1
Q
unicellular organisms
A
Protozoans
2
Q
Under protozoa:
A
Phylum Sarcomastigophora
3
Q
Under Phylum Sarcomastigophora
A
- Sarcodina
- Mastigophora
- Ciliophora
- Apicomplexa
4
Q
Now classified under fungi
A
Phylum Microsporidia
5
Q
possess polar tube
A
Phlum Microsporidia
6
Q
Spore forming microorganisms
A
Phylum Microsporidia
7
Q
types of worms
A
- Phylum Aschelminthes
- Phylum Platyhelminthes
8
Q
Types of Phylum Platyhelminthes
A
- Trematoda
- Cestoda
9
Q
Types of reproduction of protozoans
A
- asexually
- asexually and sexually
10
Q
Type of asexual reproduction of protozoans
A
- Binary Fission
- sporogony
11
Q
Type of sexual reproduction of protozoans
A
- gametogony
12
Q
Do not have cell walls
A
Protozoans
13
Q
stucture inside the nucleus of protozoans
A
nucleolus or karyosome or endosome
14
Q
The nucleus contain the ________
A
DNA
15
Q
The karyosome contains the ________
A
RNA
16
Q
2 regions of the cytoplasm
A
- endoplasm
- ectoplasm
17
Q
Inner region of the cytoplasm that is for metabolic processes
A
Endoplasm (sol region)
18
Q
Outer region of cystoplasm, important for protection, more clear (hyaline)
A
Ectoplasm (gel)
19
Q
Protozoans that possess a pseudopod
A
Sarcodina (ameba)
20
Q
Locomotor structure of ameba
A
pseudopodia
“false feet”
21
Q
Inhabit the colon except for E. gingivalis
A
ameba
22
Q
where can you find the E. gingivalis?
A
Mouth, oral cavity
23
Q
Possess peripheral chromatin
A
Entamoeba
24
Q
The nucleus of ameobas are ________
A
Vesicular
25
amebas are commensals except?
E. histolytica
26
Stages of development of amebas
- trophozoite
- cyst
27
vegetative stage of protozoans
trophozoite
28
feeding stage of protozoans
trophozoite
29
stage of protozoans that can be found in watery/Diarrheic stools
trophozoite
30
resisitant stage of protozoans
cyts
31
the infective stage of most protozoans
cyst
32
where kind of stool you can find the cyst stage of protozoans
Formed/watery stool
33
Mode of transmission of E. histolytica
Ingestion of Infective cyst
34
Is quadrinucleated
Infective cyst of E. histolytica
35
Habitat of E. histolytica
Large Intestine
36
FInal host of E. histolytica
Human
37
stages of infection of E. histolytica
- Ingestion of cyst
- Excystation in the smal intestine
- Metacyst
- Amoebulae/Metacystic Tropozoite
- Trophozoite in colon
- Encystation
- Precyst
- Cyst
- Cyst and/or Trophozoites present in stool
38
Once the ph of the small intestine becomes alkaline the cyst becomes the _________
Metacyst
39
Reproduction of Metacystic Trophozoite will become
Trophozoite
40
Can go to other internal organs
E. Histolytica
41
What other internal organs E. histolytica can go to?
