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Protozoa

Entamoeba histolytica Identification cyst: spherical, 4 nuclei, infective when eliminated trophozoite: pseudopodia - high motility, hematophagus agressive stage Transmission digestive, sexual Life cycle 1$ dirty hands, fly, vegetables, water %$ ingestion &$ mouth cyst 4$ small intestine trophozoite '$ colon pre-cyst ($ stool cyst Clinical primary location: submucosal colon lesion, pict re bloody mucous diarrhoea, self limiting of &-' years secondary location: amoebic liver abscess, peripheral zone of abscess, no inflammatory reaction or capsule surrounding, hepatomegaly Complications blood metastasis of amoebic trophozoits amoebic liver abscess, lung abscess, brain, kidney, pancreas, pleural cavity, cutaneous amoebiasis, cyst rupture, distance haematogenous metastasis, aundice, anemia !iagnosis trophozoite: stool "acute stage# cysts: stool "chronic stage#2 34.5, 36.5, antigen detection in stool2 liver abscess: 34.5, immuno-electrophoresis, agglutination, increase of leukocytes, anemia, /+7 increase 8-ray, 9+, )5, -73, scintigraphy isotope Treatment :yloxanide, -etronidazole, 5inidazole Free Living Amoebae Naegleria ssp. Acanthamoeba ssp. cyst: round, only in culture, small number cyst: 1 nucleus, external layer polygonal shape, trophozoite: anterior pseudopodia, binary fission internal layer wrinkled surface with pores trophozoite: rough exterior, several pro ections,1 nucleus - infectiv in water water, ubi!uitar "everywhere existence# 1$ streams, pounds, lakes, swimming pools 1$ trophozoites, cysts %$ mucous, skin, cornea %$ trophozoite, flagellate, cysts nasal route &$ immunocompotent: corneal multiplication &$ trophozoite )*+ multiplication ,-. keratitis 4$ trophozoite immunocompromised:haematogenous spread )*+ encephalitis primary meningo-encephalitis ",-/# chronic amoebic meningoencephalitis, death after weeks1months, brain abscess1-es, headache, acute hemorrhagic meningo-encephalitis fever, focal epileptiform attacks death after &-0 days progressive corneal ulcer

trophozoites: )+4

cysts, trophozoites "rare#: )+4 culture on xenical1axenical media

".mphotericine ;#

".mphotericine ;#

Flagellates
"iardiasis Identification cyst: oval, 4 nuclei, double coat, infective trophozoite: flatten, pearlike, 4 flagella, ventral concave w1 sucking disc, dorsal convex binary fission fecal-oral, cont$ water, food 1$ cysts, water, cont$ food %$ ingestion &$ mouth cyst 4$ duodenum trophozoites '$ stool cyst < trophozoites digestive complaints, no blood1mucous diarrhoea, intolerance to milk consumption malabsorbion immune-competent self limiting Trichomonas vaginalis cyst: not proved trophozoite: pear-like, 4 ant$ flagella, 1 recurrent flagella, actively phagocytic, active motility man-man sexually sexual intercourse, poor hygiene, mother daughter "con uctivitis# 5=&0>) destroy parasite Leishmaniasis #isceral Leishmaniasis C taneo s Leishmaniasis amastigote: roughly spherical, % nuclear chromatin "nucleus<kynetoplast# promastigote: elongated, anterior flagella, 1 nucleus, kynetoplast

Transmission Life cycle

Clinical pict re

female: a-1symptomatic chronic or acute vulvovaginitis li!uid, foamy, greenishyellow discharge, disuria male: mostly carriers, persistent, recurrent urethritis, urethral discharge contain parasite

female sandfly, blood transfusion, congenital, sexual 1$ sandfly in ects promastigote %$ promastigotes phagocytosed by macrophages turn into amastigote &$ amastigote multiplication 4$ sandfly takes blood meal w1 macrophages containing amastigotes '$ amastigote promastigote in midgut ($ devide in midgut < migrate to proboscis asymptomatic: strong tissue response 1$ ?$ tropica: solitary painless skin ulcer, no inflammation, raised edges, no satellite complete elimination lymphadenopathy, face < extremities, symptomatic: leishmanoma, fever irregular<intermittent, rigors, sweating, healing without compl$ %$ ?$ma or: many painless skin ulcers, parasites taken by reticuloendothelial inflammation surrounding, defined edges, system increase of satellite lymphadenopathy, healing w1 scar reticuloendothelial tissue "spleen, liver, &$ ?$ brasiliense complex lymph nodes# - /spundia: humid, muco cutaneous lesions bone marrow invasion, anemia, leukopaenia, aundice, emaciation, post- nose, destroy ad acent tissues in several kala-azar syndrom, nasal mucosa, small years intestine mucosa, death due to resp$ < - 9ta: dry muco cutaneous lesions face digestive inf$ ulceration, invade surrounding tissue ,ean boid: muco cutaneous lesions 4$ ?$ mexicana complex: %-& relapses,

