Chapter 11: Introduction to Parasitology

Symbiosis
• a relationship where unlike organisms exist together.

Three types of Symbiotic relationship:

1. Commensalism
• a symbiotic relationship in which two species live together and one species
benefits from the other without harming or benefitting the other.
2. Mutualism
• a symbiotic relationship in which two organisms mutually benefit from each
other.
3. Parasitism
• a symbiotic relationship where one party or symbiont (i.e., the parasite)
benefits to the detriment of the other (the host).
• in almost cases the parasitic relationship, the parasite deprives the host of
essential nutrients and produce disease in the host.

Two important elements in parasitism:

1. Parasites
 are organisms that usually depends on the host. It classified in several ways:
1.) Based on habitat
a. Ectoparasites- a parasite that lives on or in the skin but not within
the body. Fleas and liceare ectoparasites. Infestation with an
ectoparasite is called an ectoparasitosis.
b. Endoparasites- a parasite that lives in the internal organs or tissues
of its host. Examples of endoparasites include Giardia lamblia , an
anaerobic protozoan parasite which reproduces via binary fission. It
affects humans, cats, and dogs, among other wild animals.
2.) Based on ability to live independently of the host
a. Facultative parasites- is an organism that may resort
to parasitic activity, but does not absolutely rely on any host for
completion of its life cycle. It occurs among many species of fungi,
such as family members of the genus Armillaria.
b. Obligate parasites- or holoparasite is a parasitic organism that
cannot complete its life-cycle without exploiting a suitable host. If
an obligate parasite cannot obtain a host it will fail to reproduce.
3.) Based on mode of living
a. Permanent parasites- parasites that remain in a host from early
life to maturity (e.g.,Plasmodium).
b. Intermittent parasites- parasites that simply visit the host during
feeding time (e.g.,Non-pathogenic parasites).
c. Incidental parasites- parasites that occur in an unusual host
(e.g.,dog tapeworm).
d. Transitory parasites- parasites whose larva develops in a host
while the adult is free- living (e.g., Echinococcus granulosus or dog
tapeworm).
 e. Erratic parasites- parasites that are seen in an unusual organ,
different from that which it ordinally parasitizes (e.g., ascaris
lumbricoides in the lungs or kidneys).
2. Host
 are essential to the existence of parasites and organisms that harbor the
parasite and provide nourishment to the parasites.

Four types of hosts:

1. Definitive hosts
Host that are harbor the adult stage of the parasites. And an organism which
supports the adult or sexually reproductive form of a parasite. For example,
human tapeworm makes use of human as its definitive host.

2. Intermediate hosts

Host that are harbor the larval stage of the parasites. For example, some
tapeworms make use of cows, pigs, and fish as intermediate hosts.

3. Reservoir hosts
Are vertebrate hosts that harbor the parasite and may act as additional source
of infection in man. Migratory birds serve as the reservoir host for the parasites.
4. Paratenic hosts
Serve as a means of transport for the parasite (e.g., insect vectors) so that the
infective stage of a certain parasite may reach its final host.
Sources of Exposure to Infection or Infestation
Exposure to parasites may occur through:
 Contaminated water
 Food containing the parasites infective stage
 Blood sucking insect
 A domestic or wild animal harboring the parasite
 Ones self (auto-infection)
Type of Parasite
  Obligate parasite or holoparasite is a parasitic organism that cannot
complete its life-cycle without exploiting a suitable host. 
 Facultative parasite is an organism that may resort to parasitic activity,
but does not absolutely rely on any host for completion of its life cycle.
 Endoparasites live inside an organism
 Ectoparasites live on the surface of the host.
Type of Host
 accidental host. a host that shelters an organism which does not usually
parasitize that host.
 incidental host (a.k.a. dead-end host) a host that shelters an organism but
is unable to transmit the organism to a different host.
 primary host (a.k.a. definitive/final host)
 reservoir host-  an organism that harbors a pathogen but suffers no ill
effects.
Parasite-Host Relationship
 Symbiosis a relationship where unlike organisms exist together.
 Commensalism a symbiotic relationship in which two species live together
and one species benefits from the other without harming or benefitting the
other.
 Mutualism a symbiotic relationship in which two organisms mutually benefit
from each other.
 Parasitism a symbiotic relationship where one party or symbiont (i.e., the
parasite) benefits to the detriment of the other (the host).
Bloodsucking insects can torment humans and animals and can transmit
disease. They are all parasites of humans or other host animals and are abundant at
certain times of the year. Bloodsucking insects can be grouped as mosquitoes, flies,
lice, and true bugs. Other animals that may serve as sources for parasites include
pigs, cows, and birds.