Liver (most common), brain, lungs
42
Max nuclei of E. histolytica
4
43
The location of the karyosome of E. histolytica
centrally located
44
Structure of cyst that is fine and smooth in appearance, surounding the nucleus
Peripheral chromatin
45
cigar/sausage like, contain crystalline RNA, energy source
Chromidial body
46
Structures of E. histolytica cyst
- nucleus
- karyosome
- Peripheral chromatin
- Chromidial body
- glycogen vacuoles
47
movement of trophozoite of E. histolytica
- progressive
- unidirectional
48
Appearance of Pseudopodia of E. histolytica
Finger-like
49
Appearance of cytoplasm of E. histolytica
clean looking
50
presence of ingested red blood cell
trophozoite of E. histolytica
51
Appearance of rbc in unstained E. histolytica
greenish
52
In Disease Manifestations of E. histolytica, Majority of cases (90% of cases) are ______________
Asymptomatic Carrier State
53
In Disease Manifestations of E. histolytica, 10% of cases are ______________
Intestinal Disease
54
In Disease Manifestations of E. histolytica, <1% are ___________
Extraintestinal Disease
55
incubation period of Intestinal disease from E. hystolitica
1-4 weeks
56
Signs and symptoms of E. histolytica
- diarrhea
- dysentery (bloody diarrhea)
- abdominal pain
- flatulence
- weight loss
- chronic fatigue
- foul smelling stools
57
E. histolytica release ____________ to lyse mucosal lining
Enzymes
58
E. histolytica can cause the formation of __________
FLASK SHAPED ULCERS
59
Severe form of Diarrhea
Fulminating colitis
60
Clinical forms of Intestinal Amebiasis
● Dysentery
● Fulminating Colitis
● Amebic Appendicitis
● Ameboma; granuloma
61
may be mistaken for cancer (carcinoma)
Ameboma (granuloma)
62
Seen in chronic cases of amebiasis
Ameboma (granuloma)
63
64
Ectopic form of amebiasis
Extra-intestinal Disease
65
Extra-intestinal Disease due to E. histolytica can lead to ______________
Amebic liver abscess
66
Cardinal Signs of Amebic liver abscess:
○ Fever
○ Right Upper Quadrant
67
If you palpate it and it hurts it is ______
tender
68
Other signs of Amebic liver abscess include
Tender liver and hepatomegaly
69
enlargement of the liver
hepatomegaly
70
Extra-intestinal Disease that causes complication of dysentery
Cutaneous Amebiasis (Amebiasis cutis)
71
Extra-intestinal Disease that causes ulceration in the perianal area
Cutaneous Amebiasis (Amebiasis cutis)
72
Extra-intestinal Disease that causes rare manifestation of Entamoeba histolytica
Cutaneous Amebiasis (Amebiasis cutis)
73
Appearance of the liver aspirate:
Anchovy sauce
like
74
What can you find in the Liver aspirate from a patient with Amebic Liver Abscess (ALA)
Trophozoites
75
factors you have to
consider why it’s pathogenic
Virulence Factors
76
Pathology of E. histolytica
Ability to lyse tissue
77
Used by E. histolytica for attachment to the host cells
Lectin (Gal/GalNAc Lectin)
78
Lytic enzymes produced by the
parasite E. hystolytica that would lead to tissue destruction. Factor for the spread of the parasite
Cysteine Proteinases
79
Used by E. histolytica for formation of holes
Amebapores
80
bacterial dysentery
Shigella dysenteriae
81
More mucus and blood in stool
| Bacillary Dysentery or Amebic Dysentery
Amebiasis
82
No granulocytosis (no high levels of WBC)
| Bacillary Dysentery or Amebic Dysentery
Amebic Dysentery
83
No high fever
| Bacillary Dysentery or Amebic Dysentery
Amebic Dysentery
84
Seldom epidemic
| Bacillary Dysentery or Amebic Dysentery
Amebic Dysentery
85
Gradual onset
| Bacillary Dysentery or Amebic Dysentery
Amebic Dysentery
86
No prodromal features
| Bacillary Dysentery or Amebic Dysentery
Amebic Dysentery
87
No vomiting
| Bacillary Dysentery or Amebic Dysentery
Amebic Dysentery
88
Patient usually ambulant
