver
  19. 19. Ascaris causingintestinalobstruction.
  20. 20. Ascaris(roundworm):The onlynematode evercoughed orvomited up
  21. 21. Diagnosis• Stool microscopy :• Eosinophilia:  eosinophilia can be found, particularly during  larval migration through the lungs• Ultrasound:  ultrasound exams can help to diagnose  hepatobiliary or pancreatic ascariasis.  • Endoscopic Retrograde Cholangiopancreatography (ERCP) : A duodenoscope with a snare to extract the worm out of the  patient
  22. 22. Treatment• Mebendazole• Albendazole
  23. 23. Prevention • Proper washing of the vegetables. • Health education. • Washing hands before meals. • Mass treatment for the patients. • Sanitary disposal for the feces. • Avoid uses of feces as manures.
  24. 24. The Human HookwormsNecator americanusAncylostoma duodenale
  25. 25.    Morphology1. Adults: They look like an odd piece thread and are about 1cm.2. They are white or light pinkish when living. ♀is slightly larger than♂.
  26. 26. 2. Eggs: oval in shape, shell is thin and colorless. Content is 2-8cells.
  27. 27. Acylostoma duodenale & Necatoramericanus -- human hookworms • Small nematodes (1-1.5 cm) • Head is slightly bend (hook) and the ‘mouth’ carries characteristic teeth (Ancylostoma) or plates (Necator,
  28. 28. • note the presence of four "teeth," two on each  side. 
  29. 29. Necator americanus• Note the presence of two cutting "teeth“.
  30. 30. Pathogenesis and Clinical Manifestations • Skin penetration and  associated secondary  bacterial infection can  result in “ground itch” • Pulmonary phase is  usually asymptomatic • Intestinal phase: worms  attach to the mucosa and  feed on blood. Worms  continuously move to  new places exacerbating  bleeding
  31. 31. Hookworms • The main concern with hook  worm disease is blood loss •  0.03 ml to 0.26 ml (A.d) per  worm, up to 200 ml per day in  heavy infections • Chronic heavy infection results  in anemia and iron deficiency
  32. 32. Adults in intestinal mucosa
  33. 33. Diagnosis Criterion: 1. Hemoglobin is lower than 120g/L in man, 110g/L in woman. 2. find hookworm egg Method:  1. saturated brine flotation technique 2. direct fecal smear 3. culture of larvae
  34. 34. TREATMENT1. Albendazole2. Mebedazole
  35. 35. Prevention1. sanitary disposal of night soil2. individual protection3. health education4. cultivate hygienic habits5. treat the patients and carriers.
  36. 36.  Entamoeba histolytica(amoebiasis)
  37. 37. Transmission• Amoebiasis is usually transmitted by the  fecal-oral route,•  but it can also be transmitted indirectly through  contact with dirty hands or objects as well as by  anal-oral contact.
  38. 38. Pathology and  Clinical Manifestation• Pinpoint lesion on mucous membrane• Flask-shaped ulcers
  39. 39. A. Intestinal amoebiasis•   a. dysentery: dysenteric stools (pus and blood  dysentery: without feces). fever, dehydration, and      electrolyte abnormalities. •   b. non-dysenteric colitis•   c. appendicitis•   d. amoeboma: may become the leading point of an intussusception or may cause intestinal obstruction.
  40. 40. Histopathology of a typical flask-shaped ulcer of intestinal amebiasis
  41. 41. B. Extra-intestinal amoebiasis•   a. Hepatic •     (1) acute non-suppurative•     (2) liver abscess:•   b. Pulmonary
  42. 42. Amoebic Liver Abscess
  43. 43. Gross pathology of liver containing amebic abscess
  44. 44. Gross pathology of amebic abscess of liver. Tube of "chocolate" pus from abscess. 
  45. 45.  Note the reddish brown colour of the pus . This colour is due to the breakdown of liver cells.
