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// ═══════════════════════════════════════════════════════════════════════════════
//  SLIDES BEGIN
// ═══════════════════════════════════════════════════════════════════════════════

// ── COVER ──────────────────────────────────────────────────────────────────────
addTitleSlide("Medical Parasitology", "A Comprehensive Lecture Guide\nProtozoa · Trematodes · Cestodes · Nematodes");

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 1: PARASITES, HOST & HOST-PARASITE RELATIONSHIP
// ══════════════════════════════════════════════════════════════════════════════
addSectionHeader("Section 1", "Concept of Parasites, Host & Host-Parasite Relationship");

addContentSlide("Definitions: Parasite & Host", [
  {
    heading: "Parasite",
    items: [
      "An organism that lives on or inside another organism (host) and benefits at host's expense",
      "Endoparasite – lives inside host (e.g. Plasmodium)",
      "Ectoparasite – lives on surface of host (e.g. lice, ticks)",
      "Obligate parasite – cannot survive without host",
      "Facultative parasite – can survive with or without host",
      "Accidental parasite – infects abnormal host"
    ]
  },
  {
    heading: "Types of Hosts",
    items: [
      "Definitive host – sexual reproduction occurs (e.g. humans for Taenia)",
      "Intermediate host – asexual/larval stages (e.g. pig for Taenia)",
      "Paratenic/transport host – no development but parasite survives",
      "Reservoir host – maintains parasite in nature",
      "Accidental host – not normal host (e.g. human for Toxocara)"
    ]
  }
]);

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    heading: "Types of Relationships",
    items: [
      "Parasitism – parasite benefits; host harmed",
      "Commensalism – one benefits; host neither harmed nor helped",
      "Mutualism – both organisms benefit",
      "Symbiosis – broad term for living together",
      "Zoonosis – parasitic infections transmissible from animals to humans",
      "Anthroponosis – transmission only human-to-human"
    ]
  },
  {
    heading: "Outcome Determinants",
    items: [
      "Virulence & inoculum size of parasite",
      "Host immune status & genetic resistance",
      "Route of transmission (fecal-oral, vector, direct contact)",
      "Nutritional status and co-infections",
      "Balance between parasite & host → subclinical infection (rule) vs. overt disease (exception)"
    ]
  }
]);

addTableSlide("Parasite Classification Overview",
  ["Category", "Examples", "Key Feature"],
  [
    ["Protozoa – Amoebae", "Entamoeba histolytica", "Trophozoite + cyst stages"],
    ["Protozoa – Flagellates", "Giardia, Trichomonas, Trypanosoma, Leishmania", "Flagella for motility"],
    ["Protozoa – Ciliates", "Balantidium coli", "Cilia; only ciliate pathogen of humans"],
    ["Protozoa – Sporozoa", "Plasmodium, Cryptosporidium", "Obligate intracellular"],
    ["Trematodes (Flukes)", "Schistosoma, Fasciola, Paragonimus", "Leaf-shaped, suckers"],
    ["Cestodes (Tapeworms)", "Taenia, Echinococcus, Diphyllobothrium", "Segmented (proglottids)"],
    ["Nematodes (Roundworms)", "Ascaris, hookworm, Wuchereria, Trichinella", "Cylindrical, unsegmented"]
  ]
);

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 2: IMMUNE EVASION
// ══════════════════════════════════════════════════════════════════════════════
addSectionHeader("Section 2", "Immune Evasion Mechanisms of Parasites");

addContentSlide("Immune Evasion – Molecular & Structural Strategies", [
  {
    heading: "Antigenic Variation",
    items: [
      "Trypanosoma brucei – VSG (variant surface glycoproteins) switched constantly; >1000 VSG genes",
      "Plasmodium falciparum – PfEMP1 expressed on RBC surface undergoes clonal variation",
      "Giardia – surface antigen switching of VSPs"
    ]
  },
  {
    heading: "Intracellular Hiding",
    items: [
      "Toxoplasma, Leishmania, T. cruzi – survive inside macrophages",
      "T. gondii – blocks phagolysosome fusion",
      "Leishmania – inhibits oxidative burst; survives within lysosomes",
      "Plasmodium – resides inside RBCs (inaccessible to antibodies)"
    ]
  }
]);

addContentSlide("Immune Evasion – Immunological Manipulation", [
  {
    heading: "Immune Modulation",
    items: [
      "Th1 → Th2 skewing: helminths drive IL-4/IL-13 promoting IgE but not protective killing",
      "Leishmania induces IL-10/TGF-β (regulatory) → suppresses macrophage activation",
      "Schistosomes acquire host antigens → 'molecular mimicry'; evade complement",
      "Filarial worms expand T-regulatory cells → profound immunosuppression"
    ]
  },
  {
    heading: "Other Mechanisms",
    items: [
      "Complement evasion: DAF-like molecules on surface of schistosomula",
      "Proteolytic cleavage of IgG (Schistosoma, Leishmania)",
      "Polyclonal B-cell activation → non-specific antibodies, hypergammaglobulinemia",
      "Shedding of surface antigens → immune complex overload",
      "Hydatid cyst wall physically excludes immune effectors"
    ]
  }
]);

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 3: LABORATORY DIAGNOSIS
// ══════════════════════════════════════════════════════════════════════════════
addSectionHeader("Section 3", "Laboratory Diagnosis of Parasites");

addContentSlide("Specimen Collection & Microscopy", [
  {
    heading: "Specimen Types",
    items: [
      "Stool – intestinal protozoa, helminth ova & larvae (collect 3 samples on alternate days)",
      "Blood – thick & thin films (Giemsa stain) for malaria, trypanosomes, microfilariae",
      "Urine – Schistosoma haematobium eggs, Trichomonas",
      "Tissue biopsy – Leishmania (Leishman-Donovan bodies), muscle (Trichinella)",
      "Sputum / BAL – Paragonimus eggs",
      "Vaginal swab – Trichomonas vaginalis"
    ]
  },
  {
    heading: "Microscopy Techniques",
    items: [
      "Wet mount (saline + iodine) – motile trophozoites, cysts",
      "Giemsa / Wright stain – blood parasites; RBC morphology key for malaria species ID",
      "Acid-fast stain – Cryptosporidium, Cyclospora, Isospora oocysts",
      "Trichrome stain – intestinal protozoa in stool",
      "Haematoxylin-eosin (H&E) – tissue sections",
      "Knott's concentration – microfilariae (nocturnal vs. diurnal periodicity)"
    ]
  }
]);

