Strategies Novartis can use to GROW from a Billion Dollar Company to a Trillion Dollar Company like Alphabet Inc Novartis is a leading healthcare company which is situated in Switzerland and uses digital technologies and innovative science to come up with transformative ways of treatment in areas of great medicinal needs. This article explains what Novartis strategies and what they should employ so that they can rise from a billion dollar company to a trillion dollar company like the Google Alphabet Inc. Novartis was formed in March 1996 by the merging of pharmaceutical and agrochemical divisions of Ciba-Geigy and Sandoz companies. Thanks to the merging of the two companies, Novartis is one of the biggest pharmaceutical companies in the world. Novartis is one of the largest companies which achieved a great milestone within a few decades. Novartis as a whole is divided into three major divisions: Sandoz (generics), Innovative Medicines and Alcon (eyecare). Novartis is also involved in collaborative research projects that are publicly funded. Below are some of Novartis best selling drugs and their revenue 1.Cosenty – This is the top selling drug with a revenue of 4.788 billion dollars 2.Enfresto – This has a revenue of 4.644 billions dollars 3.Promacta – This has a revenue 0f 2.088 billion dollars Medicine manufactured by Novartis and their uses Medicine Medicine use Cosentyx Used to treat psoriatic arthritis Entresto Used to treat heart failure Lucentis Used to block abnormal vessel growth in the back of the eye Tasigna Used to treat chronic myelogenous leukemia which has the Philadelphia chromosome Jakavi Used to treat myelofibrosis, polycythemia vera and graft-versus-host disease Promacta Used to treat patients with abnormal low platelet count Sandostatin Used to treat patients with tumor experiencing symptoms like flushing and diarrhea Xolair Used to treat moderate and severe asthma Gilenya Used to treat multiple sclerosis How Novartis became one of the biggest pharmaceutical companies in the world 1.Market control through partnership Geigy, Sandoz and Ciba combined their power so that they can compete with strong foreign firms and formed a cartel called the Basal Syndicate or Basal IG. Basal IG secured most of the manufacturing facilities all over the US and across Europe. It later joined with IG Farben and other chemical companies to form a big cartel called the Quadrapartite Cartel which dominated all of the European market and enjoyed the profits made from the joint manufacturing. 2.Growth acceleration through mergers Since competition was very rampant in the pharmaceutical industry, Ciba and Geigy decided to merge with Sandoz AG to form Novartis. With this merge, Novartis became one of the growing giants in the pharmaceutical industry. This made Novartis gain a lot of fame and build a strong reputation over other companies. Novartis majored on agrochemical and pharmaceutical industries which made it easy to focus on a specific mar

1. HCM 124: MEDICAL PARASITOLOGY
AND ENTOMOLOGY
JACKSON C. KORIR (PhD)
0721- 413 606
jcheruiyot@mmust.ac.ke
Masinde Muliro University
of Science and Technology
(MMUST)
University of Choice

2. The Protozoa
Introduction:
The Phylum Protozoa is classified into four
subdivisions according to the methods of locomotion.
 The amoebae (Sarcodina) move by means of
pseudopodia.
 The flagellates (Mastigophora) typically move by
long, whiplike flagellae.
 The ciliates (Ciliata) are propelled by rows of cilia that
beat with a synchronized wavelike motion.
 The sporozoans (Sporozoa) lack specialized
organelles of motility.

3. Classification

4. The Protozoa
General:
 There are about 45,000 protozoan species; around 8000
are parasitic, and around 25 species are important to
humans.
 Diagnosis - must learn to differentiate between the
harmless and the medically important. This is most often
based upon the morphology of respective organisms.
 Transmission - mostly person-to-person, via fecal-oral
route; fecally contaminated food or water; other means
include sexual transmission, insect bites or insect feces.

5. The Protozoa
General:
Exist in 2 forms:
 Trophozoite - the motile vegetative stage;
multiplies via binary fission; colonizes host.
 Cyst - the inactive, non-motile, infective
stage; survives the environment due to the
presence of a cyst wall. Cysts do not multiply,
however, some organisms divide within the
cyst wall.