  46. 46. Diagnosis1. Stool examination2. Serologic studies: indirect hemagglutination, skin tests, ELISA and latex agglutination.3. Tissue examination: biopsy, aspiration
  47. 47. Treatment and Prevention• Treatment:• Diodoquin-carriers• Metronidazole-dysentery, liver abscess
  48. 48. Preventing Amoebiasis• Drink only bottled or boiled (for 1 minute) water.•  Fountain drinks and any drinks with ice cubes are not safe.  Water can be made safe by filtering it through an "absolute 1  micron or less" filter and dissolving iodine tablets in the  filtered water. • Avoid milk, cheese, or dairy products that may not have been  pasteurized. 
  49. 49. Food safety• Thoroughly cook all raw foods. • * Thoroughly wash raw  vegetables and fruits before  eating. • * Reheat food until the internal  temperature of the food  reaches at least 167º  Fahrenheit.• Wash your hands before  preparing food, before eating,  after going to the toilet or  changing diapers,  
  50. 50. Trophozoites Cysts
  51. 51. Epidemiology DistributionWorldwide distribution, endemic and epidemic.Traveler diarrheaPatients with variable immunodeficiency areincreasingly susceptible to infection with Giardia.
  52. 52. Epidemiology Transmission sourcePersons whose feces containing cystsMonkeys and pigs can also be infected, the infectedpig may be a source of human infection. Transmission drinking contaminated waterInfected by eating contaminated food
  53. 53. DiagnosisPathogenic examination (1) Fecal examination (2) Duodenal fluid or bile examination (3) Intestinal examination by gelatin capsule
  54. 54. Diagnosis Immunological diagnosisELISA: enzyme-linked immunosoebent assayIFA: indirect fluorescent antibody
  55. 55. Cysts have strong resistanceCysts can keep alive 10 or more days in feces Cysts are often waterborne, either by taking inadequately treated municipal water supplies of contaminated river or stream Giardiasis is more common in travelers, Immunodeficiency persons
  56. 56. Prevention and controlTreat the patients and cyst carriers Metronidazole TinidazoleTreatment of the drinking water Suspect water should be boiled or adequately filtered to remove the infective cysts before drinking.
  57. 57. CRYPTOSPORIDIUM
  58. 58.  fecal-oral Animal to human Contamination of water supplies (result of waste runoff) *WATER-BORNE MOST COMMON* COMMON
  59. 59. SYMPTOMS• Immunocompetent • Immunocompromised  – Mild self-limiting  – 50 or more stools per  enterocolitis (watery  day bloodless diarrhea,  – Dehydration (fatigue,  abdominal pain, nausea,  abdominal cramping,  vomiting, and fever) and nausea) – Common in AIDS  patients
  60. 60. LAB DIAGNOSIS  Microscopic exam  Acid fast stain of stool sample  Endoscopic biopsy of small intestine
  61. 61. Cryptosporidium oocysts with acid-fast stain
  62. 62. LAB DIAGNOSIS  Immunodiagnosis  Immunofluorescence assay (IFA)  Enzyme linked immunoabsorbant assay (ELISA)  Polymerase Chain Reaction (PCR)  Test of choice
  63. 63. • Infectious agents are the OOCYSTS• In immunocompromised patients ID50 is about 10 to 30 oocysts      
  64. 64. TREATMENT• Immunocompetent • Immunocompromised – Self-limiting – Cocktail therapy -used to treat symptoms but – Usually symptoms NOT THE DISEASE subside within 10 – Drugs include: letrazuril, days azithromycin, paramycin, and hyperimmune bovine colostral immunoglobulin *The only immunity is previous exposure and extent of this immunity is not known.*
  65. 65. PREVENTION• Wash hands• Wash fruits and vegetables• Avoid untreated water• Treat contaminated water• MAINTAIN PROPER HYGIENE!!
  66. 66. WATER PREVENTION • Ozone • UV light • boiling • “Chlorine not  effective against  crypto!!”
  67. 67. CONTROL OF PROTOZOA INDRINKING WATER  Multiple barrier approach:  Filtration  Chemical inactivation- ozone, combination of disinfectants  Medium-pressure ultraviolet light (UV)  Monitoring:  Presence of protozoa in raw water

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