This document discusses trematodes (flukes) and focuses on schistosomes. It describes the classification, morphology, life cycles, transmission, pathogenesis and clinical features, diagnosis and treatment of schistosomes. The three main schistosome species that infect humans are discussed - Schistosoma haematobium, S. mansoni and S. japonicum. S. haematobium causes urogenital schistosomiasis. S. mansoni causes intestinal schistosomiasis. S. japonicum is the most pathogenic and can infect both humans and other animals.
Strategies Novartis can use to GROW from a Billion Dollar Company to a Trillion Dollar Company like Alphabet Inc
Novartis is a leading healthcare company which is situated in Switzerland and uses digital technologies and innovative science to come up with transformative ways of treatment in areas of great medicinal needs. This article explains what Novartis strategies and what they should employ so that they can rise from a billion dollar company to a trillion dollar company like the Google Alphabet Inc.
Novartis was formed in March 1996 by the merging of pharmaceutical and agrochemical divisions of Ciba-Geigy and Sandoz companies. Thanks to the merging of the two companies, Novartis is one of the biggest pharmaceutical companies in the world. Novartis is one of the largest companies which achieved a great milestone within a few decades. Novartis as a whole is divided into three major divisions: Sandoz (generics), Innovative Medicines and Alcon (eyecare). Novartis is also involved in collaborative research projects that are publicly funded.
Below are some of Novartis best selling drugs and their revenue
1.Cosenty – This is the top selling drug with a revenue of 4.788 billion dollars
2.Enfresto – This has a revenue of 4.644 billions dollars
3.Promacta – This has a revenue 0f 2.088 billion dollars
Medicine manufactured by Novartis and their uses
Medicine Medicine use
Cosentyx Used to treat psoriatic arthritis
Entresto Used to treat heart failure
Lucentis Used to block abnormal vessel growth in the back of the eye
Tasigna Used to treat chronic myelogenous leukemia which has the Philadelphia chromosome
Jakavi Used to treat myelofibrosis, polycythemia vera and graft-versus-host disease
Promacta Used to treat patients with abnormal low platelet count
Sandostatin Used to treat patients with tumor experiencing symptoms like flushing and diarrhea
Xolair Used to treat moderate and severe asthma
Gilenya Used to treat multiple sclerosis
How Novartis became one of the biggest pharmaceutical companies in the world
1.Market control through partnership
Geigy, Sandoz and Ciba combined their power so that they can compete with strong foreign firms and formed a cartel called the Basal Syndicate or Basal IG. Basal IG secured most of the manufacturing facilities all over the US and across Europe. It later joined with IG Farben and other chemical companies to form a big cartel called the Quadrapartite Cartel which dominated all of the European market and enjoyed the profits made from the joint manufacturing.
2.Growth acceleration through mergers
Since competition was very rampant in the pharmaceutical industry, Ciba and Geigy decided to merge with Sandoz AG to form Novartis. With this merge, Novartis became one of the growing giants in the pharmaceutical industry. This made Novartis gain a lot of fame and build a strong reputation over other companies. Novartis majored on agrochemical and pharmaceutical industries which made it easy to focus on a specific mar
discussion about nematode,
their form, general characteristics, life cycle, discussion about their host.
diseases caused by nematodes
and discussion about different class of nematodes.
Strategies Novartis can use to GROW from a Billion Dollar Company to a Trillion Dollar Company like Alphabet Inc
Novartis is a leading healthcare company which is situated in Switzerland and uses digital technologies and innovative science to come up with transformative ways of treatment in areas of great medicinal needs. This article explains what Novartis strategies and what they should employ so that they can rise from a billion dollar company to a trillion dollar company like the Google Alphabet Inc.