6. The Protozoa
Diagnostic Features:
 Nuclear structure - important in species differentiation.
 Size - helpful in identifying organisms; must have calibrated
objectives on the microscope in order to measure
accurately.
 Cytoplasmic inclusions - chromatoid bars (coalesced RNA);
red blood cells; food vacuoles containing bacteria, yeast,
etc.
 Appearance of cytoplasm - smooth & clean or vacuolated.
 Type of motility - directional or non-directional; sluggish or
fast.

7. The Protozoa
Nuclear Structure:
 Chromatin - nuclear DNA. Present as “peripheral”
chromatin and the karyosome.
 Karyosome - a small mass of chromatin within the nuclear
space. Also called “endosome” or “centrosome.”
 Peripheral Chromatin - chromatin adhering to the nuclear
membrane.
 Nuclear membrane - membrane surrounding all nuclear
material.
Chromatoid body or “bar” - coalesced RNA within the
cytoplasm of the cyst stage.

8. Intestinal Protozoa - The
Amoebae
General Life cycle -
 The definitive host ingests the infective cyst stage from fecal
contamination in environment.
 The cyst passes into the small intestine & excystation occurs
with transformation to the trophozoite stage.
 Trophozoites colonize the host, multiplying asexually via
binary fission. They can remain near the lumen (non-
pathogens) or invade the wall of the intestine & multiply
(pathogens).
 Cysts and trophozoites are passed in the feces of the
infected host.

9. Life cycle

10. Intestinal Protozoa - The Amoebae
Entamoeba histolytica
 Epidemiology - Occurs worldwide; the highest
incidence and prevalence is in areas with poor
sanitation.
 Pathology and Clinical Manifestations - the
most pathogenic of all; causes amoebic
dysentery; can become extra-intestinal; can be
fatal. Hepatic abscess is the most common
and dangerous complication.
 Chronic infections may last for years; often
confused with colitis, cancer.
 Distribution - worldwide, mostly in tropics and
sub-tropics.

11. Intestinal Protozoa - The Amoebae
Entamoeba histolytica
Morphology & Laboratory Identification
- trophozoites range 12 to 30 microns in diameter;
- nucleus has an even distribution of peripheral
chromatin and a small, compact, centrally located
karyosome;
- cytoplasm is smooth and granular;
- inclusions, if present, are red blood cells;
- Motility is rapid, progressive, and unidirectional,
through pseudopods
- cysts range 10 to 20 microns in diameter and
contains four nuclei when mature.
- immature cyst has inclusions namely; glycogen
mass and chromatoidal bars.
- Cigar-shaped chromatoid bars may be present in
some cysts.

12. Intestinal Protozoa - The Amoebae
Entamoeba hartmanni
 Epidemiology - similar to E. histolytica
 Formerly called the “small race” of
Entamoeba histolytica.
 Technologists must be able to
differentiate this organism from E.
histolytica because E. hartmanni is non-
pathogenic.

13. Intestinal Protozoa - The Amoebae
Entamoeba hartmanni
 Morphology & Laboratory Identification -
This organism is morphologically similar to
E. histolytica. The difference lies in the
sizes of the respective organisms.
Trophozoites will measure less than 12
microns, while cysts will measure less than
10 microns.

14. Intestinal Protozoa - The Amoebae
Entamoeba coli
 Significance - this is a harmless commensal;
must be differentiated from pathogens.
 Morphology –
- trophozoites range from 10 to 35 microns in
diameter;
- cysts range from 10 to 30 microns in diameter and
contain 8 to 16 nuclei when mature; the nucleus
exhibits an eccentric karyosome with irregular,
coarse chromatin. The cytoplasm is heavily
vacuolated, containing yeast, bacteria, and debris.

15. Intestinal Protozoa - The Amoebae
Entamoeba gingivalis
 Infective site - the mouth; the organism
thrives in diseased gums, but is not
considered a causal agent. It is destroyed
in stomach if swallowed.
 Transmission - contact with fomites
(drinking glasses, eating utensils, etc.);
kissing.
 Morphology - resembles E. histolytica, but
has no cyst stage. It is the only species
which ingests leucocytes.