addContentSlide("Advanced Diagnostic Methods", [
  {
    heading: "Concentration & Culture",
    items: [
      "Formalin-ethyl acetate (FEA) sedimentation – concentrates ova & cysts",
      "Flotation (zinc sulfate/saturated NaCl) – light eggs float",
      "Baermann technique – larvae from stool (Strongyloides)",
      "Harada-Mori filter paper culture – differentiate hookworm/Strongyloides",
      "NNN medium – Leishmania culture; DMEM for Trichomonas"
    ]
  },
  {
    heading: "Immunological & Molecular",
    items: [
      "ELISA – hydatid disease (Echinococcus), toxoplasmosis, visceral leishmaniasis",
      "Indirect fluorescent antibody (IFA) – malaria, toxoplasma",
      "Rapid antigen detection (RDT) – malaria (HRP-2, pLDH antigens)",
      "PCR / real-time PCR – most sensitive; differentiates species/sub-species",
      "Antigen detection in stool – Giardia, Cryptosporidium (ELISA / lateral flow)",
      "Skin test (Montenegro / leishmanin) – cutaneous leishmaniasis"
    ]
  }
]);

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 4: IMMUNITY IN PARASITIC INFECTIONS
// ══════════════════════════════════════════════════════════════════════════════
addSectionHeader("Section 4", "Immunity in Parasitic Infections");

addContentSlide("Innate & Humoral Immunity to Parasites", [
  {
    heading: "Innate Immunity",
    items: [
      "Physical barriers (gut epithelium, mucus) limit entry",
      "Macrophages – first-line phagocytosis; NO production kills protozoa",
      "NK cells – produce IFN-γ; important against intracellular parasites",
      "Complement (alternative pathway) – opsonises parasites",
      "Eosinophils – key against helminths; ADCC via IgE/IgG on parasite surface"
    ]
  },
  {
    heading: "Humoral (Antibody) Immunity",
    items: [
      "IgG – opsonisation, ADCC, complement activation against blood-stage malaria & trypanosomes",
      "IgE – markedly elevated in helminth infections (up to 10,000 ng/mL vs. normal ~100 ng/mL)",
      "IgE triggers mast cell degranulation → expulsion of gut nematodes",
      "IgA – protects mucosal surfaces; secretory IgA in gut",
      "Passive transfer of IgG from immune adults confers temporary malaria protection"
    ]
  }
]);

addContentSlide("Cell-Mediated & Evasion Context", [
  {
    heading: "Cell-Mediated Immunity",
    items: [
      "Th1 response (IFN-γ, IL-2, IL-12) – activates macrophages to kill intracellular parasites",
      "CD8+ CTLs – kill hepatocytes harbouring malaria sporozoites",
      "Th2 response (IL-4, IL-5, IL-13) – drives IgE, eosinophilia; helminth expulsion",
      "Regulatory T-cells (Tregs) – filarial worms expand Tregs → immunosuppression",
      "IL-12 + NO synergistic killing of Leishmania by activated macrophages"
    ]
  },
  {
    heading: "Key Immunological Concepts",
    items: [
      "Susceptibility vs. resistance to Leishmania major controlled by Th1/Th2 balance",
      "HLA-B53 – protective against severe malaria in West African children",
      "Concomitant immunity – resistance to reinfection while adult worms persist (schistosomes)",
      "Premunition – partial immunity allowing low-level infection without disease (malaria)",
      "Immunosuppression by parasites → increased susceptibility to secondary infections"
    ]
  }
]);

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 5: AMOEBAE
// ══════════════════════════════════════════════════════════════════════════════
addSectionHeader("Section 5", "Amoebae");

addContentSlide("Entamoeba histolytica – Overview & Life Cycle", [
  {
    heading: "Key Facts",
    items: [
      "Causative agent of amoebic dysentery and amoebic liver abscess",
      "Pathogenic; distinguish from non-pathogenic E. dispar (identical morphology)",
      "Infective form: Quadrinucleate cyst (4 nuclei, chromatoid bars, glycogen vacuole)",
      "Active form: Trophozoite (12–60 µm; ingested RBCs in cytoplasm = hallmark of E. histolytica)"
    ]
  },
  {
    heading: "Life Cycle",
    items: [
      "1. Ingestion of cysts in fecally contaminated food/water",
      "2. Excystation in small intestine → 4 trophozoites per cyst",
      "3. Trophozoites colonise large intestine (cecum & ascending colon)",
      "4. Trophozoites may invade mucosa or encyst and pass in stool",
      "5. Cysts survive days-weeks in environment; resistant to chlorine",
      "No animal reservoir – exclusively human pathogen"
    ]
  }
]);

addContentSlide("Entamoeba histolytica – Clinical & Pathogenesis", [
  {
    heading: "Clinical Features",
    items: [
      "Intestinal: gradual onset bloody/mucoid diarrhoea, colicky pain, tenesmus",
      "Amoebic dysentery: frequent bloody stools, fever",
      "Amoebic liver abscess: fever, RUQ pain, tender hepatomegaly (most common extraintestinal)",
      "Anchovy-sauce pus – characteristic of liver abscess aspirate",
      "Cutaneous amoebiasis (rare), pleuropulmonary extension"
    ]
  },
  {
    heading: "Pathogenesis, Diagnosis & Treatment",
    items: [
      "Pathogenesis: Galactose-inhibitable lectin mediates mucosal adhesion; amoebapore lyses cells; proteases digest tissue → flask-shaped ulcers",
      "Diagnosis: Stool microscopy (trophozoites/cysts), stool antigen ELISA, serology (IHA/ELISA for invasive disease), ultrasound/CT for liver abscess",
      "Epidemiology: Worldwide; endemic in developing countries; ~50 million invasive cases/yr",
      "Treatment: Metronidazole (tissue amoebiasis) + Diloxanide furoate/iodoquinol (luminal cyst eradication)",
      "Complications: Perforation, peritonitis, ameboma, pleuropulmonary, cerebral amoebiasis"
    ]
  }
]);