Novartis was formed in March 1996 by the merging of pharmaceutical and agrochemical divisions of Ciba-Geigy and Sandoz companies. Thanks to the merging of the two companies, Novartis is one of the biggest pharmaceutical companies in the world. Novartis is one of the largest companies which achieved a great milestone within a few decades. Novartis as a whole is divided into three major divisions: Sandoz (generics), Innovative Medicines and Alcon (eyecare). Novartis is also involved in collaborative research projects that are publicly funded.
Below are some of Novartis best selling drugs and their revenue
1.Cosenty – This is the top selling drug with a revenue of 4.788 billion dollars
2.Enfresto – This has a revenue of 4.644 billions dollars
3.Promacta – This has a revenue 0f 2.088 billion dollars
Medicine manufactured by Novartis and their uses
Medicine Medicine use
Cosentyx Used to treat psoriatic arthritis
Entresto Used to treat heart failure
Lucentis Used to block abnormal vessel growth in the back of the eye
Tasigna Used to treat chronic myelogenous leukemia which has the Philadelphia chromosome
Jakavi Used to treat myelofibrosis, polycythemia vera and graft-versus-host disease
Promacta Used to treat patients with abnormal low platelet count
Sandostatin Used to treat patients with tumor experiencing symptoms like flushing and diarrhea
Xolair Used to treat moderate and severe asthma
Gilenya Used to treat multiple sclerosis
How Novartis became one of the biggest pharmaceutical companies in the world
1.Market control through partnership
Geigy, Sandoz and Ciba combined their power so that they can compete with strong foreign firms and formed a cartel called the Basal Syndicate or Basal IG. Basal IG secured most of the manufacturing facilities all over the US and across Europe. It later joined with IG Farben and other chemical companies to form a big cartel called the Quadrapartite Cartel which dominated all of the European market and enjoyed the profits made from the joint manufacturing.
2.Growth acceleration through mergers
Since competition was very rampant in the pharmaceutical industry, Ciba and Geigy decided to merge with Sandoz AG to form Novartis. With this merge, Novartis became one of the growing giants in the pharmaceutical industry. This made Novartis gain a lot of fame and build a strong reputation over other companies. Novartis majored on agrochemical and pharmaceutical industries which made it easy to focus on a specific mar
discussion about nematode,
their form, general characteristics, life cycle, discussion about their host.
diseases caused by nematodes
and discussion about different class of nematodes.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
4. Classification of Trematodes-
Based on the habitat
• Blood trematodes (flukes)
• Hepatic trematodes (flukes)
• Intestinal trematodes (flukes)
Essentials of Medical Parasitology
5. General characteristics of trematodes
• Trematodes exist in three morphological forms—
adult worm, egg and larva.
Essentials of Medical Parasitology
6. Adult Worm
The adult worms are unsegmented and flattened
dorsoventrally but some have thick fleshy bodies
Essentials of Medical Parasitology
7. Eggs
Oviparous, i.e. they lay eggs; which develop into larvae
later in the environment
• Eggs - operculated
• Except Schistosomes are eggs are non-operculated
(possess a spine).
Essentials of Medical Parasitology
8. Larvae
• Trematodes have five larval forms:
o Miracidium
o Sporocyst
o Redia (first and second generation)
o Cercaria
o Metacercaria
• Schistosomes differ from other trematodes as they do not
have redia and metacercaria larvae (they possess two
generations of sporocyst larvae)
Essentials of Medical Parasitology
9. Life cycle
• Host: Trematodes complete their life cycle in three
different hosts:
o one definitive host (man)
o two intermediate hosts.
• First intermediate host - fresh water snail or mollusk
• Second intermediate host - aquatic plant or fish or crab.
How ever, schistosomes do not need a second
intermediate host.
Essentials of Medical Parasitology
10. Mode of transmission
• By eating aquatic plants, fishes or crabs harboring
infective form (meta cercariae larva)
• Penetration of free living cercariae larva (infective form,
in schistosomiasis).
Essentials of Medical Parasitology
11. Treatment
• Praziquantel is the drug of choice for all trematodes
infection except
• Fasciola, where triclabendazole is recommended.
