Task Sheet: Case 1 Hide and Seek Behind the Bamboo Grove

1. Recall the definitions of

a. Communicable disease
Disease process that may be passed down to others
b. Parasite
Weaker organism that obtains food and shelter from another and
derives all the benefit from the association.
c. Predator
Hunts prey. Larger carnivore higher up on the food chain
d. Prey
Organism, usually a herbivore or smaller carnivore, that is hunted on
by a predator
e. Scavenger
Organism that scavenges for food
f. Symbiosis
Living together of unlike organisms
g. Commensalism
Symbiotic relationship in which two species live together and one
species benefits from the relationship without harming or benefiting
the other. (Entamoeba coli in GI)
h. Mutualism
Two organisms mutually benefit from each other ( termites and the
flagellates in GI)
i. Parasitism
Symbiotic relationship where one organism loves in or on another,
depending on the latter for its survival and usually at the expense of
the host.
ii. Facultative
May exist in a free living state or may become parasitic when the need
arises.
iii. Obligate
Need a host at some stage in their life cycle to complete their
development and to propagate their species.
iv. Endoparasite
Lives inside the body of its host (infection)
v. Ectoparastie
Lives outside the body of its host (infestation)
j. Phoreses
Relationship in which a smaller organism is carried by a larger
(cockroach that feed on fecal material may carry enteric organisms
and transfer these to food, which could be eaten by humans).
k. Host
i. Definitive: One in which the sexual cycle of the parasite occurs or one in which
the adult parasite is found. Where parasite attains sexual maturity.
ii. Intermediate host: harbors the asexual or larval stage of the parasite.
iii. Paratenic host: the parasite does not develop further to later stages, but remains
alive and is able to infect another susceptible host.
iv. Reservoir host: Mostly domestic animals that harbor parasites and are capable of
transmitting these parasites to man. Additional sources of infection.
v. Biologic vector: transmits the parasite only after the latter has completed its
development within the host. (Aedis mosquito)
2. Identify the prevalence and incidence of Parasitism in the Philippines
a. Ascaris: Cosmopolitan distribution. Prevalence : 80 -90% in high risk groups:
elementary/HS
b. Trichius : prevalence 80 84%
c. Enterobius: 29% among school children from exclusive private schools and 56%
public. Prevalence: 16 female and 9 males

3. Identify the
a. Environment
b. Host
i. Ecologic Triad
ii. Agent/Environment/Host
iii. Lever and Fulcrum Principle
1. Disease results from an imbalance between disease
agents and man/host
2. Nature and extent of the imbalance depend on the
nature and characteristic of the agent and host
3. The characteristic of the agent and host and their
interaction depend largely on the environment.
a. Agent: Metazoa
b. Host: Human (Carrier)
i. Subclinical: no symptoms
ii. Incubatory: may transmit before s/sx
iii. Convalescent: have recovered, may
still shed
iv. Chronic: lifelong infection/transmission
c. Environment: brings agents and hosts
together and influence their characteristics
and interrelationships.
i. Unsanitary disposal
ii. Presence of reservoir host
c. Effects of the Host on the parasites
Feeds and shelters the parasite
Genetic makeup of host may influence interaction between host and
parasite
a. Malaria sickle cell trait confers some protection
b. Plasmodium Duffy blood factor increases susceptibility.
Diet:
a. Protein rich: not suitable for the development of protozoa
b. Low protein: favors s/sx of amebiasis
c. High CHO: favors development of tapeworms
Immunity
a. Absolute immunity to reinfection occurs rarely after protozoan
infections
b. Acquired immunity may be very important in modifying the
severity of the disease in endemic areas.
d. Effects of the parasite on the host
Cause a disease process, morbidity, mortality
Interference with the vital processes of the host through the enzyme
systems
a. Entamoeba hystolitica secrete cysteine proteinases, which do
not only digest cellular material but also degrade epithelial
basement membrane facilitating tissue invasion.
Invasion and destruction of host tissue
a. Plasmodium invades RBCs leading to RBC rupture and release
of meorzoites.
b. Schistosoma japonicum cumulative deposition of eggs in the
liver stimulates an immune response resulting in granuloma
formation and then fibrosis leading to portal hypertension and
massive hemorrhage in the venules.
c. Hookworms have cutting plates, which can attach to the
intestinal mucosa and destroy the villi.
d. Ascaris large numbers can lead to intestinal obstruction and
may invade other organs like the appendix and bile ducts.
e. Parasite factors that contribute to the development of the disease/Parasite invasion
mechanisms
i. Most likely via mouth
T. solium, T. saginata, D latum from eating food harboring infective
larval stages
E. histolytica from drinking water with cysts

ii.

iii.
iv.

v.
vi.