| Bacillary Dysentery or Amebic Dysentery
Amebic Dysentery
89
Bloody diarrhea
| Bacillary Dysentery or Amebic Dysentery
Amebic Dysentery
90
Fishy odor stool
| Bacillary Dysentery or Amebic Dysentery
Amebic Dysentery
91
May be epidemic
| Bacillary Dysentery or Amebic Dysentery
Bacillary Dysentery
92
Acute onset
| Bacillary Dysentery or Amebic Dysentery
Bacillary Dysentery
93
Prodromal fever and
malaise common
| Bacillary Dysentery or Amebic Dysentery
Bacillary Dysentery
94
Vomiting common
| Bacillary Dysentery or Amebic Dysentery
Bacillary Dysentery
95
Patient prostrate
| Bacillary Dysentery or Amebic Dysentery
Bacillary Dysentery
96
Watery, bloody diarrhea
| Bacillary Dysentery or Amebic Dysentery
Bacillary Dysentery
97
Odorless stool
| Bacillary Dysentery or Amebic Dysentery
Bacillary Dysentery
98
Stool microscopy:
numerous bacilli, pus
cells,
| Bacillary Dysentery or Amebic Dysentery
Bacillary Dysentery
99
Stool microscopy:
numerous bacilli, pus
cells, macrophages, red cells,
no Charcot-Leyden
crystals
| Bacillary Dysentery or Amebic Dysentery
Bacillary Dysentery
100
Abdominal cramps
common and severe
| Bacillary Dysentery or Amebic Dysentery
Bacillary Dysentery
101
Tenesmus common
| Bacillary Dysentery or Amebic Dysentery
Bacillary Dysentery
102
Natural history:
spontaneous recovery
in a few days, weeks or
more; no relapse
| Bacillary Dysentery or Amebic Dysentery
Bacillary Dysentery
103
Stool microscopy: few
bacilli, red cells,
trophozoites with
ingested red blood
cells, Charcot-Leyden
crystals
| Bacillary Dysentery or Amebic Dysentery
Amebic Dysentery
104
Mild abdominal cramps
| Bacillary Dysentery or Amebic Dysentery
Amebic Dysentery
105
Tenesmus uncommon
| Bacillary Dysentery or Amebic Dysentery
Amebic Dysentery
106
Natural history: lasts for
weeks; dysentery
returns after remission;
infection persists for
years
| Bacillary Dysentery or Amebic Dysentery
Amebic Dysentery
107
Ova and Parasite Examination:
| Laboratory diagnosis
- Direct Fecal Smear (DFS)
- Concentration Techniques
- Permanent Stained Smear
108
Mababa detection pag DFS
| Laboratory diagnosis
Direct Fecal Smear (DFS)
109
Demonstration of the trophozoite
| Laboratory diagnosis
Direct Fecal Smear (DFS)
110
FECT — primarily for the recovery
of the cyst stages
| Laboratory diagnosis
Concentration Techniques
111
Not yet conclusive
| Laboratory diagnosis
Concentration Techniques
112
Confirmation of intestinal protozoans
| Laboratory diagnosis
Permanent Stained Smear
113
Stains used for permanent stain smear
| Laboratory diagnosis
Iron Hematoxylin
or Trichrome stain
114
Boeck’s, Rice Egg Saline, Diamond, Balamuth’s Egg Yolk Infusion, Robinson’s and Inoki
| Laboratory diagnosis
Culture
115
Detection of antibodies
| Laboratory diagnosis
Serology
116
specimen should be freshly passed stool
| Laboratory diagnosis
Immunoassay
117
(ELISA), IHA
| Laboratory diagnosis
Serology
118
Flask shaped ulcer may be seen
| Laboratory diagnosis
Rectal Biopsy
119
Types of Laboratory diagnosis
● Ova and Parasite Examination
● Culture
● Serology
● Molecular Methods
● Rectal Biopsy
● Examination of Liver Aspirates
120
High Risk Groups of E. histolytica
○ Men who have sex with men (MSM)
○ Food handlers
○ Poor access to clean water
121
E. histolytica is More Prevalent in ______________
- Tropics
- Poor developing countries
122
“E. histolytica look-alikes”
- E. dispar
- E. moshkovskii (Laredo strain)
- E. bangladeshi
123
Entamoeba that Prefers lower temperature
(25-30 C)
E. moshkovskii (Laredo strain)
124
used to differentiate the lookalikes
- Molecular techniques
- Isoenzyme analysis
125
Manner of reporting of E. histolytica when found under the microscope:
Entamoeba histolytica/dispar
126
