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

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

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 24.04.2012, 25.04.2012, 27.04.2012 restate the basic concepts of parasitology 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 apply the knowledge of the life cycle to the principles of laboratory diagnosis (How the knowledge of life cycle will help in diagnosis?)

Introduction-Filaria Filariasis is one of the FIVE major parasitic diseases to which WHO devotes much attention (malaria, shistosomiasis, filariasis, leishmaniasis, trypanosomiasis) . Wuchereria bancrofti and Brugia malayi are the common species of filarial nematodes involved (helminths). Dr.P.K.Rajesh.M.D.

Eight Species of Filariae Parasitizing Humans _____________________________________________________________________________ Species Site of inhabitation Vector Pathogenesis Distribution _______________________________________________________________________ W. bancrofti lymphatic tissues mosquito lymphatic damage worldwide ____________________________________________________________________ Brugia malayi lymphatic tissues mosquito lymphatic damage Asian Brugia timori lymphatic tissues mosquito lymphatic damage Island of timor ____________________________________________________________________ Onchocerca subcutaneous; eye black fly river blindness Africa volvulus Loa loa subcutaneous deer fly skin swellings Africa Dipetalonema subcutaneous midge indefinite Africa streptocerca Dipetalonema thoracic and midge indefinite Middle and perstans abdominal cavities South America Mansonella peritoneal cavity midge indefinite South America ozzardi

para-lab by l. wafa menawi Adult worm: White and thread-like. Female:5~10cm in length Male: 2.5~4cm and a curved tail with two copulatory spicules. para-lab by l. wafa menawi

Adult worm of filaria-habitat-lymphatics

para-lab by l. wafa menawi Microfilaria: 177~296 µm in length Observable in peripheral blood smear Wuchereria bancrofti Brugia malayi para-lab by l. wafa menawi

Microfilaria of B. malayi

Intermediate host-Mosquito Anopheles Intermediate host-Mosquito Aedes W.bancrofti is transmitted by Culex, Aedes, and Anopheles species B.malayi is transmitted by Anopheles and Mansonia species. Culex Mansonia

Life cycle Link the diagnosis to the life cycle-the stage in which parasites are seen in peripheral blood smears are diagnostic

para-lab by l. wafa menawi Wuchereria Life Cycle para-lab by l. wafa menawi

Clinical stages Asymptomatic Amicrofilaremia Asymptomatic Microfilaremia Acute Adenolymphangitis (ADL) (NOCTURNAL PERIODICITY) Chronic/Irreversible lymphedema Superimposed upon repeated episodes of ADL Dr.P.K.Rajesh.M.D.

Diagnostic Peripheral blood smear-nocturnal DEC provocation test Dr.P.K.Rajesh.M.D.

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

Morphological Differences of Microfilariae between W. bancroti and B Morphological Differences of Microfilariae between W. bancroti and B. malayi ________________________________________________________________ Species W. bancrofti B. malayi Appearance graceful, sweeping curves irregular, stiff curves Size larger 244-296× 7 µm smaller 177-230 × 6 µm Cephalic space shorter(1:1 or1:2) longer(2:1) (length:width) ________________________________________________________________ Nuclei body nuclei equal sized, clearly unequal sized, coalescing, defined, countable uncountable Terminal nuclei no two

para-lab by l. wafa menawi Drugs Diethylcarbamazine (DEC) reduces microfilariae concentrations kills adult worms Used for prevention (Fortified with salt) Albendazole Ivermectin kills the microfilariae produced by adult worms para-lab by l. wafa menawi

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 email depdeanpreclinical.aimst@gmail.com for genuine queries Dr.P.K.Rajesh.M.D.

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

Dracunculus medinensis Dr.P.K.Rajesh.M.D.

Life Cycle-GUINEA WORM Adult females in subcutaneous tissues of the legs and arms. Blister forms over nematode. Breaks when exposed to water. Nematode uterus ruptures and discharges first stage juveniles into the water (ovoviviparous). Juveniles ingested by copepod (intermediate host, 2 molts within copepod). Copepod swallowed by human. Juveniles migrate via lymph system. Develop to adults in subcutaneous tissues.

To prepare for symposium/CA3 Entamoeba/Giardia Malaria-Plasmodium/Toxoplasma Cestodes (T.saginata, T.solium/ Echinococcus) Trematodes-Liver fluke-Schistosomes Dracunculosis/Trichinella spiralis/Filaria/Enterobius vermicularis Ancylostoma/Ascariasis Dr.P.K.Rajesh.M.D.

Tomorrow 14.02.2012 Demonstration of parasites Interactive session Bring micro log books Total revision of parasitology relevant to element 6 B Dr.P.K.Rajesh.M.D.