16. Intestinal Protozoa - The Amoebae
Endolimax nana
 Occurrence - occurs in about 14% of the
US population; 21% worldwide.
 Pathogenicity - none.
 Morphology - trophozoites range from 5 to
10 microns in diameter. The nucleus
contains a large, blot-like karyosome; there
is little or no peripheral chromatin. Cysts
are usually sub-oval, measuring 4 to 6 by 6
to 10 microns.

17. Intestinal Protozoa - The Amoebae
Iodamoeba butschlii
 Pathogenicity - none.
 Morphology - the cyst is often
called the “iodine cyst” due to the
presence of a large glycogen
vacuole which stains dark brown
with iodine.

18. - E. histolytica
E.
hartmanni
E. coli
E.
polecki
E.nana
l.
butsch
lii
Tropho
zoiteM
oveme
nt
Active especially in
acute dysentery
Sluggish Sluggish sluggish Sluggish Active
Inclusi
ons
Red cell in case of
tissue invasion
No red cells
No red
cells
No red
cell
No red
cell
No red
cell
Morphology of Trophozites of
intestinal Amoebae (Live specimens)

19. - E. histolytica E. hartmanni E. coli E. polecki E. nana I.butschlii
Trophozoite
No. of nuclei
1 1 1 1 1 1
Karysome(N
ucleolus)
Usually central
small
Usually central
small
Usually central
small
Usually central
small
Large
Large
generally
irregular
Peripheral
chromatin
Usually
symmetrical
fine
Usually
symmetrical
fine
Usually
symmetrical
fine
Usually
symmetrical
fine
Usually
symmetrical
fine
Incon-
spicuous
Cyst No.
nuclei
4 4 8 1 1 1
Shape Circular Circular Circular Circular Usually oval Irregular
Size(dia.) 12-20 um 2-8 um 15-25 um 11-15 um 8-12 um 10-16 um
Chromatoid
body
Usually large
rounded ends
Usually large
rounded ends
Usually small
splintered ends
Variable shape Absent Absent
Glycogen
vacuole
Diffuse Diffuse Diffuse Diffuse Absent
large and
sharply
demarcated
Other
inclusions
Nil Nil Nil
Usually large
faintly staining
mass
Nil
Sometimes
minute rod
like bodies
Differential characteristics of intestinal
amoebae (stained specimens)

20. Treatment & prevention of
pathogenic amoeba
 Treatment- metronidazole marketed
under brand name flagyl followed by
Iodoquinol
 Prevention- Introduction of adequate
sanitation measures and education
about the routes of transmission.
- Avoid eating raw vegetables grown by
sewerage irrigation and night soil.

21. Tissue Dwelling Amoebae
Naegleria fowleri
 Classification - an ameboflagellate; a free-living
organism alternating between amoeboid and
flagellated forms; only the amoeboid form is found
in tissues.
 Life cycle - the amoeba gains entry via the nasal
mucosa, usually during a swimming event; it
moves along the olfactory nerve, gaining access
to the brain via the cribriform plate. Cases are
invariably fatal. Infections do not spread from
person-to-person.
Naegleria fowleri trophozoite in CSF

22. The Protozoa
Tissue Dwelling Amoebae
Naegleria fowleri
 Symptoms - Dramatic and rapidly
progressive. Headache, fever, nausea
& vomiting occur within 1 to 2 days.
Meningoencephalitis, irrational
behavior, coma & death usually occur
within 9 days of exposure.
 Diagnosis - Usually made at autopsy.
CSF contain motile amoebae. Early
diagnosis is critical. Amoebae in CSF
specimens can be cultured on non-
nutrient agar containing bacteria.

23. Tissue Dwelling Amoebae
Acanthamoeba spp.
 Life cycle - also a free-living amoeba. The
amoeba reaches the brain hematogenously after
entering a wound or lesion on the skin. More
commonly, the organism is associated with getting
into eyes via contaminated or homemade cleaning
solutions.
 Symptoms - slow onset (10 or more days).
Presents as chronic, granulomatous lesions in
brain. In eye lesions, the infection resembles a
herpes virus infection.
 Acanthamoeba keratitis - associated with users of
extended-wear contact lenses.