addContentSlide("Free-Living Amoebae", [
  {
    heading: "Naegleria fowleri",
    items: [
      "Causes Primary Amoebic Meningoencephalitis (PAM)",
      "Entry via nasal mucosa during swimming in warm freshwater",
      "Travels along olfactory nerve to brain",
      "Acute, fulminant, almost always fatal within 1–2 weeks",
      "Diagnosis: CSF microscopy (motile amoebae), PCR",
      "Treatment: Amphotericin B + Azithromycin (miltefosine experimental)"
    ]
  },
  {
    heading: "Acanthamoeba & Balamuthia",
    items: [
      "Acanthamoeba – Granulomatous Amoebic Encephalitis (GAE, subacute) + Amoebic Keratitis (contact lens wearers)",
      "Balamuthia mandrillaris – GAE in immunocompromised; also rare in immunocompetent",
      "Entry via skin wounds, respiratory tract",
      "Acanthamoeba keratitis: corneal pain, photophobia, ring infiltrate",
      "Treatment: Polyhexamethylene biguanide (PHMB) + propamidine eye drops (keratitis); combination therapy for GAE"
    ]
  }
]);

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 6: FLAGELLATES
// ══════════════════════════════════════════════════════════════════════════════
addSectionHeader("Section 6", "Flagellates");

addContentSlide("Giardia lamblia – Life Cycle & Clinical Features", [
  {
    heading: "Life Cycle",
    items: [
      "Infective form: Cyst (4 nuclei, median bodies)",
      "Active form: Trophozoite (pear-shaped, 2 nuclei, 4 pairs of flagella, ventral sucking disc)",
      "Ingestion of cysts (as few as 10 cysts infectious) in contaminated water/food",
      "Excystation in duodenum → 2 trophozoites per cyst",
      "Trophozoites attach to duodenal/jejunal brush border via sucking disc",
      "No tissue invasion; encystation occurs in lower intestine",
      "Zoonotic reservoir: beavers, dogs ('beaver fever')"
    ]
  },
  {
    heading: "Clinical Features & Management",
    items: [
      "Symptoms: Explosive watery/greasy/frothy diarrhoea, bloating, flatulence, epigastric cramps, sulphurous belching; NO blood or mucus",
      "Chronic: malabsorption, steatorrhoea, weight loss, lactase deficiency",
      "Diagnosis: Stool microscopy (3 samples), stool antigen ELISA (sensitive), duodenal aspirate/biopsy (string test)",
      "Epidemiology: Worldwide; most common intestinal protozoan infection; waterborne outbreaks common",
      "Treatment: Metronidazole 250 mg TID × 5–7 days; Tinidazole single dose 2 g (preferred)"
    ]
  }
]);

addContentSlide("Trichomonas vaginalis", [
  {
    heading: "Biology & Life Cycle",
    items: [
      "Pear-shaped trophozoite only (NO cyst stage); 4 anterior flagella + undulating membrane",
      "Strictly anaerobic; inhabits male and female urogenital tract",
      "Transmission: Direct sexual contact (STI); only trophozoite form transmitted",
      "Worldwide distribution – most common non-viral STI (~170 million cases/yr)"
    ]
  },
  {
    heading: "Clinical, Diagnosis & Treatment",
    items: [
      "Women: Profuse, frothy, yellow-green malodorous vaginal discharge; strawberry cervix; pruritus vulvae; dyspareunia; vaginal pH >4.5",
      "Men: Often asymptomatic; urethritis, prostatitis",
      "Diagnosis: Wet mount microscopy (motile trophozoites), culture (Feinberg-Whittington/Diamond medium – gold standard), PCR, NAAT",
      "Complications: Preterm birth, low birth weight, increased HIV susceptibility",
      "Treatment: Metronidazole 2 g single dose (both partners) or 500 mg BD × 7 days"
    ]
  }
]);

addContentSlide("Trypanosoma & Leishmania", [
  {
    heading: "Trypanosoma brucei (African Sleeping Sickness)",
    items: [
      "Vector: Tsetse fly (Glossina spp.); Hemoflagellate with VSG coat",
      "T. b. gambiense (West Africa) – chronic; T. b. rhodesiense (East Africa) – acute",
      "Stage 1 (hemolymphatic): Fever, lymphadenopathy, chancre at bite site; Winterbottom's sign (posterior cervical lymphadenopathy)",
      "Stage 2 (CNS): Somnolence, personality change, coma (sleeping sickness)",
      "Diagnosis: Blood/CSF microscopy, lymph node aspirate; CATT for T. b. gambiense",
      "Treatment: Stage 1 – Pentamidine; Stage 2 – Melarsoprol or Eflornithine (+ Nifurtimox)"
    ]
  },
  {
    heading: "Trypanosoma cruzi (Chagas Disease) & Leishmania",
    items: [
      "T. cruzi: Vector – Triatomine (reduviid) bug; Latin America; Romañas sign (periorbital oedema); cardiomyopathy, megacolon, megaesophagus; Nifurtimox/Benznidazole",
      "Leishmania donovani – Visceral (kala-azar): fever, hepatosplenomegaly, pancytopenia, wasting; Diagnosis: LD bodies in bone marrow/spleen aspirate; Rx: Liposomal amphotericin B / Sodium stibogluconate",
      "L. tropica/major – Cutaneous: painless ulcer with rolled edge; Rx: Sodium stibogluconate",
      "L. braziliensis – Mucocutaneous: destruction of nose, palate, pharynx; Rx: Amphotericin B"
    ]
  }
]);