Essentials of Medical Parasitology
14. Taxonomy
• Order: Strigeida
• Superfamily: Schistosomatoidea
• Family: Schistosomatidae
Essentials of Medical Parasitology
15. Morphology-Adult Worm
Essentials of Medical Parasitology
Adult worms of schistosomes (The thin female worm resides in the gynecophoric canal
of the thicker male worm)
A
17. Morphology- Larva
Larval forms are
• Miracidium
• Sporocysts (first and second generations)
• Cercaria.
There are no rediae and metacercariae stages
Essentials of Medical Parasitology
18. SCHISTOSOMA HAEMATOBIUM
• Habitat - Adult male worm holds the female worm
and resides in the venous plexus of urinary bladder
and ureter.
Essentials of Medical Parasitology
19. Epidemiology
• Endemic in 53 countries in the Middle East, the African
continent (across Nile river valley) and the Indian Ocean
islands (Madagascar, Zanzibar and Pemba).
• Extremely rare in India.
Essentials of Medical Parasitology
20. Life cycle
• Definitive host: Man
• Intermediate host: Freshwater snails of genus Bulinus.
• Mode of transmission: Man acquires infection by
penetration of skin by the infective form (cercariae)
present in contaminated water.
Essentials of Medical Parasitology
21. Life cycle of Schistosoma species
Essentials of Medical Parasitology
22. Pathogenesis and clinical features
Acute Schistosomiasis
• The invasion of cercariae in the skin causes dermatitis at
penetration site followed by allergic pruritic papular
lesion.
• Migration of schistosomula in lungs causes cough with
mild fever.
• Chronic Schistosomiasis
• Urogenital disease
Essentials of Medical Parasitology
23. Pathogenesis and clinical features
Chronic Schistosomiasis
• Urogenital disease - cystitis glandularis
• Obstructive uropathies
• Bladder carcinoma - Squamous cell carcinoma
Essentials of Medical Parasitology
25. Cross-over infection
• Though eggs of S. haematobium and S. mansoni are
usually found in urine and stool respectively; in heavy
infection, S. haematobium eggs can be found in stool
and S. mansoni eggs may be passed in urine.
• This is due to adult worms may be found in the
vessels that are not their normal habitat.
Essentials of Medical Parasitology
27. Treatment
• Praziquantel is the drug of choice; given 20 mg/kg/dose,
two doses in single day.
• Metrifonate can be give alternatively.
Essentials of Medical Parasitology
28. Prevention
• Proper disposal of human excreta and urine
• Eradication of snails by using molluscicides such as
metal salts (iron or aluminum sulfate), metaldehyde,
methiocarb and acetylcholine esterase inhibitors
• Treatment of infected persons.
Essentials of Medical Parasitology
29. Elimination of schistosomiasis
• The WHO is currently moving towards elimination of
schistosomiasis as a public health problem in Africa by
2020 and globally by 2025.
• Achieved through treatment of cases using praziquantel
to prevent morbidity in later life and also through mass
drug administration in some places (Egypt and China).
Essentials of Medical Parasitology
30. SCHISTOSOMA MANSONI
• S. mansoni produces intestinal schistosomiasis in
humans.
• Habitat - Adult male and female worms reside in
mesenteric veins draining sigmoidorectal region.
• Epidemiology
o No cases have been reported from India so far.
Essentials of Medical Parasitology
31. Morphology
• Adult worms are similar to other schistosomes with
• some minor differences
• Nonoperculated eggs have characteristic lateral
spine.
• Fork tailed cercaria is the infective form.
Essentials of Medical Parasitology
32. Life cycle
Life cycle of S. mansoni is similar to S. haematobium except:
• Humans are the definitive host; sometimes other vertebrate
hosts like monkeys, chimpanzees and dogs may act as
reservoir and definitive host
• Fresh water snails of Biomphalaria species are intermediate
hosts
• Pre-patent period is about 4–7 weeks
• Adult worm lives in mesenteric veins draining sigmoidorectal
region.