24. Superclass Mastigophora -
the flagellates.
 Inhabit the mouth, bloodstream, gastrointestinal, or urogenital tracts.
Morphological Characteristics
 Flagellum(ae) - organelles of locomotion; an extension of ectoplasm;
moves with a whip-like motion.
 Axostyle - a supporting mechanism, a rod-shaped structure; not all
flagellates have these.
 Undulating membrane - a protoplasmic membrane with a flagellar rim
extending out like a fin along the outer edge of the body of some
flagellates.
 Costa - a thin, firm rod-like structure running along the base of the
undulating membrane.
 Cytosome - a rudimentary mouth; also referred to as a gullet.

25. Superclass Mastigophora -
the flagellates.
Identification of a flagellate is based upon:
 Size.
 Shape.
 Motility.
 Number and morphology of nuclei.
 Number and location of flagellae.
 Location in the body of the host.

26. Superclass Mastigophora -
the flagellates.
There are three groups of flagellates:
• Luminal flagellates
-Giardia duodenalis
-Dientmoeaba fragilis
• Hemoflagellates
-Trypanosoma species.
-Leishmania species.
• Genital flagellates
-Trichomonas vaginalis

27. Intestinal flagellates
Giardia duodenalis
 Most common protozoan parasite
 Life cycle - man ingests cysts from fecally
contaminated environment; the organism excysts in
the upper intestine; trophozoites multiply and attach
to the intestinal mucosa; often enter the gall bladder.
Trophozoites and cysts are passed in the feces.
 Diagnosis - identification of cysts or trophozoites in
stool specimens or duodenal contents.

28. 1-2. Giardia cysts are the infective stage of G. intestinalis. As
few as 10 cysts can cause infection (1). These cysts are ingested
by consuming contaminated food or water, or fecal-orally. They
can survive outside the body for several months, and are also
relatively resistant to chlorination, UV exposure and freezing.
3. When cysts are ingested, the low pH of the stomach acid
produces excystation, in which the activated flagella breaks
through the cyst wall (1). This occurs in the small intestine,
specifically the duodenum. Excystation releases trophozoites,
with each cyst producing two trophozoites.
4. Within the small intestine, the trophozoites reproduce
asexually (longitudinal binary fission) and either float free or
are attached to the mucosa of the lumen.
5. Some trophozoites then encyst in the small intestine.
Encystation occurs most likely as a result of exposure to bile
salts and fatty acids, and a more alkaline environment. Both
cysts and trophozoites are then passed in the feces, and are
infectious immediately or shortly afterward. Person-to-person
transmission is possible.
Life cycle of Giardia

29. Intestinal flagellates
Giardia duodenalis
Morphology - very distinctive.
Dorsal-ventrally flattened, and Bi-
laterally symmetrical.
 Cyst - 9 x 12 micrometers and
contain 2 to 4 nuclei; parabasal
bodies are present.
 Trophozoite - Four pairs of
flagella - one pair located anterior,
two pair located ventrally, and one
pair located posteriorly. An
axostyle and parabasal bodies are
present.
Trophozoite Cyst

30. Intestinal flagellates- Giardia
duodenalis
 Epidemiology - prevalence 1 to 30%, common in children’s day care
centers; can be transmitted in water. Sexual transmission has been
well documented.
 Pathology and Clinical Manifestations - symptoms can be severe;
diarrhea, foul-smelling, greasy, mucus-laden stools, flatulence,
nausea, cramps. Most infections are asymptomatic; chronic cases
experience weight loss, malabsorption of fat, protein, folic acid, and
fat-soluble vitamins.
 Laboratory diagnosis- Examination of diarrhoeal stool- trophozoite or
cyst, or both may be recovered in wet preparation.
 Treatment- quinacrinehydrochloride or metronidazole.

31. Intestinal flagellates-
Dientamoeba fragilis
 General - Formerly classified as an
amoeba; electron microscopy and
immunological studies have suggested a
flagellate nature.
 Laboratory diagnosis - detection of bi-
nucleated trophozoites; fragmented
karyosomes consisting of 4 to 8 granules
of chromatin.

