Medical Parasitology

Parasitology: is the science that deals with

parasites, which infect man temporarily or
permanently.

Parasitism: indicates that one species
(parasite) depends upon another species (host)
to derive benefits such as food, shelter and
maintenance of species. This association may
show harmful effects to the host.
The association (relation) between 2
organisms
Parasitism: One organism (parasite) gets
benefit and lives on the expense of another
organism (host) that usually loses or suffers.
Mutualism: The two organisms get benefit from
each other.
Symbiosis: Mutual benefit but the two organisms
cant live independently.
Commensalism: One organism gets benefit while
the other (host) is not affected.
Description of Parasites
A- Ectoparasite: Live on the outside of the host
(infestation).
B- Endoparasite: Live within the body of the host
(infection).
They are either obligate or facultative parasites
Obligate Parasite: Cant live independent from the host
i.e. permanent residence. ex: Trichomonas
Facultative Parasite: Can live free far from the host or as
parasite. ex.: Fasciola
They are also classified into: Permanent Parasite, Temporary Parasite,
Accidental Parasite, Coprozoic Parasite and also Pseudo parasite,
while the Zoonotic parasites are those which are normally found in
wild /domestic animals and may harm man.

Types of hosts
Final or Definitive Host: Harbors the
sexually mature parasite (adult worm or
sexual stage of protozoa).
Intermediate Host: Harbors the immature or
asexual stage.
Reservoir Host: Animal that harbors the
same species of parasites as man and so is a
potential source (store) of infection to man
with this parasite.
Vector: Usually an arthropod that carries the
parasite to its host.
Modes of Transmission of Parasitic Diseases
Contact- Food & drink- Arthropods- Contact with
larvae- Blood borne- Transplacental
1- Contact:
Direct contact with infested persons e.g. scabies, lice.
Indirect contact with infected persons towels, bed
sheets e.g. scabies.
Sexual contact e.g. Trichomonas vaginalis.
2- Food and drink: Is the most common.
Eating or drinking contaminated water or food
e.g. helminthes ova, protozoan cysts.
Eating raw or under cooked or under salted fishes
e.g. Heterophyes heterophyes.
Eating raw or undercooked meat
e.g. Taenia saginata (in cattle meat), T. solium and
Trichenella spiralis (in pig or pork meat).
3- By arthropods
Mechanically by non-blood sucking insects e.g. housefly transmit
protozoal cysts or helminthes ova.
Biologically by bite of blood sucking insects e.g. malaria,
filariasis, trypanosomiasis.
Ingestion of insect containing the infective stage: e.g. infected
flea (in Hymenolepis nana) and other insects (in H. diminuta) or
infected Cyclops in water (in Dracunculus medinensis).
4- By contact with motile larval stages in the external
environment:
Cercaria of schistosoma in water (swimming, washing or
irrigation).
Larvae of ancylostoma in soil (penetrate the skin of persons
walking bare-footed in muddy soil).
5- Blood transfusion and contaminated syringes
e.g. malaria.
6- Transplacentally e.g. Toxoplasma, Trypanosomiasis.
Effects of parasitic infection on the host
1- Anemia due to: Sucking of blood & blood loss e.g. Ancylostoma.
Destruction and feeding on Red cells hemoglobin e.g. malaria.
Depression of bone marrow e.g. Leishmania donovani.
Vit B12 deficiency e.g. Diphyllobothrium latum.
2- Loss of weight due to: Sucking digested food e.g. Taenia and Ascaris.
Preventing fat absorption e.g. Giardia lamblia.
3- Mechanical effects:
Intestinal obstruction in heavy ascariasis and in taeniasis.
Intestinal perforation (ascariasis, taeniasis).
Pressure atrophy in Hydatid (liver and lung).
4- Poisoning or allergic reaction due to toxic substances produced by the
parasite in blood.
5- Localized irritation e.g. gastrointestinal disturbances with colic,
dyspepsia, diarrhea, dysentery.
6- Facilitating secondary bacterial infection.

allergic or Poisoning - effects Mechanical - weight of Loss - Anemia
infection bacterial secondary Facilitating - irritation Localized - reaction
Methods of control of parasites
1- Control of hosts:
Man
Vector
Intermediate hosts
Reservoir host
2- Personal hygienic measures
3- General hygienic measures


Parasitology is classified into three main
groups
Protozology
(proto = primitive)
Study of protozoa
Helminthology
(Helminth = Worm)
Study of helminth
Entomology
Study of
arthropods
Helminthes = Worms
I. Phylum Platyhelminths (means flat worms)
i. class Trematoda (trematodes or flukes)
i i. class Cestoda (cestodes or tapeworms)
II. Phylum Aschelminths
class Nematoda (nematodes or roundworms)
Important Pathogenic Trematodes:

1. Fasciola sp.: include F. hepatica, F. gigentica
2. Heterophyes heterophyes
3. Schistosoma sp.: include S. haematobium, S. mansoni,
S. J aponicum
General Features
All consist of flat, fleshy, leaf-shaped, un segmented body
except Schistosoma sp. which are cylindrical.
They dont have a respiratory system nor a blood vascular
system.
The body is equipped with 2 muscular suckers for
attachment; (oral and a ventral), except the genus
Heterophyes, which has a third genital sucker.
All are hermaphroditic (i.e. male and female reproductive
organs exist in a single body), except schistosomes that have 2
separate sexes.
Their life cycles involve a sexual and an asexual reproduction
parts.
All require one or more intermediate host(s) for completion
of their life cycles.
The 1
st
intermediate host of all flukes is snail, where
asexual reproduction occurs.
The adult worm develops in the secondary intermediate
host (except the schistosomes which do require only one
intermediate host).
The eggs of flukes are equipped with a lid at the top
called operculum, through which the larval worm comes
out to find its appropriate snail host.
The characteristic eggs are the diagnostic stages of
trematodes diseases.
The mode of transmission is by ingestion of cyst-
contaminated food, except in Schistosoma, where
cercaria penetrate the skin directly.
A. Hermaphroditic
Trematodes
the most important ones
1. Fasciola sp.
2. Heterophyes heterophyes
1. Fasciola sp.
F. hepatica, F. gigentica
Length: 30 - 75 mm
Common name: Sheep liver fluke {giant liver fluke}
Disease: Fascioliasis liver rot
Geographical distribution: Europe, Middle East, Asia. In
areas where sheep, cattle {pigs} are raised.
Definitive host: sheep, cattle, pigs and man.
Primary intermediadte host: Snail Lymnoea truncatula for
F. hepatica and Lymnoea caillaudi for F. gigantica.
Secondry intermediate host: Leaves of fresh-water plants
Mode of infection: Ingestion of raw water-cress containing
metacercaria
Infective stage: Metacercaria.
Location of adult: Bile duct
Symptoms: Hepatomegaly, fever, vomiting, diarrhea,
eosinophilia, necrotic foci of liver (liver rot)
F. hepatica, adult worm measuring 2-5 cm
by 8-13 mm, are flat, oval in shape with a
cephalic cone containing the oral sucker. It
can live in biliary ducts for up to 10 years.
Fasciola hepatica, living adult
in bile duct of sheep.
F. gigantica adult worm
Fasciola sp.
Laboratory diagnosis
Fasciola egg demonstration
of operculated egg in stool; or
in duodenal or biliary drainage
The eggs are ellipsoidal with
small distinct operculum. The
operculum can be opened.
Treated with Triclabendazole with Bithionol
2.Heterophyes heterophyes
Length: 1-1.7 mm
Common name: Intestinal fluke
Disease: Heterophiasis
Geographical distribution: Africa, Middle East, Asia
Definitive host: Dog, cat, man
Primary intermediate host: Snail Pirenella conica
Secondry intermediate host: Fresh water fish (Boury, Bolti)
Mode of transmission: Ingestion of raw fish containing encysted
metacercaria
Infective stage: Encysted metacercaria.
Location of adult: Small intestine
Symptoms: Abdominal pain, non-bloody diarrhea
Heterophyes
heterophyes
Adult fluke of
Heterophyes heterophyes.
Laboratory diagnosis
Operculated egg in stool
containing metacercaria
Treated with Praziquantal
B. Non-Hermaphroditic Trematodes
These include the Schistosoma
sp. also known as {blood
flukes} or {digenetic blood
trematodes}.
They exist as separate sexes
but live attached to each other
through a groove in the male,
the {gynecophoric canal} or the
{schist}
They do not require a
secondary intermediate host.
No metacercaria are formed.
All species share a common
life cycle.

Schistosoma

All cause Bilharzia; also known as bilharziasis,
schistosomiasis snail fever; or Katayamas fever in acute
schistosomiasis
All transmitted by direct skin penetration of cercariae during
swimming
S. haematobium S. mansoni S. japonicum
Geog.
distribution
Africa, Middle
East especially
Egypt
South America,
Caribbean& Egypt
Far East (Japan,
China,
Philippines)
Location Veins of urinary
bladder
Veins of large
intestine, colon
Veins of small
intestine, liver
Snail Bulinus truncatus Biomphalaria
alexandrina
Oncomelania sp

Definitive
host
Man Man Man, dogs, cats ,
rodents & pigs
Clinical features
The 1
st
sign is itching and pruritic rash (cercarial
dermatitis) at penetration site.
Acute intestinal schistosomiasis (mostly by S. mansoni
and S. japonicum) is characterized by fever (Katayamas
fever, that occurs after weeks of initial infection),
headache, hepatosplenomegaly and eosinophilia.
Acute urinary schistosomiasis (by S. haematobium) is
accompanied by fibrosis of bladder with hematuria.
Manifestations of chronic schistosomiasis include
formation of bladder and urinary stones, bleeding
oesophagal varices, hepato and splenomegaly, diarrhea
(hematuria may progress to cancer).
egg in
intestinal
wall
egg
embolization
in hepatic
venules
Egyptian with
splenomegaly
Portal hypertension and ascites
due to infection with S. mansoni
Laboratory diagnosis
If no eggs appear, demonstration in rectal biopsy (for all
species), or in biopsy of bladder (for S. haematobium).
X-rays of urinary tract or intestine.
Serologic tests, and antibody detection by ID injection of
cercarial antigens (useful in recent infections)
Microscopic examination of characteristic eggs in
stool (for all species), or in urine (for S. haematobium)
S. haematobium eggs,
prominent terminal spine
at the posterior end.
S. mansoni eggs,
prominent lateral
spine near the
posterior end.
S. japonicum eggs,
typically oval or
subspherical, and has a
vestigial spine
Treatment
Praziquantel is the drug of choice for
infections by all Schistosoma.

Oxamniquine is effective in treating
infections by S. mansoni in some areas in
which praziquantel is less effective