Modes of Transmission
Ingestion of contaminated food and water (fecal- oral transmission) is the most
common mode of transmission of parasites. Those that are transmitted by ingestion
of contaminated water include the intestinal protozoa (cyst stage) and the
embryonated egg stage of the intestinal roundworms.
Some parasites actively enter the body through penetration of the skin from the
soil or from the contaminated water (eg., blood fluke). Other modes are bite of
blood sucking insect vectors, inhalation of eggs and many more.
PORTAL OF EXIT OF PARASITES
The most common exit of parasites is through anus. Eggs of medically important
roundworms are excreted together with human feces and contaminated soil and
water. For example urine may serve as a portal exit for trichomonas vaginalis.
MECHANISMS OF DISEASE PRODUCTION BY PARASITES
Pathogenesis refers to the dynamics of any disease process. Some parasites
may cause inapparent infection causing no symptoms, and producing no detectable
harm. For example malaria can be inapparent continuously for long periods or
between short periods of relapse.
TRAUMATIC DAMAGE
In this mechanisms, May be due to the direct physical damage caused by the
parasites in the organ or at the point of entry of the parasite. Small lessions may
result the bite of mosquitoes (e.g., malaria) and other insects.
LYTIC NECROSIS
Produced by enzymes produced by some parasites. E.g. Entamoeba histolytica
lyses intestinal cells and produces amoebic ulcers. These enzymnes also enables the
parasite to penetrate the tissue of the colon, producing ulcerations of the colon and
extra- intestinal visceral.
STIMULATION OF HOST TISSUE REACTION
Majority of animal parasites provoke host tissue reactions. These reactions
may be in the form of cellular proliferation and infiltration at the site of the parasite
entry or may involve systemic increase in certain types of cell, especially those
circulating the blood. For example infection with the blood fluke schistosoma
japonicum may eventually lead to development of cancer of the liver.

TOXIC ALLERGIC PHENOMENA (Immunopathology)

Proteins or other metabolites produced by the parasites may lead to
hypersensitivity or allergic reactions due to stimulation of antibody production. An
example of this is infection with pinworm.

IMMUNOPHATOLOGIC REACTIONS OF HUMANS TO VARIOUS PARASITES

Type 1: Allergy or anaphylactic
Mechanism: Parasite antigen
Result: Anaphylactic shock, bronchospasm
Example: Helminths
Type 2: Antibody mediated
Mechanism: Antibody + parasite antigen on the cell surface- complement activation
or ADCC
Result: lysis of cell bearing parasite antigens
Example: Trypanosomecruzi
OPENING OF PATHWAYS FOR ENTRY OF OTHER PATHOGENS INTO THE TISSUE
The presence of parasites and the damage they produce to the tissue may
favor the entry and proliferation of other organisms, especially bacteria.
GENERAL LIFE CYCLE OF PARASITES
All parasites have a life cycle that involves a period of time spent in a host
organism and that can be divided into phases of growth, reproduction, and
transmission. Here is the general life cycle of parasites.

Classification of Parasites:
There are two major groups of paracites: the single-cell protozoa (sub-kingdom
Protozoa) and the multicellular metazoa (sub-kingdom Metazoa) called Helminths.
They are represented by four major groups namely Flagellates, Ciliates, Sarcodina,
 and Sporozoans. In some systems of biological classification, protozoan is a high-
level taxonomic group. The parasitic intestinal helminths can be divided into three
groups which include Nematodes (roundworms), Cestodes (tapeworms), and
Trematodes (flukes).