Essentials of Medical Parasitology
33. Pathogenesis and clinical feature
• Cercarial Dermatitis
• Acute Schistosomiasis (Katayama Syndrome)
o Acute phase of disease occurs within 4–8 weeks of
infection, especially when the schistosomes start
producing eggs.
o Antigens (released from eggs) and the adult worms
stimulate the host humoral response, leading to the
formation of immune complexes and serum sickness like
illness called Katayama fever
Essentials of Medical Parasitology
34. Chronic Schistosomiasis
• Intestinal disease - granuloma formation around the eggs in the
intestine.
• Hepatosplenic disease - Granuloma formation and fibrosis in
liver
• Pulmonary involvement
• Neuroschistosomiasis involving brain and spinal Cord
• Kidney: Nephrosclerosis and kidney failure
• Liver abscess: S. aureus colonizes the granuloma leading to liver
abscess.
Essentials of Medical Parasitology
35. Laboratory diagnosis
Stool Microscopy:
• Acute cases, eggs with lateral spine can be
demonstrated in stool or rarely in urine
• In chronic cases or in patients with low worm
burden, the number of eggs excreted in stool is less
and intermittent.
Essentials of Medical Parasitology
36. • Rectal Biopsy Specimen -Histopathological
demonstration of lateral spined eggs in biopsy
material from rectal mucosa
Essentials of Medical Parasitology
Laboratory diagnosis (cont..)
37. • Antibody Detection - Less useful as they cross-react with
other helminth infections
• Antigen Detection - Useful for assessing the severity of
disease and to monitor the efficacy of treatment.
o ELISA is available to detect circulating schistosome
antigens (CCA and CAA) in the serum and urine
o Dipstick test is available for detecting CCA in urine
Essentials of Medical Parasitology
Laboratory diagnosis (cont..)
38. Treatment
• Praziquantel is the drug of choice; given 20 mg/kg/dose,
two doses in single day.
• Oxamniquine is also very effective.
Essentials of Medical Parasitology
39. SCHISTOSOMA JAPONICUM
• Most pathogenic species among the schistosomes.
• Only schistosome species that shows zoonotic
transmission.
Essentials of Medical Parasitology
40. Habitat and epidemiology
• Habitat - Adult worms reside in the mesenteric veins
draining the ileocecal region.
• Epidemiology - Most commonly in China, Indonesia and
Philippines. It is eradicated from Japan since 1960.
• No cases have been reported from India so far.
Essentials of Medical Parasitology
41. Morphology
• Adult worms are similar to other schistosomes with the
following differences:
• Tegument: The body surface is smooth
• Eggs are relatively smaller and more spherical than those
of other schistosomes and have rudimentary lateral
spine
Essentials of Medical Parasitology
42. Life cycle
• Life cycle of S. japonicum is similar to that of S. mansoni with
few exceptions:
• Definitive host is mainly man and some times domestic
animals like cat, dog and cattle
• Intermediate host—snails of Oncomelania species
• Prepatent period is around 5 weeks
• Higher egg output: The female worm lays more than 3,000
eggs/day.
Essentials of Medical Parasitology
43. Pathogenesis and clinical features
• Cercarial dermatitis
• Katayama fever
• Intestinal disease: Deposition of egg granulomas in the
intestinal wall (large intestine) leads to mucosal hyperplasia,
ulcers, micro abscess formation and sometimes,
pseudopolyposis with blood loss
• Hepatosplenic disease
• Cerebral schistosomiasis
• Carcinoma: Both colorectal carcinoma and liver carcinoma
Essentials of Medical Parasitology
44. Laboratory diagnosis
• The diagnostic methods of S. japonicum is similar to
that of S. mansoni.
• The additional information tests:
o Pyrosequencing
o Magnetic fractionation method
Essentials of Medical Parasitology
45. Treatment
• Praziquantel is given 20 mg/kg/dose, three doses in
single day.