Clonorchis, Opistorchis, and Haplorchis via improperly cooked fish with

parasitic larvae
Skin penetration
Hookworms and strongyloides via exposure of skin to soil
Schistosoma enter skin via water
Bites
Arthropods serving as vectors and transmitting parasites through bites
a. Malaria, filariasis, lesihmaniasis, trypanosmiasis
Congenital transmission
Toxoplamsa gondii trophozoites can cross the placental barrier
Transmammary infection with anclystoma and strongyloides via
mothers milk
Inhalation
Of air-borne eggs of Enterobius
Sexual intercourse
Trichomonas vaginalis

4. Identify the morphology of the following intestinal parasites (Ascaris, Enterobius, Trichus,
Anclycostoma) as to
a. Gross specimen
b. Microscopic slides
5. Draw/discuss/identify the lifecycle of Nematodes:
a. Ascaris
b. Enterobius
c. Trichiurs
d. Ancylostoma
6. Identify the clinical manifestations, as to:
a. Larval stage
b. Adult stage
7. Identify the ancillary diagnostic procedures to identify the lifecycle of the following
nematodes:
a. Ascaris
b. Enterobius
c. Trichiurs
d. Ancylostoma

Gross
Specimen

Morpholog
y

Ascaris
Adult: cylindrical with
a tapering anterior
end. Whitish streaks
are seen along the
entire length of the
body. Have three
characteristic well
developed lips.

Polymyarian type of
morphology. With
smooth striated
cuticles.
Males: 10-31 cm

Enterobius
Male: spindle shaped,
oral end lacks true
mouth capsule but has
3 lips and a pair of
laterally cephalic
inflections, called
cephalic alae.
Posteriori end is
strongly curved tetrad
with a single
conspicuous spicule.
Female: tail portion is
distinctly attenuate.
Vagina is long and
extends posteriorly.
Uteri are
tremendously
distended as the
entire body is packed
with eggs.
Meromyarian, two to
five cells per dorsal or
ventral half.
Female: 8-13mm by
0.4

Trichiurus
Adult: long, slender,
whip-like anterior
end, and a thicker
short posterior end.
Esophagus consists
of thin, narrow tube
surrounded by a
column of glandular
cells called
stichocytes.

Ancylostoma
Adult:
Generally stout,
somewhat
cylindrical objects.
Slightly constricted
anterior end and
continues in the
same curve as the
body. Large buccal
capsule is heavily
reinforced by a
chitinoid material,
oval in counter, with
a greater transverse
diameter.

Holomyarian, cells
are numerous, small,
and closely packed
in a narrow zone.

Meromyarian type
of somatic muscle
arrangement where
the cells are few in
number.

Male: 30 45 mm

Females: 22-35cm

Lifecycle

Clinical
Manifestati
on

Eggs in feces
fertilized SOIL
ingested larvae in
SI circulation
lungs trachea,
swallowed adults in
SI eggs in feces
(from indiscriminate
defecation).

Uteri distended with

eggs

Females : 35 0 50
mm

Male: 2-5 mm by 0.1

Males die after

copulation

Adults in lumen of
cecum lays egg on
perianal folds in
external environment
ingested
infective stage
embryonic egg
larvae hatch in
intestine penetrate
and envelop in
mucosa adults in
lumen of cecum.

Eggs in feces
advanced cleavage
in SOIL ingested
larvae hatch in
intestine
penetrate and
develop in mucosa
adult in cecum
eggs in feces

Infective stage: fully

embryonated egg.
Larva hatches in the
SI and penetrate the
intestinal wall. Larvae
enter venules to go to
the liver through the
portal vein, on to the
heart and pulmonary
vessels where they
break out of capillaries
to enter the air sacs.