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 7: CILIATES
// ══════════════════════════════════════════════════════════════════════════════
addSectionHeader("Section 7", "Ciliates – Balantidium coli");

addContentSlide("Balantidium coli – Only Ciliate Pathogen of Humans", [
  {
    heading: "Biology & Life Cycle",
    items: [
      "Largest intestinal protozoan of humans (50–100 µm trophozoite)",
      "Has both trophozoite (covered in cilia, kidney-bean shaped macronucleus) and cyst stages",
      "Reservoir: Pigs (primary host) – highest risk in pig farmers",
      "Transmission: Fecal-oral; ingestion of cysts in water/food contaminated with pig feces",
      "Excystation in small intestine → trophozoites colonise large intestine"
    ]
  },
  {
    heading: "Clinical Features, Diagnosis & Treatment",
    items: [
      "Often asymptomatic in immunocompetent",
      "Symptomatic: Diarrhoea progressing to dysentery (blood/mucus), abdominal pain, tenesmus",
      "Pathogenesis: Hyaluronidase and proteases; ulcers in colon (flask-shaped, resembling E. histolytica)",
      "Complications: Colonic perforation, appendicitis, peritonitis",
      "Diagnosis: Fresh stool microscopy – motile ciliated trophozoites (rolling/rotating motion) or cysts; large macronucleus diagnostic",
      "Epidemiology: Rare; worldwide, higher in tropics/subtropics; poor sanitation + pig contact",
      "Treatment: Tetracycline 500 mg QID × 10 days (DOC); Metronidazole or Iodoquinol alternative"
    ]
  }
]);

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 8: PLASMODIUM (MALARIA)
// ══════════════════════════════════════════════════════════════════════════════
addSectionHeader("Section 8", "Plasmodium – Malaria");

addContentSlide("Plasmodium – Life Cycle", [
  {
    heading: "In Mosquito (Definitive Host – sexual cycle)",
    items: [
      "1. Female Anopheles mosquito ingests gametocytes during blood meal",
      "2. Gametocytes → gametes → fertilisation → zygote → ookinete",
      "3. Ookinete penetrates midgut wall → oocyst",
      "4. Sporozoites develop in oocyst → rupture → migrate to salivary glands",
      "5. Sporozoites injected into human during next blood meal (infective stage)"
    ]
  },
  {
    heading: "In Humans (Intermediate Host – asexual cycle)",
    items: [
      "Exo-erythrocytic (liver) stage: Sporozoites → hepatocytes → schizonts → merozoites (1st release)",
      "P. vivax/P. ovale: Hypnozoites persist in liver → relapses",
      "Erythrocytic (blood) stage: Merozoites → ring forms → trophozoites → schizonts → merozoites (RBC rupture = fever)",
      "Periodicity: P. falciparum/vivax/ovale 48h (tertian); P. malariae 72h (quartan); P. knowlesi 24h",
      "Some merozoites → gametocytes (sexual forms) → ingested by mosquito"
    ]
  }
]);

addContentSlide("Plasmodium – Clinical Features & Species Differences", [
  {
    heading: "Symptoms & Signs",
    items: [
      "Classic malaria paroxysm: Cold stage (rigors) → Hot stage (high fever 39–41°C) → Sweating stage",
      "Headache, myalgia, nausea, vomiting, anaemia (haemolytic), splenomegaly",
      "P. falciparum – Malignant tertian (most severe): cerebral malaria, blackwater fever (haemoglobinuria), ARDS, AKI, hypoglycaemia, algid malaria",
      "P. vivax/P. ovale – Benign tertian; relapses from hypnozoites",
      "P. malariae – Quartan malaria; nephrotic syndrome (immune complex); recrudescence"
    ]
  },
  {
    heading: "Pathogenesis",
    items: [
      "P. falciparum: RBC cytoadherence (PfEMP1 on RBC) → rosetting → microvascular obstruction",
      "Cytokine storm (TNF-α) → fever, organ dysfunction",
      "Haemolysis → anaemia + haemoglobinuria (blackwater fever)",
      "Sequestration of infected RBCs in brain capillaries → cerebral malaria",
      "Dyserythropoiesis contributes to anaemia beyond haemolysis"
    ]
  }
]);

addTableSlide("Malaria Species Comparison",
  ["Feature", "P. falciparum", "P. vivax", "P. malariae", "P. ovale"],
  [
    ["Fever cycle", "Quotidian → tertian (36–48h)", "48h (tertian)", "72h (quartan)", "48h (tertian)"],
    ["RBC preference", "All ages (esp. young)", "Reticulocytes", "Older RBCs", "Reticulocytes"],
    ["RBC appearance", "Maurer's clefts; multiple rings", "Schüffner's dots; enlarged", "No dots; normal size", "Schüffner's dots; oval, fimbriated"],
    ["Liver stage", "No hypnozoites", "Hypnozoites (relapses)", "No hypnozoites", "Hypnozoites (relapses)"],
    ["Severity", "Highest; cerebral malaria", "Can be severe; relapses", "Moderate; nephrotic syndrome", "Mild; relapses"]
  ]
);

addContentSlide("Malaria – Diagnosis & Treatment", [
  {
    heading: "Diagnosis",
    items: [
      "Thick blood film (Giemsa) – screening; detects all stages",
      "Thin blood film – species identification; % parasitaemia",
      "RDT (HRP-2 antigen for P. falciparum; pLDH pan-malaria)",
      "PCR – most sensitive & specific; research/reference labs",
      "QBC (Quantitative Buffy Coat) – fluorescent staining",
      "Serology (IFA/ELISA) – epidemiological surveys, not acute diagnosis"
    ]
  },
  {
    heading: "Treatment",
    items: [
      "Uncomplicated P. falciparum: Artemisinin-based Combination Therapy (ACT) – e.g. Artemether-lumefantrine OR Artesunate-amodiaquine",
      "Severe/cerebral malaria: IV Artesunate (drug of choice); IV Quinine + Doxycycline if unavailable",
      "P. vivax/ovale: Chloroquine (blood stage) + Primaquine (hypnozoites/prevents relapse) – check G6PD first",
      "P. malariae: Chloroquine",
      "Chemoprophylaxis: Mefloquine / Doxycycline / Atovaquone-proguanil (Malarone) / Chloroquine (sensitive areas)"
    ]
  }
]);