Treatment for E. histolytica
- Metronidazole
- Diloxanide Furoate
- Iodoquinol
127
Treatment for E. histolytica for Asymptomatic carriers
Diloxanide Furoate
128
Prevention E. histolytica
○ Proper Disposal of Waste
○ Proper Sanitation
○ Access to safe water and food
○ Development of an effective vaccine
129
Cause of non-pathogenic ameoba
fecally contaminated water
130
max nuclei of E. coli cyst
| OTHER COMMENSAL AMEBAE
8
131
location of karyosome E.coli cyst
| OTHER COMMENSAL AMEBAE
Eccentric
132
Prominent & larger karyosome
| OTHER COMMENSAL AMEBAE
Entamoeba
coli cyst
133
The Peripheral chromatin of E. coli cyst is _____
| OTHER COMMENSAL AMEBAE
course/rough
134
Chromatoidal bars
of E. coli cyst are
| OTHER COMMENSAL AMEBAE
Needle-like; splintered; broomstick;
witchbroom
135
What has larger trophozoite? E. coli or E. histolytica
| OTHER COMMENSAL AMEBAE
E. coli
136
Movement of E.coli trophozoite
| OTHER COMMENSAL AMEBAE
sluggish;
non-progressive
137
Pseudopodia of E. coli
| OTHER COMMENSAL AMEBAE
Blunt
138
Cytoplasm of E. coli is :
| OTHER COMMENSAL AMEBAE
- Dirty looking
- Has ingested bacteria; yeast
139
Small race of E. histolytica
| OTHER COMMENSAL AMEBAE
Entamoeba
hartmanni
140
Movement of Entamoeba hartmanni Trophozoite
| OTHER COMMENSAL AMEBAE
Sluggish and non-progresive
141
Ameba of pigs and monkeys
| OTHER COMMENSAL AMEBAE
Entamoeba
polecki
142
Most common parasite in Papua
New Guinea
| OTHER COMMENSAL AMEBAE
Entamoeba
polecki
143
Chromotoidal bar of Entamoeba polecki
| OTHER COMMENSAL AMEBAE
angular/pointed
144
location of karyosome in Entamoeba polecki
| OTHER COMMENSAL AMEBAE
center
145
Max nucleus of Entamoeba polecki (troph & cyst)
| OTHER COMMENSAL AMEBAE
1
146
Movement of Entamoeba polecki
| OTHER COMMENSAL AMEBAE
progressive
147
Peripheral chromatin is evenly distributed
| OTHER COMMENSAL AMEBAE
Entamoeba
polecki
148
Morphologically similar to E. polecki
| OTHER COMMENSAL AMEBAE
Entamoeba
chattoni
149
Seen in apes and monkeys
| OTHER COMMENSAL AMEBAE
Entamoeba
chattoni
150
Smallest intestinal amoebae (as
small as RBC)
| OTHER COMMENSAL AMEBAE
Endolimax
nana
151
Shape of Endolimax nana cyst
| OTHER COMMENSAL AMEBAE
Oval
152
Max nuclei of Endolimax
nana cyst
| OTHER COMMENSAL AMEBAE
4
153
No peripheral chromatin
| OTHER COMMENSAL AMEBAE
Endolimax nana
154
Location of Endolimax nana karyosome
| OTHER COMMENSAL AMEBAE
Eccentric
155
due to the location of the karyosome of Endolimax nana cyst
| OTHER COMMENSAL AMEBAE
Cross eyed cyst
156
max nucleus of Endolimax nana Trophozoite
| OTHER COMMENSAL AMEBAE
1
157
Endolimax nana Trophozoite movement
| OTHER COMMENSAL AMEBAE
non progressive manner
158
Ameba of swine (pigs)
| OTHER COMMENSAL AMEBAE
Iodamoeba
butschlii
159
Uninucleated with a large eccentric karyosome; with achromatic
granules
| OTHER COMMENSAL AMEBAE
Iodamoeba
butschlii
160
karyosome of Iodamoeba
butschlii appearance
| OTHER COMMENSAL AMEBAE
“Basket of flowers”
161
Large glycogen vacuole
| OTHER COMMENSAL AMEBAE
Iodamoeba
butschlii
162
Iodamoeba butschlii Trophozoite movement
| OTHER COMMENSAL AMEBAE
Sluggish movement
163
Ameba of oral cavity (gum line)
| OTHER COMMENSAL AMEBAE
Entamoeba
gingivalis
164
No cyst stage
| OTHER COMMENSAL AMEBAE
Entamoeba
gingivalis
165
This is the first amebae described in humans
| OTHER COMMENSAL AMEBAE
Entamoeba gingivalis
166
MOT of Entamoeba
gingivalis
| OTHER COMMENSAL AMEBAE
person to person
167
Max nucleus of Entamoeba
gingivalis trophozoite
| OTHER COMMENSAL AMEBAE
1
168
location of karyosome in Entamoeba gingivalis
| OTHER COMMENSAL AMEBAE
-Centrally located karyosome
169
Fine peripheral chromatin
| OTHER COMMENSAL AMEBAE
Entamoeba
gingivalis
170
Entamoeba
gingivalis is capable of ingesting what?