!iagnosis

Treatment

cysts: direct examination "lugol#, smear giemsa stain trophozoites: stool, duodenal li!uid, duodenal biopsy, enterotest "string test#, endoscopic isolates -etranidazole, .lbendazole, milk intolerance

trophozoites: genital discharge1urine, giemsa stain, phase contrast microscopy, antigen detection, saline wet preparation metronidazole

amastigote: liver, spleen, bone marrow puncture Biemsa stain promastigote: in cultures *** /?3+., 34.5

chronic ulcer, @)hicleroA smear, Biemsa stain, biopsy, *** medium, leishmanianin test "montenegro test#

Identification Transmission Life cycle

Clinical pict re

!iagnosis Treatment

Tripanosoma $r cei %African Trypanosomiasis& flattened, fusiform shaped, slender pointed leaves, actively motile trypomastigote: 1 nucleus, post$ kynetoplast, flagellum arises, simple fission, general configuration variable, antigenic variation Blossina spp$ - tsetse fly 1$ tsetse fly: infected blood meal - trypomastigotes %$ midgut: procyclic trypomastigotes "epimastigote# salivary glands: metacyclic trypomastigotes "infective form# free in blood<)+4: long slender free in blood: short stumpy 5$ br$ gambiense: subacute1chronic infection 5$ br$ rhodesiense: toxic effects 1$ painful trypanosomal chancre, local lymph glands, slowly regress %$ hematogenus phase: fever become chronic, skin maculo papular rush, enlarged lymph nodes "FinterbottomDs sign#, spenomegaly, aundice, anemia, myocarditis, genital<urinary signs, neurological signs &$ late stage: changes in behavior, sleep disorders, spaciticity, choreiform, GarandelDs sign, neuro-endocrine disturbances thin1thick blood film, bone marrow aspiration, )+4 Biemsa, .spirate from chancre, .ntibodies by 34.5, /?3+., ).55, .ntigen detection early stage: suramin, pentamidine late stage: melarsoprol

Tripanosoma Cr zi %American Trypanosomiasis& similar to brucei, but larger nucleus fly, blood transfusion 1$ insect in ects skin, mucosa, con unctiva C metacyclic form epimastigote variety oftissues cells C intracellular amastigotes %$ insect bloodmeal: stomach Ctrypomastigote intestine C epimastigote, promastigote skin infestation C metacyclic form )ongenital )hagaDs disease: )*+<visceral malformation, death after %E chagoma: painful cutaneous oedema at bite site: 7omanaDs sign toxaemic stage: lymphadenopathy, hepatosplenomegaly complication heart: cardiomegaly, arrhythmias,cardiac feilure visceral: colonic < oesophagus megaly blood examination, xenodiagnosis, mucsle biopsy "rare#, blood culture on ***, )45, 34.5, /?3+. *trimox "not effective agains intracellular amastigote#

'ematozoa ( )alaria
Identification Transmission Life cycle Plasmodi m #iva* Plasmodi m +vale Plasmodi m )alariae Plasmodi m Falcipar m sporozoites: elongated, crescent shape, central nucleus merezoites: inside hepato-1erythrocytes anopheles spp$ mos!uito, intravenous drug users, blood transfusion 1$ insect sporozoites - sexual %$ pre-erytrocytic schizogony "liver# asexual &$ erythrocytic schizogony "diagnostic stage#: asexuate forms young trophozoite, mature trophozoite, schizont, sexuate forms female, male gametocytes sporozoites irregular fever becomes regular cold stage, hote stage, sweating stage anemia, splenomegaly, aundice p$ falciparum: cerebral malaria, hypoglycemia black water fever, abortion thin blood film Biemsa, ?eishman, 7omanovski thick blood film 4ield, Biemsa antigen detection, specific antibody detection most common: 34.5 Festern blot, ,)7, anemia, leukopoenia, leukocytosis, thrombopaenia, hyperglobulinaemia specific chemotherapy )hloro!uine but resistance rapidly installed