 Most parasitic protozoa reproduce by binary fission the sporozoa which

undergo both sexual and asexual reproduction
 Flagellates are equipped with one or more whip-like flagella that enable them
to move
 Amoeba move by means of pseudopodia, ciliates posses rows or patches of cilia
that serve as their organ locomotion
 Sporozoa do not posses any organ for motility

The figures 11.2 and 11.3

Subkingdom
Protozoa

Phylum Phylum Phylum

Sarcomastigophora Ciliophora Apicomplexa

Subphylum Subphylum
Sarcodina Mastigophora

Class Class
Lobosea Zoomastigophora Class Class
(amoebas) (flagellates) Kinetofragminophorea Sporozoa

Figure 11.2
 Subkingdom
Metazoa

Phylum Phylum
Nemathelminthes Platyhelminthes

Class Class Class Class

Nematoda Filarie Cestoda Trematoda
(roundworms) (tissue roundworms) (tapeworms) (flakes)

Figure 11.3

Table 11.3

Parasite Biologic, Morphologic, and physiologic characteristic

Protozoa
Amoeba Unicellular; cyst Binary Pseudopods Facultative Assimilation by
and trophozoite fission anaerobe pinocytosis or
forms phagocytisis
Flagellates Unicellular cyst Binary Flagella Facultative Simple diffusion or
and trophozoite fission anaerobe ingestion via
forms cytostome, pinocytosis
or phagocytosis
Cilliates Unicellular cyst Binary cilia Facultative Ingestion via
and trophozoite fission or anaerobe cytostome, food
forms conjugation vacuole
Sporozoa Unicellular, Schizogony None Facultative Simple diffusion
frequently and anaerobe
intracellular; sporogony
multiple forms ,
including
trophozoites,
cysts (oocysts),
 gametes

Helminths

Cestodes Multicellular, hermaphro No single Adults usually Absorption of

head with ditic organelle, anaerobic nutrients from
segment body usually intestines
,lack of digestive attachmentto
tract; head mucosa;
equipped with possible
hooks and or muscular
suckers for motility
attachment (proglottids)
Trematodes Multicellular; leaf Hermaphro No single Adults usually Ingestion absorption
shaped with oral ditic organelle anaerobic of body fluids, tissue
and ventral sucks , schistosoma muscle or digestive contents
blinf alimentary spp, has directed
tract. separate motility
sexes
Nematodes Multicellular; Separate No single Adults usually Ingestion or
round smooth, sexes organelle, anaerobic, absorption of body
spindle shaped, active larvae possibly fluids, tissue or
tubular digestive muscular aerobic digestive contents.
tract; possibility of motility
teeth or plates for
attachment

Laboratory Diagnosis of Parasitic Infections

Specimen Collection , Handling and Transport

Essential to the management of parasitic infections is knowing the proper laboratory

diagnostic procedure to request, includes the knowledge of the proper specimen to
collect, the specimen varies depends on the portals of entry and exit parasite. The
most common portal of entry is the mouth and the most common portal of exit is
the anus. Multiple specimen may be needed for adequate detection that involve
collection of three specimens. One specimen collected every other days , for
suspected cases of amoebiasis up to specimens within a period of 14 days.

Timing of specimen collection is important.

 To demonstrate the motility characteristics of protozoans parasites, fresh
specimen must be used.
 The diagnostic stage for most protozoans is the trophozoite, which is usually
found in liquid stool. It recommend that liquid stool be examined within 30
 minutes after collection. Cyst forms may be held for the maximum of 24 hours
after collection
 Preservatives or fixatives may be added if the specimen cannot be examined
right away , the preservatives that may be used include formalin, polyvinyl
alcohol , sodium acetate formalin and modifies polyvinyl alcohol.
 Stool specimen must be collected with clean water and container should be
tightly, 2.5 g of stool is recommend.
 No contamination with urine must be allowed to avoid of the parasite by acidic
urine and stoll should not be collected from water from the toilet bowl since
some parasites may be destroyed by water.
 Proper labeling of the container must be observed and accompanied by fully
accomplished request form
 Universal precautions must be observed when handling all specimen and gloves
must be worn at all times.