| OTHER COMMENSAL AMEBAE
WBC
171
Entamoeba gingivalis is seen in patients with __________
| OTHER COMMENSAL AMEBAE
pyorrhea alveolaris
172
Scavengers and eat debris; can ingest WBCs, debris, RBC (rare)
| OTHER COMMENSAL AMEBAE
Entamoeba
gingivalis
173
Found inhabiting the gum line of
teeth, tartar and gingival pockets of teeth of unhealthy mouths and even healthy mouths; may also be seen in genital tract
| OTHER COMMENSAL AMEBAE
Entamoeba
gingivalis
174
Appropriate specimen for Entamoeba gingivalis
| OTHER COMMENSAL AMEBAE
mouth scrapings
175
Found inhabiting lakes, pools, tap water, air conditioning units and heating units (facultative
parasites)
FREE LIVING PATHOGENIC AMEBAE
176
FREE LIVING PATHOGENIC AMEBAE:
○ Acanthamoeba
○ Balamuthia
○ Naegleria
177
Most pathogenic FREE LIVING PATHOGENIC AMEBAE
Naegleria
178
Parasitic stage of FREE LIVING PATHOGENIC AMEBAE location
Central Nervous System
179
Naegleria fowleri Belongs to Family _________
Vahlkampfiidae
180
Free Living Amoeboflagellate
Naegleria fowleri
181
Trophozoite stage of this parasite has ameba and flagellate form
Amoeboflagellate
182
The cyst of Naegleria fowleri can only be found in the ________
environment
183
able to resist high temperatures
thermophilic
184
thermophilic parasites
Naegleria fowleri cysts
185
stage of Naegleria fowleri that can be recovered on humans
Trophozoite
186
Feeding form, “Limax” form of Naegleria fowleri
Ameboid (ameba)
187
Swimming form of Naegleria fowleri
Ameboflagellate (flagellate)
188
Naegleria fowleri Entry into the body
Olfactory Epithelium, respiratory tract, Skin and Sinuses
189
When the Naegleria fowleri reach the CNS it can cause the disease called _____________
Primary Amebic Meningoencephalitis
(PAM)
190
Diagnostic stage of Naegleria fowleri
Trophozoite
191
Matter of reproduction of Naegleria fowleri
Promitosis
192
stage of Naegleria fowleri with presence of two anterior flagella
Flagellated stage
193
Max nucleus of Naegleria fowleri trophozoite
1
194
No peripheral chromatin
Naegleria fowleri trophozoite
195
In Primary Amebic Meningoencephalitis
(PAM), Once the symptoms
appears, the patient
would die after ______
7 days
196
Signs and symptoms of Primary Amebic Meningoencephalitis
(PAM)
○ Headache
○ Fever
○ Rhinitis
○ Lethargy
○ Olfactory problems
○ Mental confusion and
coma
197
Rish factors of Primary Amebic Meningoencephalitis
(PAM)
Swimming in
contaminated pools lakes and rivers
198
Incubation period of Rish factors of Primary Amebic Meningoencephalitis
2-3 days or as long as
1-2 weeks
199
Pathogenic
Determinant of Primary Amebic Meningoencephalitis
(PAM)
- PRESENCE OF Amebostomes
- Cytopathic Effect on Host Tissues
200
food cups, used to attach
to the surface of the cell
Amebostomes
201
Amebostomes release what?
phospholipase
202
Naegleria fowleri Cytopathic Effect on Host Tissues
● Secretion of lytic enzymes
● Membrane Pore-forming proteins
● Induction of apoptosis
● Direct feeding of the ameba
203
Diagnosis:
- Wet mount examination of CSF
- Smears stained with Wright’s or Giemsa
- Biopsy
- CSF Analysis
- Culture (Bacteria Seeded Agar
Culture)
- Molecular Methods
Primary Amebic Meningoencephalitis
(PAM)
204
What can you see in patient's with Primary Amebic Meningoencephalitis
(PAM) - Wet mount examination of CSF
Decreased CSF glucose, Increased protein; High WBC
205
Used in Culture (Bacteria Seeded Agar
Culture) for diagnosis of PAM
Modified Nelson’s
Medium
206
Usually diagnosis of PAM is done ____________
Post mortem
207
Treatment &
Prevention for PAM
- Amphotericin B With Clotrimazole
- New Agents: Azithromycin;
Voriconazole
208
Morphologically similar to Naegleria fowleri but biochemically distinct species present in the country
Naegleria
philippinensis
209
Acanthamoeba spp. Belongs to Family ____________
Acanthamoebiadae
210
Acanthamoeba spp. types:
- Acanthamoeba castellani
- A. culbertsoni
- A. hutchetti
- A. polyphaga
- A. rhysoides
211
Free-living Ameba
Acanthamoeba spp.