Mild catarrhal
inflammation of the
intestinal mucosa
from the attachment
of the worms.
Mechanical irritation.

Frequent blood
streaked diarrheal
stools, abdominal
pain and tenderness,
NV, anemia, and
weight loss.

Migration of egglaying females to the

anus causes irritation
of the peril anal
region.

No larval migration
to the heart/lungs

Lung: Host
sensitization allergic
manifestations (lung
infil, asthma attacks,
and lip edema). Vague
abdominal pain. With
eosinophilia
Heavy infx bowel
obstruction.

Scratching
secondary bacterial
infection.

Invasion of H.
hemolyica possible

Direct Fecal smear

Kato technique or
cellophane thick
smear method.
Kato Katz

Cellulose-tape
perianal swab:
Best obtained a few
hours after person has
returned, or the first in
the morning before
bowel movement or
bath.

Females: 9-11 mm
by 0.35 mm
Males: 5-9 mm by
0.3mm
Eggs in feces
embryonated egg in
external
environment
rhabditiform larva
rhabditiform
larva in soil
filariform larva
(infective stage)
skin penetration
circulation lungs
trachea
pharynx
swallowed
attached to SI
adults eggs in
feces.
Skin:
maculopapular
lesions, localized
erythema. ground
itch
Lung: if abundant
pneomonitis,
bronchitis.
SI: abdominal pain,
steatorrhea,
diarrhea with blood.
Blood eosinpohilia.
CHRONIC.
Progressive,
secondary,
microytic,
hypochromic
anemia of the iron
deficiency type, due
to primarily to
continuous loss of
blood.

Severe colicky
abdominal pain,
brought about by
movements of the
worm inside.

Diagnostic
procedures

Small, cylindrical,
fusiform, grayishwhite.

Seen in heavy
frequent blood
streaked diarrhea...
rectal prolpse where
worms are attached
to mucosa.
Lab: Direct fecal
smear

Hypoalbuminema
r/t combined loss of
blood, lymph, and
protein.
Direct Fecal Smear
Kato technique
ZnSO4 centrifugal
flotation
HaradaMori
hatching

Treatment
plan:

Broad spectrum
antihleminthics:
DOC: albendazole
400mg single dose
(200 mg for children
under 2)
Teratogenic.

Grahams scotch
adhesive tape
DOC; pyrantel
pamouate (10mg/kg)

Kato Katz technique

DOC: mebendazole
500 mg

High reoccurrence
rates... treatment
may be impractical.
Priority given to
women, children
and patients with
malnutrition. PTB or
anemia.
Broad spec; meben
and alben
(benzimadaole
blocks the uptake of
glucose by most
intestinal and tissue
nematodes.)
DOC: albendazole
(larvicidal and
ovicidal) 400mg.

Prevention

Sanitary disposal of
human feces.
Health education
Mass chemotherapy
done periodically with
target population.

The only intestinal

nematode that cannot
be controlled through
sanitary disposal of
human feces.

Sanitary disposal of
human feces.
Health education
Mass chemotherapy
done periodically
with target
population. Wash
hands. Thorough
washing hand
cooking of food.

Anemia: give iron

and better diet.
Sanitary disposal of
human feces.
Health education
Mass chemotherapy
done periodically
with target
population. Wearing
of shoes

8. Identify the role of the private practitioner in the prevention of communicable diseases
and parasitism vs. role of the public health physician.
Prevent disease
Early detection
Clinician must use all the skills of medicine to diagnose the infection
and prescribe appropriate treatment.
a. Given limitation of the public health physicians, he/she must be
mindful of the prevalence and certain diseases in his/her area.
Must consider interventions directed at the community level:
education, mass chemotherapy, encouragement of the use of
proper sanitation. (teaching geared at children is almost
synonymous to community targeted intervention as family are
more involved)
Must conduct Through physical examination and must pay attention to
minute details: soft heart murmur that may be indicative of bacterial
endocarditis,
9. Make a wellness plan for the patient and his family, regarding prevention of parasitism.
Learning Goal:

Task Sheet: Case 2 Kinilaw King

1. Identify/discuss the types of cestodes that are commonly found in the Philippine:
a. Taenia saginata
b. Taenia solium
2. Identify/discuss the epidemiology of T. solium and T. saginata
3. Identify/discuss the mode of transmission and lifecycle of tapeworms.
4. Identify/discuss the signs and symptoms related t tapeworm infection.
5. Identify/discuss the mode of treatment of Taeniasis
a. T. Saginata
b. T. solium
6. Identify/discuss the methods of preventing tapeworm infection
Taenia saginata
Beef tapeworm of humans.
Cosmopolitan in distribution
Humans as definitive host
Lives in upper jejunum 25 years

Morphology

Pathogenes
is

Chief complaint: irritated by alcohol, and

passage of proglottids sometimes result
after a drinking bout.
Devoid of hooks or resotellum. Attached
to scholex is a short neck from which a
chain of immature, mature and gravid
progllotids develop.

Nonspecific symptoms: epigastric pain,

vague discomfort, hunger pangs,
weakness, weight loss, loss of appetite,

Taenia Solis
Pork tapeworm of man. Cosmopolitan
distribution. May serve as definitive or
intermediate host.

Adult 2-4 meters in length.

Scholex carries a cushion like rostellum with a
double crown of 25 to 30 large and small hooks.
Resembles T. saginata, except: difference lies in
the presence of an accessory ovarian lobe, the
absence of a vaginal sphincter, and the smaller
number of follicular testes in the mature
proglottid.
Intestinal: mild nonspecific abdominal
complaints. Unlikely obstruction.

pruritis ani.
Rare: obstruction.

Diagnosis

Lifecycle

Treatment

Epidemiolo
gy

Prevention

Sp. Dx; proglottids, eggs or scholex,

Egg in feces embryonated eggs or

proglottids ingested CATTLE
oncosphere hatches, penetrates intestinal
wall circulation circulation
cucticrercus bovis in muscle tissue of
cattle ingested raw or with improperly
cooked meat Scholex attaches to
intestine adult in small intestine.
Gravid proglottids - egg in feces.
DOC: praziquantel 5-10mg/kg

Cystercercosis most common in striated

muscles and in the brain. Cysts may survive for
5 years. Upon death, the cystic fluid increases
and there is a pronounce tissue response to the
parasite. The parasite is eventually calcified.
Symptomology dependent on the size and
location of the lesion.
Neurocysticcercosis Convulsions
Sp. Dx; proglottids, eggs or scholex
Neurocysticcercosis may be suspected in a
patient with epileptic seizers without associated
systemic symptoms but living in an endemic
area.
CT, MRI
CSF ELISA, EITB, Western blot for IgG and IgM. ,
Egg in feces pork intermediate host
oncosphere hatches penetrates intestinal wall
circulation ingested with raw or improperly
cooked meat scolex attaches to intestine
adult in SM gravid proglottids in feces or
environment circulation oncosphere hatches
penetrates intestinal wall - -> cycsticercus in
lungs, brain, eye, CT.

Intestine; Praziquantel and niclosamide

Cysticercus: praziquanel at higher doses.
Corticosteroid and mannitol therapy
Distribution of both infections is highly related to the habit of eating raw or improperly
cooked meat. (Religious restrictions...)
T. solium: Slavic counties, Latin America, Southeast Asia, China, and India
T. saginata endemnicity in Ethiopia and east Africa.
Maintenance of the life cycle is dependent on the level of environmental sanitation practiced
in the area.
Animal intermediate hosts especially the pigs should be kept in pens to avoid access to
human feces.
Contamination of the grazing fields with human feces favors infection of the intermediate
hosts.
Philippines: T. saginata > T. solium
Though surveys show that pigs are more infected than cattle
Overall prevalence of taeniasis: 0.56% in selected areas.
Thorough cooking of meat is a primary measure. Freezing at -20 C for 10 days
Sanitary inspection of all slaughtered pigs, cows, and cattle.