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 9: TRYPANOSOMA (detailed – covered partially under Flagellates)
// ══════════════════════════════════════════════════════════════════════════════
addSectionHeader("Section 9", "Trypanosoma – African & American Trypanosomiasis");

addContentSlide("T. brucei – African Sleeping Sickness", [
  {
    heading: "Epidemiology & Life Cycle",
    items: [
      "~65 million at risk in sub-Saharan Africa; ~10,000 new cases/yr",
      "T. b. gambiense: West/Central Africa; chronic (months-years); humans primary reservoir",
      "T. b. rhodesiense: East Africa; acute (weeks-months); animal reservoir (cattle, game)",
      "Vector: Tsetse fly (Glossina) – both sexes bite; both sexes transmit",
      "In tsetse: procyclic → epimastigote → metacyclic trypomastigote (infective)",
      "In human: metacyclic trypomastigote in blood/lymph → CNS"
    ]
  },
  {
    heading: "Clinical, Complications & Treatment",
    items: [
      "Stage 1 – hemolymphatic: Trypanosomal chancre, irregular fever (waves of parasitaemia from VSG switching), lymphadenopathy, Winterbottom's sign, hepatosplenomegaly, rash",
      "Stage 2 – neurological: Somnolence, personality change, tremor, ataxia, coma",
      "Complications: Endocarditis, pericarditis, meningoencephalitis, coma, death",
      "Diagnosis: Blood smear, lymph node aspirate, CSF; CATT card agglutination test",
      "Stage 1 treatment: Pentamidine (T. b. gambiense); Suramin (T. b. rhodesiense)",
      "Stage 2 treatment: Eflornithine (DFMO) ± Nifurtimox; Melarsoprol (arsenic; toxic)"
    ]
  }
]);

addContentSlide("T. cruzi – Chagas Disease", [
  {
    heading: "Life Cycle & Epidemiology",
    items: [
      "Endemic in Latin America (Mexico to Argentina); ~6–7 million infected",
      "Vector: Triatomine (reduviid 'kissing') bugs – bite near mouth/eyes during sleep; defaecate near bite",
      "Transmission: Bug faeces rubbed into bite/conjunctiva; also blood transfusion, organ transplant, congenital, food",
      "In bug: epimastigote stage; in human: trypomastigote (blood) + amastigote (intracellular)"
    ]
  },
  {
    heading: "Clinical Features & Management",
    items: [
      "Acute: Chagoma (skin lesion), Romañas sign (unilateral painless periorbital oedema), fever, malaise; acute myocarditis/encephalitis in children",
      "Indeterminate: Asymptomatic; serology positive",
      "Chronic (10–30 years later): Chagasic cardiomyopathy (arrhythmias, CCF, sudden death), megaesophagus (dysphagia), megacolon (constipation)",
      "Diagnosis: Acute – blood smear/PCR; Chronic – serology (ELISA x2 different antigens required); Xenodiagnosis",
      "Treatment: Benznidazole (DOC) or Nifurtimox – effective mainly in acute phase",
      "Complications: SCD, CCF, thromboembolic stroke, aspiration pneumonia"
    ]
  }
]);

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 10-13: TREMATODES (FLUKES)
// ══════════════════════════════════════════════════════════════════════════════
addSectionHeader("Section 10–13", "Trematodes (Flukes)\nIntestinal · Liver · Blood · Lung");

addContentSlide("Trematode – General Life Cycle", [
  {
    heading: "General Features",
    items: [
      "Leaf-shaped, unsegmented, hermaphroditic (except Schistosoma – dioecious)",
      "All require a freshwater snail as first intermediate host",
      "Life cycle: Egg → Miracidium (→ snail) → Sporocyst → Rediae → Cercariae → Metacercariae → Adult worm",
      "Humans infected by eating undercooked fish/plants/crustaceans with metacercariae (except Schistosoma – cercariae penetrate skin)"
    ]
  },
  {
    heading: "Overview by Site",
    items: [
      "Intestinal flukes: Fasciolopsis buski, Heterophyes, Metagonimus",
      "Liver flukes: Fasciola hepatica, Clonorchis sinensis, Opisthorchis",
      "Blood flukes: Schistosoma mansoni, S. haematobium, S. japonicum",
      "Lung flukes: Paragonimus westermani, P. kellicotti"
    ]
  }
]);

addContentSlide("Intestinal Trematodes – Fasciolopsis buski", [
  {
    heading: "Life Cycle & Epidemiology",
    items: [
      "Largest intestinal fluke (up to 7.5 cm)",
      "Endemic in East/Southeast Asia (China, India, Thailand)",
      "First intermediate host: freshwater snail (Segmentina/Hippeutis)",
      "Second intermediate host: water plants (water chestnut, water caltrop, lotus)",
      "Humans infected by eating raw water plants with attached metacercariae",
      "Adults attach to duodenum/jejunum"
    ]
  },
  {
    heading: "Clinical, Diagnosis & Treatment",
    items: [
      "Symptoms: Diarrhoea (alternating with constipation), abdominal pain, nausea, malabsorption",
      "Heavy infection: Intestinal obstruction, oedema (from protein loss), ascites, facial oedema",
      "Pathogenesis: Local inflammation at attachment site; toxic metabolites",
      "Diagnosis: Stool microscopy – large operculate eggs (130–140 × 80–85 µm, shoulder near operculum)",
      "Treatment: Praziquantel (drug of choice) 25 mg/kg TID × 1 day; Niclosamide"
    ]
  }
]);

addContentSlide("Liver Trematodes – Fasciola & Clonorchis", [
  {
    heading: "Fasciola hepatica (Sheep Liver Fluke)",
    items: [
      "Zoonotic fluke of sheep and cattle; humans are accidental hosts",
      "Worldwide distribution; freshwater snail (Lymnaea) → aquatic vegetation (watercress) → humans",
      "Acute phase: Fever, RUQ pain, hepatomegaly, eosinophilia (migratory larval phase in liver parenchyma)",
      "Chronic phase: Biliary obstruction, cholangitis, cholecystitis",
      "Diagnosis: Stool/bile microscopy (large operculate eggs); serology (ELISA); imaging",
      "Treatment: Triclabendazole (DOC) – NOT praziquantel"
    ]
  },
  {
    heading: "Clonorchis sinensis (Chinese Liver Fluke) & Opisthorchis",
    items: [
      "East Asia; snail → freshwater fish (metacercariae in muscle) → humans",
      "Adults live in bile ducts; chronic biliary irritation",
      "Symptoms: RUQ pain, cholangitis, jaundice; may be asymptomatic",
      "Complications: Cholangiocarcinoma (Group 1 carcinogen), cholecystitis, biliary cirrhosis, pancreatitis",
      "Diagnosis: Stool microscopy (small operculate eggs with shoulder); ERCP/imaging",
      "Treatment: Praziquantel 25 mg/kg TID × 2 days"
    ]
  }
]);