212
Characterisitc Feature of Acanthamoeba spp
Presence of Acanthapodia
213
spine like pseudopodia; spine like appearance
Acanthapodia
214
Entry point of Acanthamoeba spp
- Nose
- Eyes
- Broken skin
215
difference of Acanthamoeba spp to Naegleria fowleri
slower progression
216
Infective stage of Acanthamoeba spp
IS: cyst or trophozoite
217
Unique characteristic of Acanthamoeba spp cyst
Double wall
218
Outer wall of Acanthamoeba spp cyst
wrinkled
219
Inner wall of Acanthamoeba spp cyst
polyhedral
220
max nucelus of Acanthamoeba spp Trophozoite
1
221
Acanthamoeba spp Trophozoite have presence of _________
contractile vacuole
222
Acanthamoeba spp causes?
* Granulomatous Amebic Encephalitis
* Amebic Keratitis
* Cutaneous lesions
223
Incubation period of Granulomatous Amebic
Encephalitis
10 days
224
Chronic; slow progression
Granulomatous Amebic
Encephalitis
225
Patients will experience this after getting GAE
- meningitis
- Encephalitis
- presences of granulomas lesions
226
Common among debilitated or
immunocompromised patients
Granulomatous Amebic
Encephalitis
227
Affects the eyes,
ulcerations sa cornea
Amebic Keratitis
228
Mistaken for herpes keratitis
Amebic Keratitis
229
Implicated among contact lens
users
Amebic Keratitis
230
Appropriate specimen for Amebic Keratitis
Corneal Scrapings
231
Presence of hard erythematous
nodules or skin lesions
Cutaneous lesions
232
Cutaneous lesions ussualy seen in ___________
AIDS patients
233
Diagnosis:
● Biopsy
● Corneal Scrapings
● Culture
● Molecular Methods
Amebic Keratitis
234
Used in culture for Acanthamoeba spp.
○ Culberto’s medium
○ Non nutrient medium
with Gram (-) bacteria
235
Treatment for Amebic Keratitis
- Fluorocystine
- ketoconazole
- amphotericin B
236
Very Fatal once cerebral manifestations
appear
Amebic Keratitis
237
Prevention of Amebic Keratitis
Boil water/prolong
heating of water can
kill the parasite
238
Acanthamoeba is more
resistant to ______________
chlorine
disinfection
239
Acathamoeba can be a
possible reservoir for:
- legionella
- myobateria
- Gr(-) bacilli
240
Balamuthia mandrillaris Family _____________
Leptomyxidae
241
Balamuthia mandrillaris is recognized as a new species causing ____________
Amebic
meningoencephalitis
242
Associated with GAE
Balamuthia mandrillaris
243
Trophozoite of Balamuthia mandrillaris characteristics
branching
244
Cyst of Balamuthia mandrillaris characteristics
Wavy
245
Other free living ameba that causes amebic encephalitis:
● Sappinia diploidea
● Hartmannella vermiformis
246
Considered now as opportunistic
Hartmannella vermiformis
Parasitology lec
flashcards
Decks in class (24)
# Cards
-
Introductory Concepts of Parasitology200
-
ameba246
-
Flagellates189
-
Introductory Concepts of Parasitology 2245
-
Phylum Apicoplexa-plasmodium122
-
Other Apicomplexa94
-
Generalities of nematodes59
-
Ascaris lumbricoides63
-
Trichuris trichiura30
-
Enterobius vermicularis48
-
Hookworms104
-
Animal Hookworms and Trichostrongylus40
-
Filarial worms116
-
Other Filarial Worms119
-
TISSUE NEMATODES120
-
Hemoflagellates228
-
Strongyloides stercoralis74
-
Cestodes64
-
Order Pseudophyllidea and Order Cyclophyllidea114
-
Trematodes78
-
Blood Flukes168
-
Lung flukes and Intestinal fluke50
-
flukes229
-
tapeworms121