Clinical pict re

!iagnosis

Treatment

Cestodes
Taenia ,aginata %beef tape-orm& Lifespan Identification %'-&' years scolex: 4 suckers, no hooks Taenia ,oli m %beef tape-orm& Cysticercosis 'ymenolepis Nana %!-arf tape-orm& scolex: 4 globular suckers, subglobular, rostellum, %H-&H hooklets !iphyllobotri m lat m %fish tape-orm& %I years scolex: % slit longitunial grooves "like suckers# no rostellum, no hooklets body: &HHH-4HHH proglottis "1H-1%m# proglottis: genital pore in middle contineous discharge of eggs "&($HHH-1 mio1 day# plerocercoid encysted in fish viscera1muscles operculated, brown shell no embryo no inf$ water dependent raw fish Echinococ s

1'-%H years scolex: 4 suckers, short C. cell losae pigmented rostellum, scolex: 4 suckers, %H-'H hooklets rostellum, hooklets body: JHH-1HHH proglottis "4-(m# proglottis: inside uterus &H$HHH-'H$HHH fertilized eggs cystercus cellulosae intramuscular1adipose, eyes, )*+, subcutaneous round1oval, thick membrane embryo ( hooklets no acid fast raw pork 1$ eggs in feces %$ pig: ingestion of 5$ solium eggs C. racemos s no scolex

piriform scolex, % rows of hooks, 4 suckers

body: 1$HHH-%$HHH proglottis "J-1Hm# proglottis: contain fertilized eggs

proglottis: 1HH-%HH, increase in size posterior cystercoid, inside interstinal villous JH-1JH in each segment, oval globular, infective % membranes % poles w1 4-J filaments embryo ( hooklets direct, person-person faecal cont$ water1food

proglottis: &-', containing up to '$HHH eggs hydatid cyst ectocyst endocyst % shells, inner thicker, oncosphere contains & pairs of hooklets, discharge infective

Larvae

cystercercus bocis intra-muscular1adipose round1oval, thick membrane embryo ( hooklets acid fast raw beef 1$ eggs in feces %$ cattle: ingestion of

Egg

Transmission Life cycle

:6: dogs 3-: sheep, goat, man 1$ unembryonated eggs 1$ embryonated eggs in in feces feces

eggs1gravid proglittis &$ oncosperes hatch intestinal wall, circulate in musculatur 4$ cystercerci in mm$ '$ h man: ingestion of raw infected meat ($ scolex attaches to intestine 0$ adults in s$ intestine Clinical pict re digestive complaints, neuro-psychic signs, general signs, allergies: cutaneous

eggs1gravid proglittis &$ oncosperes hatch intestinal wall, circulate in musculatur 4$ cystercerci in mm$ '$ h man: ingestion of raw infected meat ($ scolex attaches to intestine 0$ adults in s$ intestine digestive complaints, neuro-psychic signs, general signs, allergies: cutaneous neuro-cysticercosis, ocular cysticercosis, muscle cysticercosis, subcutaneous cysticercosis: not painful nodes, become painful when larvae dead eggs: stool, /?3+., /35;, western blot, soft tissue x-ray, -73, ventriculography, mielography, )+4 hypereosinophilia, parazi!uantel, albendazole, surgery, antiepileptic and steroids in ocular1)*+ a-1symptomatic, digestive, allergies,

%$ embryonate in water &$ cr staceans: ingestion 4$ procercoid larvae in body cavity '$ small fish: plerocercoid larva ($ predator fish 0$ h man. adults in s$ intestine I$ proglottids release eggs a-1symptomatic, digestive complaints, general signs, allergies: cutaneous, neurovegetative signs, neuropsychiatic signs megaloblastic anemia

%$ dog: oncosphere hatches, penetrates intestinal wall &$ hydated cyst in liver, lung, etc$ 4$ protoscolex form cyst '$ scolex attaces to intestine ($ adult in s$ intestine accidentally in human liver hydatid cyst (HK right lobe, bile duct compression, liver abscess lung hydatid cyst lung abscess other: spleen, kidney, bone, cerebral protoscolices in urine, sputum,pleural effusion etc$, /?3+., 34.5, Festern blot 6emagglutination, skin test, chest x ray, ultrasound, )5, -73, hypereosinophilia albendazole, surgery