Microscopic Examination

All fresh specimens submitted for examination must be undergo in microscopic

examination and which it divided into three stages:
1. Direct wet precautions
2. Concentration technique
3. Use of permanent stains
The microscope to be used must be equipped with ocular micrometer since size is
important diagnostic feature.

Direct wet precautions or direct wet mount

Purpose : to detect the presence of motile protozoan trophozoites; other stages

detected include , cysts, oocysts, and larvae of worms
Principle: a small potion of unfixed stool is mixed with saline or iodine then studied
under the microscope.

Procedure:
1. Place a small amount of unfixed stool on a glass slide
2. Add a drop of 0.85% saline
3. Mix using a wooden applicator stick
4. Place a cover slip on the slide
5. Examine slide using both low - power and high power objectives of the
microscope.
Variation include addition of a drop of iodine (lugol’s or D’antoni’s) to enhance the
detail of protozoan cysts. This is called direct iodine wet preparation.
Concentration method

Purpose:
 to aggregate parasites present into a small volume of the sample that
enables the detection of small number of parasites that might not be
detected in direct wet preparation.
 To remove debris and other contaminants that might interfere with the
microscopic examination.

Concentration techniques can be used on both fresh and preserved specimens. It

can be used to detect cysts, oocysts, ova, and larvae of nematodes.

Two types of concentration techniques that are available ,

 Flotation
 Sedimentation.

Sedimentation(Formalin - Ethyl Acetate Sedimentation Procedure)

(Most widely used)

Principle: this is based on specific gravity, parasites are heavier that the solution
used and thus sttle in the sediment of the tube while the fecal debris which are
lighter will rise to the upper layer of the test tube

Procedure: ethyl acetate is added o a saline-washed formalin - fixed sample in a test

tube and then centrifuged

Advantage: it provides good recovery of most parasites and it is relatively easy to

perform

Disadvantage: the preparation contains more fecal debris than a flotation

techniques.

Zinc sulfate flotation technique

Principle: this is based on differences in a specific gravity and the sample debris. The
zinc sulfate used has a specific gravity of 1.18- 1.20 and it used as the concentrating
solution.

Advantage: It is able to remove more fecal debris, hence will yield a cleaner
preparation.
Disadvantage: some helminths eggs are denser and may not float to the upper layer
of the test tub.
Permanent Stains
This serves as the final step in microscopic examination for detection of parasites. A
small amount of the fixed sample is placed on the slide glass and allowed to dry
after which it is stained. It design to confirm the presence of cysts and trophozoites
of protozoans. Stain that may be be used include wheatly trichome, iron
hematoxylin (to demonstrate morphology of intestinal protozoa) and other
specialized stains.

Other Specimens and Laboratory Procedures

Duodenal Material

This may be collection using a nasogastric tube (NGT) or through the enteric capsule
test (entero test). the collected duodenal fluid must be examined immediately to
prevent rapid deterioration of trophozoites, the sample undergoes centrifugation
prior to microscopic examination of the sediment.

In Entero test the patient is made to swallow a gelatin capsule that contains a coil of
yarn that is weighted. The yarn released and carried to the duodenum as the
dissolves in the stomach. The bile-stained material attached to the string is then
examined microscopically with wet preparation followed by application of
permanent stains.

Sigmoidoscopy Material

Sigmoidoscopy is used to collect and examine material from the colon and this is
helpful for the diagnosis of infection with entamoeba bistolytiea. Biopsy of colon
material may be done.

Cellophane Tape or Scotch Tape Preparation

This procedure is done to detect eggs of the pinworm enterobius vermicularis. The
female parasite migrates to the anus at night where it lays it eggs , it may also be
used to detect eggs of the tape worm taenia spp.