Vaccine
• No vaccine is licensed
Essentials of Medical Parasitology
47. LIVER FLUKES –
FASCIOLA HEPATICA
• Fasciola hepatica, also known as the common liver
fluke or sheep liver fluke.
• The disease is called fascioliasis.
Essentials of Medical Parasitology
50. Life cycle
• Host: Sheep is the principal definitive host. Goats cattle
and humans are other definitive hosts.
• The amphibian snails (Genus: Lymnaea) are the first
intermediate hosts
• Water plants serve as the second intermediate hosts.
• Mode of transmission: The sheep and other definitive
hosts including man get infection by eating water plants
and water cress containing metacercariae.
Essentials of Medical Parasitology
52. Pathogenesis
• Incubation period varies from days to few months.
• Acute disease - develops during metacercarial migration (1–2
weeks after infection) and includes fever, Right upper-
quadrant pain, hepatomegaly and eosinophilia.
• Chronic phase - Liver parenchyma is inflamed with formation
of multiple subcapsular abscesses (called as liver rot). Bile
duct obstruction by adult worm and biliary cirrhosis are also
reported but less commonly.
• Halzoun or Marrara syndrome
Essentials of Medical Parasitology
53. Laboratory diagnosis
• Stool Microscopy -Typical operculated eggs can be
demonstrated in the stool specimen
• Operculated eggs of F. hepatica are morphologically similar
to that of F. gigantica, F. buski, Echinostoma and
Gastrodiscoides
• Spurious infection (pseudofascioliasis): eggs may be detected
in the stool of people who have eaten F. hepatica infected
liver. This can be differentiated from true infection by stool
examination of the patient, 3 days after a liver free diet.
Essentials of Medical Parasitology
54. • Antibody Detection - helps in early diagnosis before the
eggs are detected in stool.
o ELISA, counterimmune electrophoresis and Western blot
techniques
• Molecular Methods - PCR-based methods are available to
detect F. hepatica specific genes in stool specimens. PCR is
highly sensitive
• Other Methods - Imaging methods
Essentials of Medical Parasitology
Laboratory diagnosis (cont..)
55. FASCIOLA GIGANTICA
• Life cycle: Similar to that of F. hepatica. Only
difference is first intermediate host is aquatic snail
• Clinical features and laboratory diagnosis and
treatment: Same as that of F. hepatica.
Essentials of Medical Parasitology
56. CLONORCHIS SINENSIS
• Habitat - Adult worm lives in the bile duct, pancreatic
duct and common bile duct of man and other domestic
animals.
• Epidemiology - found primarily in Eastern Asia like
China, Korea, Japan and Malaysia; infects over 35 million
peopleglobally.
• However, infections from India are not reported so far
though the first case was detected from Kolkata.
Essentials of Medical Parasitology
59. Essentials of Medical Parasitology
MORPHOLOGY
EGG
(saline mount) showing the small knob at
the abopercular end (flask-shaped
appearance)
60. Life cycle of Clonorchis sinensis
Essentials of Medical Parasitology
61. Pathogenesis
• In light worm burden: People are usually asymptomatic
• In chronic infection with heavy worm burden:
o Mechanical obstruction of the bile duct and irritation
due to toxin released by the flukes leads to cholangitis,
dilatation of the bile duct and bile retention
o Bile duct carcinoma: Chronic irritation of the bile duct
for long periods can lead to cholangiocarcinoma.
Essentials of Medical Parasitology
62. Laboratory diagnosis
• Stool Microscopy - Demonstration of the characteristic
flask-shaped eggs in the stool establishes the diagnosis.
• Antibody detection: ELISA using recombinant propeptide
of cathepsin L proteinase (rCsCatLpropeptide) is available
for detection of specific IgG4 antibodies.