Complications acute appendicitis intestinal obstruction !iagnosis proglottis: clothes, stool eggs: ziehl neelsen red scotch test hypereosinophilia Treatment parazi!uantel, niclosamide

proglottis: eggs: ziehl neelsen blue hypereosinophilia

eggs: stool

eggs: direct coprology, Lit;1% deficiency, anemia, leukopenia, throbopenia, hypereosinophilia

parazi!uantel, niclosamide

parazi!uantel, niclosamide

parazi!uantel, niclosamide

locations

Trematodes
Fasciola hepatica %liver fl /es& Lifespan Identification in large bile ducts of sheep, cattle, accidentally in human, brwonish, hermaphrodite Paragonim s ssp. %l ng fl /es& 1H-%H years in lung cavities, cuticle harboring spines, % ventreal and oral suckers, reddish-brownish, hermaphrodite ,chistosoma spp. %blood fl /es& '-&H years in mesenteric venous system, separated sex m: % suckers "ventral<anterior#, flattened and rolled body groove on ventral face gynecophoric canal "protection of f$# f: smooth cuticle, % suckers, inside gynecophoric canal , oval, thin, transparent shell, containing motile miracidium inside, but not infective +$ haematobium terminal spine +$ mansoni lateral spine +$ aponicum laterla flattened spine in water active penetration through skin 1$ eggs contain miracidium, water development %$ actively swimming miracidia hatch, penetrate snail: sporocysts rediae cercariae &$ cercariae penetrate :6 loosing tail schistosomule 4$ blood circulation liver "%-& months# portal vein ($ female worm lays egg migrate to mesenteric veins system skin penetration, @swimmerDs itchA @fishermanDs itchA invasion phase, allergic < toxic phenomena,

Egg

large ovoid, non-infective, water development

operculated, unembryonated, non-infective, water development

Transmission Life cycle

ingestion of cercariae "water# or metacercariae "vegetables-watercress# 1$ unembryonated eggs in feces %$ embryonated eggs in water &$ miracidia hatch, penetrate snail: sporocysts rediae cercariae 4$ free-swimming cercariae encyst on water plants '$ human: ing$ of metacercariae on water plants ($ excyst in duodenum 0$ adults in hepatic biliary duct abdominal pain " rarely diarrhoea# migratory phase: fever, hypereosinophilia, right hyperchondrial pain $$$

Clinical pict re

eating raw fresh water crustaceans "crabs, crayfish# 1$ unembryonated eggs in feces %$ embryonated eggs in water &$ miracidia hatch, penetrate snail: sporocysts rediae cercariae 4$ cercariae invade crustacean and encyst into metacercariae '$ human: ingestion of raw1pickled crustaceans ($ excyst in duodenum 0$ adults in cystic cavities in lungs lay eggs, excreted in sputum, eggs swallowed and passed in stool digestive stage migration stage: fever, skin allergy, subcutaneou nodules

liver phase: reaches bile duct, hepatomegaly, aundice ectopic migration: pruritic nodules1 abscesses halzoun: painful local allergic reaction pharangeal mucosa !iagnosis eggs: bile fluid or feces serology in migration phase

pulmonary stage: cough, bloody sputum, chest pain, fever, night sweating, right heart insufficiency, fibrosis ectopic worms: eye, epididimitis, testis, )*+, abdomen, painful lymphadenopathy, migrating subcutaneous swelling, rarely abscess eggs: sputum, feces, abscess fluid )45, hypereosinophilia, x ray, )5

Treatment

parazi!uantel triclobendazole

parazi!uantel

hypereosinophilia, hepatomegaly, splenomegaly, cough, katayama fever chronic phase: granuloma formation +$ mansoni liver, intestine, spleen, cerebral +$ haematobium bladder, kidney +$ aponicum katyama fever, bloody, mucous diarrhoea "close to mansoni# eggs: urine "+$ haematobium#, feces, biopsies of rectum, bladder, liver /?3+., haemagglutination, 34.5 ultrasonography, intravenous urography, chest x ray, chistography ,arazi!uantel, .mbilhar, Lansil, +urgery

Nematodes
Lifespan Identification Ascaris L mbricoides 1-% years largest round worm, in small bowel cylindrical, creamy-brown color head: & ant$ lips, teeth thick<smooth cuticle %HH$HHH-%'H$HHH eggs1day fertilized: ovid, unembryonated, soil development, % shells, internal thin, external thick < irregular albuminous coat unfertilized: non-homogenous content, irregular coat To*ocara ,pp. in dogs < cats intestine like ascaris larvae: smaller than ascaris eggs: similar size but pitted surface soil development never found in human feces Trich ris Trichi ra %-hip-orm& & months adult located in caecum ant$ &1' thin post$ %1' thick and bulbous eggs brownish, transparent blisterlike plug, unembryonated, noninfectiv, soil development Enterobi s #ermic laris ( weeks round worm, yellowish, cervical vesicle, rhabditoid oesophagus double tranparent shell, embryonated, infective