Blood

Examination of blood can detect the presence of blood - borne parasites such as
leisbmania, trypanosoma , Plasmodium and the filarial worm. Universal precautions
and asepsis must be observed during the collection and handking of blood
specimen. In cases of suspected malaria infection , thick smears serve for screening
purposes and be used when parasites are few in number while the thin smears are
best to demonstrate the malarial parasites in the red blood cells. The prepared
smears may be stained using wright’s stain or giemsa stain.

Cerebrospinal Fluid (CSF)

CSF may be used to diagnose certain amebic infection . it may also be used in
patients with african sleeping sickness. Similar to blood , the csf must be
immediately examined if detection of parasites motility is desired. Wet preparation
can be done to detect characteristic morphologic forms of Naegleria, Acanthatoeba
and Typanosoma as well as Toxoplasma gondii, Taenia solium (cysticercosis), and
ECbinococcus.
Tissue and biopsy Specimens

This may be utilized to detect the presence of leishmania, Toxoplasma gondii,

trypanosoma, taenia solium and trichinella spiralis in tissues. In patients with
suspected anemic liver abscess, the abscess material taken from the liver in the
specimen of choice.

Genitourinary Secretions

The specimen of choice for detecting the blood fluke sehistosoma baeatobium is
urine. It may also be used to detect triebomonas vaginallis , which may also be
Isolated from genital secretions. Urine samples are centrifuged and the sediments
examined for the presence of the parasites. Genital secretions may be collected
using sterile cotton swab . saline wet preparation is then performed to demonstrate
the trophzoite of parasites.

Others:

1. Sputum - Paragonimus westermani, Strongyloides stercoralis (with

hyperinfection), E. Bistolytica, Ascaris lumbricoides larve, and the larvae of
hookworms
2. Eye specimens - Acantbamoeba keratitis , Toxoplasma gondii and loa loa.
3. Mouth scrapings and nasal discharge- E. gingivalis , Tricbomonas tenax,
Naegleria fowleri.
4. Skin snips - skin fluid without bleeding obtained by making a small cut into skin
with a razor blade ; to detect motile microfilarie.
5. Xenodiagnosis - special method for diagnosis of chaga’s disease where an
uninfected reduviid bug (the vector) is allowed to take a blood mmetal from an
 infected patients and feces of the bug is then examined for the presence of
trypanosoma cruzi.

CHAPTER SUMMARY

 Symbiosis is a form of relationship where unlike organism live together. forms

of symbiotic relationship include commensalism, mutualis and parasitism.
 Parasites are grouped based on the following: habitat (ectoparasites and
endoparasites), ability to live independently of the host (faccultative and
obligatory) and more of living (permanent , intermittent , erratic, incidental and
transitory).
 There are four types of host: definitive, intermediate, reservoir and paratenic.

 The most common source of parasites is contaminated soil and water . other
sources include :
1. Food contaminating the parasites infective stages
2. A blood sucking insects,
3. A domestic or wild animal harboring the parasites
4. Another person and his or her clothing, bedding or the immediate
environment he or she has contaminated
5. One’s self (auto infection)
 The most common mode of parasites is through ingestion of contaminated
food and water (fecal - oral transmission)
 Other means by which parasites are transmitted are through;
1. Bite of an insect vector
2. Skin penetration
3. Sexual intercourse
4. Transplacental transfer (mother of fetus)
5. Mother’s milk (transmammary)
 The most common portal exit of parasites is through the anus
 Parasites produces disease though the five basic mechanism ;
1) Traumatic or physical damage
2) Lytic necrosis
3) Toxic or allergic phenomena
4) Stimulation of host tissue reaction
5) Opening of pathways for entry of other pathogens into the tissues
 Stool is the most common specimen used to detect the presence of parasites
 Other specimens include :
1. Urine,
2. Genital secretion
3. Blood
4. Sputum
5. CSF
6. And other sterile body secretions.
 Microscopic examination of the stool specimen is the most widely used to
detect presence of parasites.