Lecture 27,28,29,30: Parasitology 4 lectures titled L 27: Intestinal protozoa L 28: Blood and tissue protozoa L 29: Intestinal helminths 4 lectures titled L 27: Intestinal protozoa L 28: Blood and tissue protozoa L 29: Intestinal helminths L 30: Tissue helminths. L 30: Tissue helminths.OBJECTIVES: The objectives of this lecture are to introduce students to the basic concepts of parasitology introduce students to the basic concepts of parasitology introduce the various terms related to parasitology introduce the various terms related to parasitology highlight the significance of life cycle in the laboratory diagnosis of parasitic infections highlight the significance of life cycle in the laboratory diagnosis of parasitic infections

At the end of these lectures, students should be able to: restate the basic concepts of parasitology restate the basic concepts of parasitology define of the various terms related to basic parasitology define of the various terms related to basic parasitology discuss briefly the life cycle and pathogenesis of medically important parasites discuss briefly the life cycle and pathogenesis of medically important parasites apply the knowledge of the life cycle to the principles of laboratory diagnosis apply the knowledge of the life cycle to the principles of laboratory diagnosis Learning Outcomes

6B-parasitology-CHECK SLO General properties of parasites General properties of protozoa/helminth Helminth-cestode/trematode/nematode Life cycle Entamoeba/ Malaria/ Giardia Life cycle Ascariasis/Ankylostoma/Filarial worms Lab diagnosis-sample collection Microscopy-egg/cyst/trophozoite Culture/PCR/ag detection/ab detection

Assignment-Wormy world symposium , , restate the basic concepts of parasitology restate the basic concepts of parasitology define of the various terms related to basic parasitology (do not just google-it may show layman definitions) define of the various terms related to basic parasitology (do not just google-it may show layman definitions) discuss briefly the life cycle and pathogenesis of Plasmodium, Babesia, Toxoplasma, Leishmania etc discuss briefly the life cycle and pathogenesis of Plasmodium, Babesia, Toxoplasma, Leishmania etc apply the knowledge of the life cycle to the principles of laboratory diagnosis (How the knowledge of life cycle will help in diagnosis?) apply the knowledge of the life cycle to the principles of laboratory diagnosis (How the knowledge of life cycle will help in diagnosis?)

Dr.P.K.Rajesh.M.D. Malaria Mal- aria=bad air Female anopheles Protozoan Plasmodium APICOMPLEXA

Dr.P.K.Rajesh.M.D. 500_BCHippocratesClinical Symptoms 1880LaveranBlood Stage 1898RossMosquito Transmission 1948GarnhamLiver Stage Introduction will include history, but if you are just seeing this slide and tomorrow is the final exam, go to sleep!anyway no need to mug this slide.

Dr.P.K.Rajesh.M.D. Plasmodium Agent causing malaria APICOMPLEXA Plasmodium vivax Plasmodium falciparum Plasmodium malariae Plasmodium ovale Plasmodium knowlesii Mosquito-definite host Man-intermediate host

Dr.P.K.Rajesh.M.D. Distribution Equatorial Vector/agent Plasmodium vivax Plasmodium falciparum Plasmodium malariae Plasmodium ovale Plasmodium knowlesii

Dr.P.K.Rajesh.M.D. Modes of transmission Female Anopheles Mosquito bite Blood transfusion Syringes/needles Transplacental

Dr.P.K.Rajesh.M.D. Life Cycle Mosquito salivary gland Sporozoites Liver merozoites RBC trophozoites, schizont, merozoites Gametocytes

Dr.P.K.Rajesh.M.D. All the best if you were not present for this lecture.

Dr.P.K.Rajesh.M.D. After completing the lesson come back to this slide to check if you can link the diagnosis to the life cycle.If you can make a poster for symposium

Dr.P.K.Rajesh.M.D.

P.vivax LIVER-8 DAYS(42 um) RBC-t(3u),s(10u),m(1.5u) 2 DAY,TERTIAN Single ring stage RBC’S enlarged Gametocytes Micro-9-10,large lateral nucleus Macro-10-12,small compact peripheral

Dr.P.K.Rajesh.M.D. P.falciparum Liver-6 days.(60u) RBC-MULTIPLERINGS. Same size(36-48) Only rings and gametocytes Micro-broader shorter,ends blunt,nucleus scattered Macro-long narrow,ends pointed,nucleus compact CENTRE

Dr.P.K.Rajesh.M.D. Differences? VIVAX EXO- ERYTHROCYTIC RBC’S ENLARGED RELAPSE-YES SINGLE RING CHLORO SENS ROUND GAMETOCYTE FALCIPARUM NO HEPATICLATENCY RBC’S INTACT NO RELAPSE MULTIPLE RINGS CHLORO RESIST CAN BE CULTURED BEAN SHAPED GAMETOCYTE

Dr.P.K.Rajesh.M.D. P.malariae Africa/Karnataka BAND forms PRE-15 DAYS TSM-72 HRS QUARTAN GAM –7.5 u (Think like falciparum)

Dr.P.K.Rajesh.M.D. P.ovale PRE – 9 DAYS RBC –48 HRS OVAL RBC’S (think like vivax)

Dr.P.K.Rajesh.M.D. Immunity NATURAL/INNATE AGE OF RBC NATURE OF Hb.- sickle cell,thalasaemia, fetal hb. ENZYME-G6PD-D DUFFY FACTOR NEGATIVE ACQUIRED HUMORAL Ab to all stages, Inhibits invasion Inhibits growth Promotes rbc sequest- CELLMEDIATED NONSPECIFIC

Dr.P.K.Rajesh.M.D. Clinical features Intermittent fever Cold/Hot/Sweating Hepatosplenomegaly hemolytic anemia bilirubinemia

Dr.P.K.Rajesh.M.D.

Diagnosis PERIPHERAL BLOOD SMEAR QBC DIPSTICK- PARASIGHT-F ACRIDINE ORANGE CULTURE PCR

Dr.P.K.Rajesh.M.D. As per the learning outcome, Relate it to lifecycle/species rather than resorting to memory

Dr.P.K.Rajesh.M.D. As per the learning outcome, Relate it to lifecycle/species rather than resorting to memory

Dr.P.K.Rajesh.M.D. Google-Rajendran, Rajesh et al, Asymptomatic malaria JAPI, 2001

Dr.P.K.Rajesh.M.D. Last slide was to establish the importance of immunological tests (ag,ab) in the diagnosis and this slide for molecular tests (PCR)

Dr.P.K.Rajesh.M.D. Complications Black water fever Cerebral Malaria Lactic acidosis Tropical splenomegaly

Dr.P.K.Rajesh.M.D. Drugs of choice Chloroquine phosphate -250MG 4 stat/2 after 6 hours/ 1 bd for 2 days Primaquine to prevent relapse Sulphamethoxozole+pyrimethamine ARTESEMIN derivatives

Dr.P.K.Rajesh.M.D.

Prevention Vector- Antilarval/Antiadult Screening carriers Screening Blood donors Bottom’s up Chemoprophylaxis Immunoprophylaxis Yes, with admin duties and voluntary advisory duties I am not in my room 24/7, please for genuine queries