Egg

Transmission Life cycle

ingestion of eggs 1$ eggs soil development %$ infective larva hatches small bowel, penetrates gut wall &$ liver "circulatory system# 4$ lung '$ pharynges small intestine "sexually mature worm# a-1symptomatic migration phase: fever, cutaneous, respiratory allergies, ?oefflerDs syndrome adult stage: intestinal obstruction, ectopic migration appendix, biliary tree, pancreatic duct liver - colangitis, liver abscesses, granuloma formation small intestine acute peritonitis

cats, dogs, vegetables, dirty hands, congenital transmission of toxocara larvae in dogs 1$ eggs soil development %$ migration phase: larvae trapped in tissue granuloma &$ wondering of larvae pathology due to antigenic stimulation < granulomatous reaction 1$ visceral larva migrans : pruritus, abdominal pain, fever hepatosplenomegaly, respiratory complains, myocarditis, )*+ damage %$ covered toxocariasis : lymphadenopathy, asthenia, rheumatoid syndrome, fever of long period of time &$ asymptomatic patiens: hypereosinophilia 4$ ocular larva migrans: loose of vision, granuloma formation liver biopsy stool examination not positve /?3+., )3/, F;, )+4 high leukocytosis, hypereosinophilia, increase muscle enzymes, 3g/, biologic inflammatory syndrome 9+, )5, -73 opthalmologic and fundus examination

accidental ingestion of fertilized eggs 1$ embryonated in soil %$ larvae hatch in intestine &$ penetration and development in mucosa 4$ adults in caecum '$ eggs in feces a-1symptomatic abdominal pain, dysenteric syndrome "bloody, mucous diarrhoea, sometimes pus#, rectaltenesmus, nausea, vomiting rectal prolapsed, anemia, appendicitis, death "in malnourished sub ects#

Clinical pict re

man to man transmission digestive retro-infection 1$ human: embryonated eggs ing$ %$ larvae hatch in s$ intestine &$ adults in lumen of ceacum 4$ f$ migrates to perianal region at night to lay eggs &$ eggs on perianal folds "larvae inside eggs mature within 4-(h# retroinfection a-1symptomatic abdominal pain, anal pruritus, behaviour chages, insomnia, vulvovaginitis, urethritis, cutaneous larva migrans apendicitis, peritonitis, urinary tract migration

!iagnosis

un-1fertilized eggs: stool larvae: sputum, gastric uice hypereosinophilia

eggs: stool anemia, hypereosinophilia

adults: stool eggs: stool "1'K of cases# scotch test

Treatment

.lbendazole, -ebendazole, ,yrantel pamoate, ?evamisole

:iethylcarbamazine, .lbendazole, 3vermectine

.lbendazole, -ebendazole

.lbendazole, -ebendazole

Identification

Egg Larvae

'oo/-orms slender, cylindrical, ant$ mouth<esophagus fixed in intestinal mucosa, buccal capsule w1 teeth .:, cutting plates *., male is smaller<harbours copulatory bursa ovoid, transparent shell, 4-J cell stage when discharged, fertilized but not infective 1$ stage: hatches out of egg %$ stage: rhabditoid, not infective, rhabditoid oesophagus, large buccal capsule, no sheath &$ stage: infective, filariform oesophagus,sheathed, pointed tail man-man 1$ filiariform larva penetrate skin "infective stage# %$ circulation: lung, trachea, pharynx &$ adults in small intestine 4$ eggs in feces '$ rhabditiform larva hatches in soil "not infective# itching, pruritus, rarely coutaneous allergy, intestinal: bloody diarrhoea, abdominal pain, loose of iron < proteins,anemia,heart failure

,trongyloides ,tercoralis contain about %H ovoid, thin-shelled eggs, larvae hatch to intestinal mucosa ovoid, thin shelled eggs 1$ rhabditoid feces %$ rhabditoid, oesophagus, small bucal capsule &$ filariform oesophagus, nosheathed, forked tail strongyloid larvae: skin penetration 1$ filiariform larva < rhabditoid larva "feces# penetrate skin %$ circulation: lung, trachea, pharynx &$ adults in small intestine 4$ eggs in mucosa occasionally in feces

