Matrices of tropical infection

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Protozoa
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Nematode (roundworm)
Nematode principles Lympatic filariasis Onchocerciasis Loiasis Microscopic differentiation of microfilariae Strongyloidiasis Ascariasis Ancylostomiasis (hookworm) Trichuriasis (whipworm) Enterobiasis (pinworm) Angiostrongyliasis (rat lungworm) Dracunculiasis (Guinea worm) Anisakiasis Trichinellosis (Trichinosis) Gnathostomiasis Spirurinasis Soil-transmitted helminths

Trematode (fluke, distoma)
General issues of Helminths Trematode principles Schistosomiasis Clonorchiasis Fascioliasis Paragonimiasis Metagonimiasis

Cestode (tapeworm)
General issues of Helminths Cestode principles Diphyllobothriasis Sparganosis Taeniasis Echinococcosis

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Reproduction of protozoa

	Virus	Bacteria and Rickettsia	Protozoa	Nematode	Trematode	Cestode
asexual			Intestinal amoeba Giardia Trypanosoma Leishmania
sexual			Plasmodium Trypanosoma also has sexual stage Leishmania also has sexual stage Cryptosporidium Cyclospora Isospora

Routes of transmission

Vertical transmission that matters

	Virus	Bacteria and Rickettsia	Protozoa	Nematode	Trematode	Cestode
placental	HIV Hepatitis B	Syphilis	Chagas
transvaginal	HIV Hepatitis B	Neonatal gonococcal conjunctivitis
breastfeeding	HTLV-1

Water

	Virus	Bacteria and Rickettsia	Protozoa	Nematode	Trematode	Cestode
Direct contact to freshwater	nil	Leptospirosis Melioidosis	Acanthamoeba spp. (cornea)	Schistosomiasis
Aspiration of freshwater		Melioidosis	Naegleria fowleri
Ingestion of freshwater		Melioidosis	Naegleria fowleri			Dracunculiasis (Guinea worm)

Soil

	Virus	Bacteria and Rickettsia	Protozoa	Nematode	Trematode	Cestode
soil to skin		Melioidosis		Ancylostomiasis (hookworm) (by larvae) Strongyloidiasis (by larvae)
soil to mouth				Ascariasis (by eggs) Toxocariasis (by eggs)
direct anus to mouth though called as soil-transmitted helminths				Enterobiasis (pinworm) (by eggs) Trichuriasis (whipworm) (by eggs)

Aquatic organism

	Virus	Bacteria and Rickettsia	Protozoa	Nematode	Trematode	Cestode
freshwater fish				Gnathostomiasis (by larvae)		Metagonimiasis (by metacercariae) (sweetfish 鮎)
freshwater crab						Paragonimiasis (by metacercariae)

Animals

	Virus	Bacteria and Rickettsia	Protozoa	Nematode	Trematode	Cestode
Rodent	Hantavirus Lassa Monkeypox	Leptospirosis Plague
Domestic animals		Bartonellosis Brucellosis

Flies

	Virus	Bacteria and Rickettsia	Protozoa	Nematodes	Trematodes	Cestodes
Sandfly		Bartonellosis (Oroya fever, Carrion's disease)	Leishmaniasis
Blackfly				Onchocerciasis
Tse Tse fly			African trypanosomiasis
Deer fly Chrysops				Loiasis
Horse fly Tabanus				Loiasis

Incubation period/Latent infection

	Virus	Bacteria and Rickettsia	Protozoa	Nematode	Trematode	Cestode
Incubation/latency possibly > 1 year		Melioidosis	Leishmania Trypanosoma cruzi

Target organs

Eye involvement

	Virus	Bacteria and Rickettsia	Protozoa	Nematode	Trematode	Cestode
Conjunctivitis	Zika	Leptospirosis as conjunctival suffusion

Skin involvement

	Virus	Bacteria and Rickettsia	Protozoa	Nematode	Trematode	Cestode
larvae migrans				Ancylostomiasis (hookworm) Gnathostomiasis Strongyloidiasis as larva currens

Liver and spleen involvement

	Virus	Bacteria and Rickettsia	Protozoa	Nematode	Trematode	Cestode
Jaundice	Viral hepatitis Yellow fever	Leptospirosis	Malaria
Hepatosplenomegaly		Melioidosis Brucellosis Oroya fever	Malaria Visceral leishmaniasis		Schistosomiasis
Hepatomegaly predominant	Viral hepatitis	Leptospirosis
Splenomegaly predominant			Visceral leishmaniasis

Infected cells

	Virus	Bacteria and Rickettsia	Protozoa	Nematode	Trematode	Cestode
Macrophage		Tuberculosis Brucellosis Melioidosis	Trypanosomiasis Leishmaniasis

Syndromes

	Virus	Bacteria and Rickettsia	Protozoa	Nematode	Trematode	Cestode
Katayama syndrome						Schistosomiasis
Löeffler syndrome				Ascariasis Strongyloidiasis Ancylostomiasis (hookworm)
Mazzotti reaction				DEC for onchocerciasis highly possible Ivermectin for onchocerciasis sometimes possible Ivermectin for loasis with onchocerca sometimes possible
Wakana syndrome				Ancylostomiasis (hookworm)

Treatment

Treatment for helminths

	Virus	Bacteria and Rickettsia	Protozoa	Nematode	Trematode	Cestode
Diethylcarbamazine (DEC)				Lymphatic filariasis Loiasis when <8,000MF/mL NEVER for Onchocerciasis and beware of co-infection
Ivermectin				Onchocerciasis but Mazzotti 10% and encephalopathy NEVER for Loiasis and beware of co-infection Strongyloidiasis Ancylostomiasis (hookworm) Gnathostomiasis
Albendazole				Loiasis when >8,000MF/mL Ancylostomiasis (hookworm) Trichuriasis (whipworm) Trichinellosis Toxocariasis Enterobiasis (pinworm) Gnathostomiasis		Echinococcosis
Praziquantel				Ascariasis	Adult of schistosoma Clonorchiasis Paragonimiasis	Diphyllobothriasis Taeniasis Echinococcosis
Triclabendazole					Fasciolasis
Doxycycline				Adult of lymphatic filariae for Wolbachia Adult of onchocerca for Wolbachia
Mechanical removal Spontaneous resolution No effective treatment				Dracunculiasis (Guinea worm) Anisakiasis Angiostrongyliasis (rat lungworm)		PAIR for Echinococcus granulosus Surgery for Echinococcus multilocularis

Options for LF, Oncho and Loiasis

	Lymphatic filariasis	Onchocerciasis	Loiasis
Diethylcarbamazine (DEC)	1st line	NEVER possibly Mazzotti	<8,000MF/mL
Ivermectin		1st line but Mazzotti 10%	NEVER possibly encephalopathy
Albendazole			>8,000MF/mL

	Lymphatic filariasis	→LF & Oncho←	Onchocerciasis	→Oncho & Loiasis←	Loiasis
Diethylcarbamazine (DEC)	1st line	NEVER	NEVER	NEVER	<8,000MF/mL
Ivermectin		Ivermectin + Albendazole may be safe	1st line but Mazzotti 10%	NEVER	NEVER
Albendazole				may be an option	>8,000MF/mL
Other option				Cytapheresis of oncho MF before DEC