addContentSlide("Blood Trematodes – Schistosoma", [
  {
    heading: "Life Cycle & Epidemiology",
    items: [
      "~240 million infected worldwide; 700 million at risk",
      "Three main species: S. mansoni (Africa, S. America), S. haematobium (Africa, ME), S. japonicum (Asia)",
      "Cercariae (fork-tailed) penetrate intact human skin in freshwater",
      "Schistosomula → lungs → portal system → adult worms (male and female)",
      "Adults pair in portal veins; migrate to mesenteric (S. mansoni/japonicum) or vesical (S. haematobium) veins",
      "Eggs cause disease via granuloma formation"
    ]
  },
  {
    heading: "Clinical, Diagnosis & Treatment",
    items: [
      "Swimmer's itch (cercarial dermatitis) – penetration phase",
      "Katayama fever (acute schistosomiasis): fever, urticaria, eosinophilia, hepatosplenomegaly",
      "Chronic: Hepatic fibrosis + portal hypertension (S. mansoni/japonicum); haematuria + bladder cancer (S. haematobium)",
      "Diagnosis: Stool/urine microscopy for eggs (S. haematobium eggs have terminal spine; S. mansoni – lateral spine)",
      "Serology, rectal snip, Kato-Katz technique",
      "Treatment: Praziquantel 40 mg/kg single dose (S. haematobium/mansoni); 60 mg/kg (S. japonicum)"
    ]
  }
]);

addContentSlide("Lung Trematodes – Paragonimus westermani", [
  {
    heading: "Life Cycle & Epidemiology",
    items: [
      "Endemic in East Asia, West Africa, Central/South America",
      "First IH: Freshwater snail; Second IH: Freshwater crabs/crayfish",
      "Humans infected by eating raw/undercooked freshwater crabs",
      "Metacercariae excyst in duodenum → penetrate intestinal wall → migrate through diaphragm → lungs",
      "Adult worms encapsulated in lung parenchyma (pair in cysts)"
    ]
  },
  {
    heading: "Clinical Features, Diagnosis & Treatment",
    items: [
      "Pulmonary paragonimiasis: Chronic cough, haemoptysis (rusty/brown sputum), pleuritic chest pain; mimics TB",
      "Chest X-ray: Ring-shaped or nodular opacities, pleural effusion, calcifications",
      "Extrapulmonary: Cerebral (seizures, intracranial hypertension), abdominal",
      "Diagnosis: Sputum/stool microscopy for eggs (operculate, 80–120 × 45–60 µm); serology (ELISA); imaging; BAL",
      "Complications: Pleural effusion, pneumothorax, secondary bacterial pneumonia, cerebral cysts",
      "Treatment: Praziquantel 25 mg/kg TID × 2 days (DOC); Triclabendazole alternative"
    ]
  }
]);

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 14: CESTODES (TAPEWORMS)
// ══════════════════════════════════════════════════════════════════════════════
addSectionHeader("Section 14", "Cestodes – Tapeworms");

addContentSlide("Cestodes – General Features & Intestinal Tapeworms", [
  {
    heading: "General Features",
    items: [
      "Segmented flatworms: Scolex (head with suckers ± hooks) + neck + proglottids (immature → mature → gravid)",
      "No digestive system – absorb nutrients through tegument (body surface)",
      "Hermaphroditic; eggs released when gravid proglottids detach",
      "Taenia saginata (beef tapeworm): Humans = definitive host; cattle = IH; up to 10m long; no hooks on scolex",
      "Taenia solium (pork tapeworm): Humans can be both definitive host (intestinal) AND intermediate host (cysticercosis)",
      "Diphyllobothrium latum (fish tapeworm): Copepod → fish (IH); scolex has bothria (grooves); causes B12 deficiency"
    ]
  },
  {
    heading: "Symptoms, Diagnosis & Treatment",
    items: [
      "Often asymptomatic; passage of proglottids in stool",
      "Mild GI symptoms: nausea, vague abdominal pain, weight loss",
      "D. latum: macrocytic (megaloblastic) anaemia from B12 competition",
      "Diagnosis: Stool microscopy – eggs (T. saginata & T. solium eggs identical; distinguish by counting uterine branches in proglottids: T. saginata 15–30 vs. T. solium 7–13)",
      "Treatment: Praziquantel 10 mg/kg single dose; Niclosamide alternative"
    ]
  }
]);

addContentSlide("Cysticercosis & Echinococcosis", [
  {
    heading: "Neurocysticercosis (T. solium)",
    items: [
      "Humans ingest T. solium eggs (from contaminated food/water/hands – autoinfection possible)",
      "Oncospheres → circulation → brain, muscle, eye, subcutaneous tissue → cysticerci",
      "Most common helminthic infection of CNS; leading cause of acquired epilepsy worldwide",
      "Symptoms: Seizures (most common), raised ICP, hydrocephalus, focal neurological deficits",
      "Diagnosis: CT/MRI (cysts with/without scolex, calcifications); serology (EITB)",
      "Treatment: Albendazole + Dexamethasone + Anti-epileptics; surgical for hydrocephalus"
    ]
  },
  {
    heading: "Echinococcosis (Hydatid Disease)",
    items: [
      "E. granulosus (cystic; dogs–sheep cycle); E. multilocularis (alveolar; foxes–rodents)",
      "Humans are accidental IH; ingest eggs from dog faeces",
      "Hydatid cysts in liver (60–70%), lung (20–25%), brain, bone",
      "Symptoms: Slowly expanding cyst; RUQ mass; cyst rupture → anaphylaxis; secondary echinococcosis",
      "Diagnosis: Ultrasound/CT (cyst wall with daughter cysts/hydatid sand); serology (ELISA, Casoni test historical)",
      "Treatment: PAIR (Puncture-Aspiration-Injection-Reaspiration) + Albendazole; Surgery for large/complicated cysts"
    ]
  }
]);