Trichinella spp. ant$: glandular cells-stichocytes f$ twice longer than m$

Transmission Life cycle

raw meat:pig,wild boar, hoarse,bear 1$ ingestion of inf$ meat %$ larvae released in small intestine &$ adults in small intestine 4$ migrate lymphatic system encysted larva in striated mm$ "mostly collagen capsule# digestive phase: diarrhoea, hypoproteinemia acute phase: lymphatic vessels, invade muscle cells, headach, fever, sweating, trachicardia, cutaneous allergy, eyelid oedema, intolerance to light, pain eye movement, leukocytosis, haemorrhages bed nails, intracon unctival haemorrhages, hypereosinophilia2 muscular phase: mm$ movements pain, rigity complications: cardiovascular, neurological, ocular, respiratory, digestive, "death# microscopic examination, artificial digestion muscle biopsy, antigen detection

Clinical pict re

itching, lung migration?oefflerDs syndrome, digestive: no bood, diarrhoea, abdominal pain, weight lost, chronic1intermitted diarrhoes, hyperinfection syndrome

!iagnosis

eggs: stool iron anemia, hypereosinophilia,

rhabditoid larvae: stool duodenal fluid, e unal biopsy, 34.5,

hypoalbuminaemia Treatment Identification .lbendazole, -ebendazole Filiarial -orms wuchereris bancrofti brugia malayi (not as severe) round, slender, white cuticle, in lymph nodes, lymphatic system microfiliaria:motile larval worms, noctal periocidy culicides aedes, mansonia bite 1$ fly in ects larvae into human %$ adults in lymphatics discharge mf into lymph < blood channels &$ fly takes blood meal w1 mf 4$ mf shed sheaths, penetrate flyDs midgut, migrate to thoracic mm$ '$ migrate to head lymphangitis, lymphadentitis, elephantiasis, chyluria "whie, milky urine due to fatty lymph# secondary infections due to streptococcus1fungi !iagnosis Treatment thin<thick blood film, G*N55, Biemsa stain, :/) test, lymph examination, )45, 34.5, /?3+. :/), -ectizan, surgeryelephantiasis, antifungal1antibiotics

hypereosinophilia, chronic diarrhoea, cutaneous-, pulmonary signs .lbendazole +ncocercaiasis round worm, free living in subcutaneous fibrous nodule, moving freely microfilaria: living<moving freely inskin simulium black fly 1$ fly in ects larvae into human %$ adults in subcutaneous nodule discharge mf into skin, lymphatics "urine, blood, sputum# &$ fly takes blood meal w1 mf 4$ mf penetrate flyDs midgut, migrate to thoracic mm$ '$ migrate to head skin demage: itch night, cutneous nodules at bony prominences, de-1pigmentation, minor elephantiasis, eye demage: punctate keratitis "@snow flakeA keratitis#, sclerosing keratitis, blindness, retinal damage, optic nerve atrophy, glaucoma skin biopsy, cutaneous nodules nodulectomy, hypereosinophilia 3vermectine, :/)

specific 3gB antibodies /?3+., latex agglutination, western blot,tyvelose, multiplex -,)7 .lbendazole, -ebendazole, )orticosteroids "severe# !racontiasis longest filarial worm, uterus filled with rhabditoidform larvae, eliminate in water through blister larvae: motile, pointed tail inf$ water w1 cyclops 1$ ingestion of copepod w1 larvae %$ larvae penetrate stomach < intestinal wall, mature<reproduce &$ fertilized female migrate surface skin, blister egg discharge 4$ larvae consumed by copepod local allergic<infl$ reaction, local painful, itching, swelling, fever, papulablister2 rarely-diarrhoea, vomiting complications: tetanus, painful arthritis, calcification of worm based on clinical signs extraction of worm "%-4weeks# metronidazole: reduce infl$ anti-tetanus, surgery

Loa Loa adult: slender, white, round worm, inhabits subcutaneous tissue, moves freely, lifespan:M1J-%Hyears microfilaria: sheath form, diurnal periodicity, lifespan: 1-% years chrysops insect bite 1$ fly in ects larvae into human %$ adults in subcutaneous tissue female discharge mf into blood &$ fly takes blood meal w1 mf 4$ mf shed sheaths, penetrate flyDs midgut, migrate to thoracic mm$ '$ migrate to head assymptomatic common symptomatic: painful, ichty clabar swelling2 itchy cutaneous track, moving slow2 ocular location: moving under con untiva but no blindness2 dead worm: calcification - no harm, painful granulomatous thick<thin blood film: Biemsa surgical extraction "con unctiva# :/)

Transmission Life cycle

Clinical pict re