• Antigen detection: ELISA is also available for detection of
circulating antigen in the serum
Essentials of Medical Parasitology
63. • Molecular Methods - multiplex PCR; Real-time PCR is
developed targeting mitochondrial NADH
dehydrogenase subunit 2 (nad2) DNA elements.
Essentials of Medical Parasitology
Laboratory diagnosis (cont..)
64. Treatment
• Praziquantel (25 mg/kg, three doses in 1 day) is the
drug of choice
Essentials of Medical Parasitology
66. • Eggs measure 27 µm × 15 µm in size, flask shaped
with an operculum and a knob, similar to that of C.
sinensis.
Essentials of Medical Parasitology
MORPHOLOGY- Eggs
67. MORPHOLOGY-
LARVAE
• Metacercaria is the infective form of the parasite.
• Found in the flesh of the fresh water fish. Other
larval stages are cercaria, redia, sporocyst and
miracidium.
Essentials of Medical Parasitology
68. INTESTINAL FLUKES-
FASCIOLOPSIS BUSKI
• Habitat - found in the mucosa of duodenum and
jejunum of man and pig.
• Epidemiology - mainly endemic in Southeast Asian
countries such as India, China, Pakistan, Bangladesh,
Thailand and Malaysia.
• Risk factors include poverty, unhygienic sociocultural
practices, food habits and availability of open type of
pig farms
Essentials of Medical Parasitology
70. MORPHOLOGY (cont..)
• Eggs are large (130–140 µm × 80–85 µm size),
operulated and bile stained eggs, similar to that of F.
hepatica.
• Larvae - Metacercaria is the infective form to man
and pig.
Essentials of Medical Parasitology
72. Pathogenesis
• Light infection: It may be asymptomatic or its
attachment to intestinal mucosa leads to local
inflammation, ulcerations with mucus and blood in stool
• In severe infection: Partial obstruction of intestinal
tract, malabsorption and protein losing enteropathy,
marked eosinophilia and leukocytosis
Essentials of Medical Parasitology
73. Laboratory diagnosis
• Detection of large number of operculated eggs in the
stool sample gives probable diagnosis of F. buski.
Essentials of Medical Parasitology
74. Treatment
• Praziquantel is the drug of choice. It is given as 25 mg/kg,
three doses in 1 day
• Niclosamide is given alternatively.
Essentials of Medical Parasitology
75. OTHER LESS COMMON INTESTINAL
TREMATODES
• Gastrodiscoides hominis
Essentials of Medical Parasitology
76. OTHER LESS COMMON INTESTINAL
TREMATODES
• Heterophyes heterophyes
Essentials of Medical Parasitology
77. OTHER LESS COMMON INTESTINAL
TREMATODES
• Metagonimus yokogawai
Essentials of Medical Parasitology
78. LUNG FLUKE –
PARAGONIMUS WESTERMANI
• Paragonimus westermani is also known as oriental
lung fluke.
• Causes endemic hemoptysis in man.
Essentials of Medical Parasitology
79. Epidemiology
• Paragonimiasis is endemic in Northeast states of
India.
• Many cases are reported from Manipur with a
prevalence of 6.7%.
Essentials of Medical Parasitology
80. Habitat
• Adult worm lives in the parenchyma of lung.
Essentials of Medical Parasitology
82. LIFE CYCLE
• Host: P. westermani completes its life cycle in one
definitive host (man, or dogs and cats)
Two intermediate hosts:
• first—snail (Genus: Melania or Semisulcospira and Brotia
species),
• second—crabs or crayfishes.
• Mode of transmission: Man acquires infection by eating
uncooked, partially cooked, salted, or pickled crab or
crayfish
Essentials of Medical Parasitology
84. Pathogenesis
• Pulmonary Paragonimiasis
• Extrapulmonary Paragonimiasis –
o Cerebral paragonimiasis
o Cutaneous paragonimiasis: Migratory subcutaneous
nodules
o Larva migrans
Essentials of Medical Parasitology