32. Intestinal flagellates
Dientamoeba fragilis
Diagnostic stage - the trophozoite in
feces. There is no cyst stage.
 Morphology - 1 or 2 nuclei, with little
or no peripheral chromatin;
karyosome is divided into 4 to 8
distinct granules.
 May rarely ingest rbc’s.

33. Intestinal flagellates
Dientamoeba fragilis
 Pathology - infection is usually asymptomatic; can be
associated with diarrhea, anorexia, abdominal pain.
 Association with pinworm - the organism may be
transmitted from host to host within the egg of Enterobius
vermicularis.
 Distribution - worldwide, there is a 1% to 20%
prevalence.

34. Intestinal flagellates-
Chilomastix mesnili
 A non-pathogen - must be
differentiated from Giardia.
 Found in cecum and colon.
 Transmission - by ingestion of
mature cysts.

35. Intestinal flagellates-
Chilomastix mesnili
Morphology -
 Trophozoite - 4 flagella (3
anterior, 1 associated with the
cytostome; one nucleus, always
located anteriorly.
 Cyst - lemon shape; 1 nucleus;
cytostome may be seen.

36. The Trichomonads
Characteristics -
 Undulating membrane - protoplasmic
membrane with flagellar rim extending out
like a fin along outer edge of body.
 Flagella - several in a tuft, provides
locomotion.
 Axostyle - functions for support.
 Costa - firm rod-like structure running
along base of the undulating membrane.
 Cytostome - rudimentary mouth.

37. The Trichomonads-
Trichomonas hominis
 Commensal - must differentiate from
pathogens.
 Transmission - direct person-to-person
fecal transmission; no cyst stage.
 Morphology - “arc-shaped” exhibits a
wobbly, jerky, motility.
 Must differentiate from T. vaginalis - in
instances where feces is contaminated with
urine.

38. TheThe Trichomonads-
Trichomonas vaginalis
 Life cycle - trophozoite lives in the
vagina, urethra, epididymis, and prostate;
multiplies via longitudinal fission; no cyst
stage.
 Mode of infection - sexual intercourse or
fomites.
 Diagnosis - identification of trophozoites
in body fluids (wet mounts of discharges)
or on PAP smears.

39. Trophozoite

40. The Trichomonads
Trichomonas vaginalis
 Pathology - Females: vaginal discharge; burning, Itching,
or chafing. Frequency of urination or dysuria. Males:
frequently asymptomatic. If the prostate is involved, the
patient may develop discharge, dysuria, and enlargement
of prostate with tenderness.
 Morphology - has an axostyle and short undulating
membrane that extends less than half the body length; 4
flagellae.
 Treatment- Metronidazole

41. Class Ciliophora - The Ciliates
Balantidium coli
 Epidemiology - Rarely found.
 This is the only ciliate parasite of humans.
 Largest parasitic protozoan - trophozoite
is 30-120 x 25-125 microns; the cyst
averages 50 - 70 microns in diameter.
 Life cycle - The cyst is ingested via fecal
contamination in environment; cysts
excyst in the small intestine; trophozoites
migrate to large intestine.

42. Class Ciliophora - The Ciliates
Balantidium coli
 Pathology & Symptoms - Many infections
are asymptomatic, organism feeding on
bacteria at surface of mucosa. Severe
infections - with the aid of hyaluronidase,
the organism burrows into submucosa,
producing ulcers. Symptoms - dysentery,
abdominal pain, nausea & vomiting, fever,
headache.
 Diagnosis - Diagnosed by observing cysts
& trophozoites in fecal samples.
 Treatment-The drug of choice is
tetracycline; iodoquinol and metronidazole
are alternative agents.

43. Class Ciliophora - The Ciliates
Balantidium coli
 Morphology - Large, oval shape;
two nuclei, 1 large kidney shaped
(macronucleus) & 1 small
micronucleus (micronucleus not
often seen); body surface covered
by longitudinal rows of cilia;
cytostome present.
 Primary animal reservoir - pigs,
monkeys.