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 15: INTESTINAL NEMATODES
// ══════════════════════════════════════════════════════════════════════════════
addSectionHeader("Section 15", "Intestinal Nematodes");

addContentSlide("Intestinal Nematodes – Overview & Ascaris", [
  {
    heading: "Common Intestinal Nematodes",
    items: [
      "Ascaris lumbricoides – roundworm (largest intestinal nematode)",
      "Trichuris trichiura – whipworm",
      "Hookworm – Ancylostoma duodenale (Old World), Necator americanus (New World)",
      "Enterobius vermicularis – pinworm / threadworm",
      "Strongyloides stercoralis – threadworm (unique: autoinfection; hyperinfection in immunocompromised)"
    ]
  },
  {
    heading: "Ascaris lumbricoides",
    items: [
      "Most common human helminth infection (~1.2 billion infected)",
      "Infective stage: Embryonated egg (ingested); life cycle includes pulmonary migration (Löffler's syndrome: cough, eosinophilia)",
      "Adult worms in small intestine; female up to 35 cm",
      "Symptoms: Often asymptomatic; large worm burden → malabsorption, intestinal obstruction, biliary/pancreatic obstruction",
      "Diagnosis: Stool O&P – large bile-stained corticated eggs",
      "Treatment: Albendazole 400 mg single dose (DOC); Mebendazole, Ivermectin"
    ]
  }
]);

addContentSlide("Hookworm, Trichuris & Enterobius", [
  {
    heading: "Hookworm",
    items: [
      "Infective stage: Filariform (L3) larvae penetrate skin (barefoot walking on soil)",
      "Migration: Skin → blood → lungs → trachea → swallowed → small intestine",
      "Adults bite and suck blood from intestinal wall → iron deficiency anaemia + hypoproteinaemia",
      "A. duodenale also transmitted orally; can arrest development (hypobiosis)",
      "Symptoms: Ground itch (dermatitis), Löffler's syndrome, profound iron deficiency anaemia, oedema",
      "Treatment: Albendazole or Mebendazole + iron supplementation"
    ]
  },
  {
    heading: "Trichuris & Enterobius",
    items: [
      "Trichuris trichiura (whipworm): Barrel-shaped eggs with polar plugs; anterior end embeds in colon; symptoms: dysentery, rectal prolapse in heavy infection; Rx: Mebendazole/Albendazole",
      "Enterobius vermicularis (pinworm): Gravid female migrates to perianal region at night to deposit eggs; perianal pruritis (nocturnal); most common helminth in developed countries; rarely vulvovaginitis; Diagnosis: Scotch tape/NIH swab test (morning, before bathing); Rx: Mebendazole/Albendazole single dose + repeat at 2 weeks; treat all household contacts"
    ]
  }
]);

addContentSlide("Strongyloides stercoralis", [
  {
    heading: "Life Cycle (Unique Features)",
    items: [
      "Only nematode with free-living cycle AND autoinfection capability",
      "Infective: Filariform L3 larvae penetrate skin",
      "Internal autoinfection: Rhabditiform larvae in gut can develop to L3 → penetrate colon wall → hyperinfection without leaving host",
      "Hyperinfection syndrome in immunocompromised (steroids, HIV, HTLV-1): massive larval dissemination; mortality >80% if untreated",
      "Free-living cycle also possible in soil"
    ]
  },
  {
    heading: "Clinical Features, Diagnosis & Treatment",
    items: [
      "Cutaneous: Larva currens – rapidly moving serpentine pruritic rash (perianal/buttocks)",
      "Pulmonary: Cough, wheezing, haemoptysis (Löffler-like)",
      "Intestinal: Diarrhoea, malabsorption, epigastric pain",
      "Hyperinfection: Paralytic ileus, septicaemia (gram-negative bacteria ride larvae through gut wall), meningitis",
      "Diagnosis: Stool – rhabditiform larvae (key: short buccal cavity + prominent genital primordium); Baermann technique; serology (ELISA); Agar plate culture",
      "Treatment: Ivermectin 200 µg/kg/day × 2 days (DOC); Albendazole alternative; prolonged treatment in hyperinfection"
    ]
  }
]);

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 16: FILARIAL NEMATODES
// ══════════════════════════════════════════════════════════════════════════════
addSectionHeader("Section 16", "Filarial Nematodes");

addContentSlide("Lymphatic Filariasis – Wuchereria & Brugia", [
  {
    heading: "Life Cycle & Epidemiology",
    items: [
      "Wuchereria bancrofti (90%), Brugia malayi, B. timori",
      "~120 million infected; 40 million disabled; tropical/subtropical regions",
      "Vector: Mosquito (Culex, Aedes, Anopheles depending on species)",
      "Infective stage: L3 larvae deposited on skin during mosquito bite → enter bite wound",
      "Adults in lymphatics; microfilariae (L1) circulate in blood – NOCTURNAL PERIODICITY (midnight peak for W. bancrofti)",
      "Mosquito ingests microfilariae → develop to L3 in flight muscles (10-14 days)"
    ]
  },
  {
    heading: "Clinical Features & Management",
    items: [
      "Asymptomatic microfilaraemia (most common)",
      "Acute: Episodic adenolymphangitis (ADL) – fever, lymphadenopathy, retrograde lymphangitis (distinct from bacterial)",
      "Chronic: Lymphoedema, hydrocele, chyluria; Elephantiasis (irreversible gross limb swelling)",
      "Tropical Pulmonary Eosinophilia (TPE): microfilariae trapped in lungs → wheeze, cough, high IgE, eosinophilia",
      "Diagnosis: Night blood smear (thick film, Giemsa); Knott's concentration; ICT antigen test (W. bancrofti); serology",
      "Treatment: DEC (Diethylcarbamazine) 6 mg/kg/day × 12 days; Ivermectin + Albendazole (MDA programmes); Doxycycline (kills Wolbachia endosymbiont)"
    ]
  }
]);

addContentSlide("Onchocerciasis & Loiasis", [
  {
    heading: "Onchocerca volvulus (River Blindness)",
    items: [
      "~18 million infected; sub-Saharan Africa, Yemen, Central/South America",
      "Vector: Simulium (blackfly) – breeds in fast-flowing rivers",
      "Adults in subcutaneous nodules (onchocercoma); microfilariae migrate in skin & eye",
      "Skin: Onchodermatitis – pruritus, 'leopard skin' depigmentation, lichenification, 'sowda'",
      "Eye: Microfilariae die in cornea → sclerosing keratitis → 'river blindness' (2nd leading infectious cause of blindness)",
      "Diagnosis: Skin snip microscopy (microfilariae); slit lamp (eye); Mazzotti test; PCR",
      "Treatment: Ivermectin (kills microfilariae; given 6-monthly) + Doxycycline (anti-Wolbachia)"
    ]
  },
  {
    heading: "Loa loa (Loiasis) & Mansonella",
    items: [
      "Loa loa: Vector – Chrysops (mango/deer fly); Central/West Africa; DAY-TIME periodicity microfilariae",
      "Calabar swellings – transient migratory subcutaneous oedema; worm visible crossing conjunctiva",
      "Diagnosis: Day blood smear; worm extraction from conjunctiva",
      "Treatment: DEC (kills both adults and microfilariae); caution – encephalopathy if high microfilaraemia",
      "Mansonella spp.: Generally non-pathogenic or mild symptoms; in blood/skin; treat with Ivermectin/Mebendazole"
    ]
  }
]);

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 17: TISSUE NEMATODES
// ══════════════════════════════════════════════════════════════════════════════
addSectionHeader("Section 17", "Tissue Nematodes");

addContentSlide("Trichinella spiralis", [
  {
    heading: "Life Cycle & Epidemiology",
    items: [
      "Single host parasite – both intestinal AND tissue phase occur in same host",
      "Transmitted by eating undercooked meat (pork, bear, walrus) containing encysted larvae",
      "Intestinal phase: Larvae → adults in small intestine (1 week); females release larvae",
      "Tissue phase: Larvae migrate via blood to striated muscle → nurse cells (nurse cell-larva complex) → calcify",
      "Predilection for diaphragm, masseter, extraocular, deltoid, gastrocnemius",
      "Worldwide; US outbreaks from pork, game meat"
    ]
  },
  {
    heading: "Clinical Features, Diagnosis & Treatment",
    items: [
      "Intestinal phase (1–2 wk): Nausea, vomiting, diarrhoea, abdominal cramps",
      "Tissue migration phase (2–8 wk): High fever, periorbital oedema (pathognomonic), myositis, splinter haemorrhages, eosinophilia, elevated CK/LDH",
      "Myocarditis, encephalitis, pneumonitis in heavy infections",
      "Diagnosis: Clinical triad (fever + periorbital oedema + myalgia) after eating raw meat; serology (ELISA); muscle biopsy (larvae in nurse cells); eosinophilia",
      "Treatment: Albendazole (DOC; 400 mg BD × 8–14 days) + corticosteroids for severe disease; Mebendazole alternative",
      "Complications: Myocarditis (arrhythmias), encephalitis, pulmonary infiltrates"
    ]
  }
]);

addContentSlide("Toxocara & Larva Migrans Syndromes", [
  {
    heading: "Toxocara canis / cati (Visceral & Ocular Larva Migrans)",
    items: [
      "Dogs and cats are definitive hosts; humans are accidental dead-end hosts",
      "Humans ingest embryonated eggs from soil contaminated with dog/cat faeces (children playing in sandpits)",
      "Larvae hatch in gut → penetrate wall → migrate but cannot complete development → die in tissues",
      "Visceral Larva Migrans (VLM): Hepatomegaly, fever, eosinophilia, pulmonary infiltrates, urticaria (children <5 yr)",
      "Ocular Larva Migrans (OLM): Retinal granuloma, uveitis, vision loss – may mimic retinoblastoma",
      "Diagnosis: Serology (ELISA anti-Toxocara IgG); eosinophilia; liver biopsy; ophthalmoscopy",
      "Treatment: Albendazole 400 mg BD × 5 days (DOC) ± corticosteroids; photocoagulation for OLM"
    ]
  },
  {
    heading: "Cutaneous Larva Migrans & Gnathostoma",
    items: [
      "Cutaneous Larva Migrans (CLM): Ancylostoma braziliense (cat/dog hookworm); larvae penetrate skin but cannot migrate deeper; serpiginous pruritic track moving ~2 cm/day; Treatment: Ivermectin 200 µg/kg single dose (DOC) or Albendazole",
      "Gnathostoma spinigerum: Larvae in freshwater fish/frogs; intermittent migratory swellings; eosinophilic meningitis; Rx: Albendazole or Ivermectin",
      "Dracunculus medinensis (Guinea worm): Drinking water with infected Cyclops (copepod); female worm emerges through skin of leg (100 cm); no drug treatment; mechanical removal by winding on stick; near-eradication programme"
    ]
  }
]);

// ─── SUMMARY / DRUG REFERENCE SLIDE ────────────────────────────────────────
addSectionHeader("Quick Reference", "Anti-Parasitic Drug Summary");

addTableSlide("Anti-Parasitic Drugs – Quick Reference",
  ["Drug", "Class/Parasites", "Key Notes"],
  [
    ["Metronidazole", "Amoebae, Giardia, Trichomonas, Balantidium", "Tissue + luminal activity; avoid alcohol"],
    ["Praziquantel", "All trematodes (except Fasciola), most cestodes", "DOC for schistosomiasis; 40 mg/kg single dose"],
    ["Albendazole", "Most nematodes, Echinococcus, cysticercosis", "Broad-spectrum; teratogenic; use with steroids for NCC"],
    ["Ivermectin", "Strongyloides, Onchocerca, Loa loa, CLM, scabies", "Avermectin; active against microfilariae"],
    ["Artemisinin-based (ACT)", "Plasmodium falciparum (uncomplicated)", "Artemether-lumefantrine; IV artesunate for severe disease"],
    ["Chloroquine", "P. vivax, P. malariae (sensitive), P. ovale", "Widespread falciparum resistance; accumulates in RBCs"],
    ["Primaquine", "Hypnozoites (P. vivax, P. ovale)", "Check G6PD before use; haemolysis risk"],
    ["DEC (Diethylcarbamazine)", "Lymphatic filariasis, Loa loa, TPE", "Kills micro- and macrofilariae; Mazzotti reaction"],
    ["Triclabendazole", "Fasciola hepatica/gigantica", "Only effective drug for Fasciola"],
    ["Benznidazole/Nifurtimox", "T. cruzi (Chagas)", "Most effective in acute phase"],
    ["Pentamidine", "T. b. gambiense stage 1", "Also second-line Pneumocystis"],
    ["Liposomal Amphotericin B", "Visceral Leishmaniasis", "Drug of choice; less toxic than conventional AMB"]
  ]
);

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