MODULE 14

Module Title: Major Parasitic Diseases of Humans

Overview:
This module introduces students to parasites and the diseases they cause to human. Parasites
are organisms that live on or in other living organisms at whose expense they gain some advantage.
Parasitism is a symbiotic relationship that is of benefit to one party or symbiont (the parasite) and
usually detrimental to the other party (the host). This does not mean that the parasite necessarily
causes disease in the host, although disease does occur in certain parasitic relationships. In all parasitic
relationships, the parasite deprives the host of nutrients. Parasites that live on the outside of the host’s
body are called ectoparasites, whereas those that live inside are called endoparasites. Arthropods such
as mites, ticks and lice are ectoparasites. Parasitic protozoa and helminths are endoparasites.

Module Objectives:
At the end of the module, the student should be able to:
1. Differentiate between ectoparasite and endoparasite; definitive host and intermediate hosts.
2. Differentiate between facultative and obligate parasites; mechanical vectors and biologic vectors.33.
3. Classify a particular parasitic infection a s a protozoal or helminth disease.
4. Categorize parasitic infections by body system.
5. Correlate a particular parasitic infection with its major characteristics, causative agent, reservoir,
mode of transmission and diagnostic laboratory procedures.

Module Coverage:
A. Protozoal and Helminth Infections of Humans
B. Arthropod borne Human Disease

TOPIC A
Topic Title: Protozoal Infections of Humans
Introduction:
Protozoa are in the Kingdom Protista. Most are unicellular and are classified according to their
mode of locomotion. Not all protozoa are parasitic. Some protozoa are facultative parasites, capable of a
free-living existence but also capable of becoming parasites when they accidentally gain entrance to the
body. The free-living amoebae normally reside in soil or water but can cause serious diseases when they
gain entrance to the eyes or central nervous system.
This topic introduces student to protozoal infections which are often diagnosed by microscopic
examination of body fluids, tissue specimens, or feces. Peripheral blood smears are usually stained with
Giemsa stain whereas fecal specimens are stained with trichome, iron-hematoxylin or acid-fast stains.
Most parasitic protozoal infections are diagnosed by observing either trophozoites or cysts in the
specimen. The trophozoite is the motile, feeding, dividing stage in a protozoan’s life cycle, whereas the
cyst is the dormant stage.

Topic Objectives:
At the end of the topic, the student should be able to:
1. Describe a particular protozoal infection.
2. Classify a particular parasitic infection as a protozoal or helminth disease.
3. Categorize various parasitic infections by body system.
4. Correlate a particular parasitic infection with its major characteristics, causative agent, reservoir,
mode of transmission and diagnostic laboratory procedures.
Topic Contents:
 PPP

TOPIC B
Topic Title: Arthropod borne Human Disease
Introduction:
Arthropods may serve as mechanical or biologic vectors in the transmission of certain infectious
diseases. Mechanical vectors merely pick up the parasite at point A and drop it off at point B. A biologic
vector is an arthropod in whose body the pathogen multiplies or matures. Many arthropod vectors of
human diseases are biologic vectors. A particular vector may serve as both a host and a biologic vector.
This topic introduces students to three classes of arthropods (insects, arachnids and
crustaceans) that are studied in parasitology. The insects that are studied include lice, fleas, flies,
mosquitoes and reduviid bugs. Arachnids include mites and ticks. Crustaceans include crabs, crayfish,
and certain Cyclops species.

Topic Objectives:
At the end of the topic, the student should eb able to:
1.Correlate a particular parasitic infection with its major characteristics, causative agent, reservoir,
mode of transmission and diagnostic laboratory procedures.
2. Identify the way by which arthropods may be involved in human diseases.

Topic Content:
 PPP

Review of Key Points

 Parasites are defined as organisms that live on or in other living organisms (hosts), at
whose expense they gain some advantage (usually by depriving the host of nutrients).
 Of the three categories of organisms (parasitic protozoa, helminths, and arthropods)
that are studied in a parasitology course, only one category (parasitic protozoa)
contains microorganisms.
 Parasites that live on the outside of the host’s body are referred to as ectoparasites,
whereas those that live inside are called endoparasites.
 The definitive host is defined as the host that harbors the adult or sexual stage of the
parasite or the sexual phase of the life cycle. The intermediate host is the host that
harbors the larval or asexual stage of the parasite or the asexual phase of the life cycle.
 An accidental host is a living organism that can serve as a host in a particular
parasite’s life cycle, but is not a usual host in that life cycle. Some accidental hosts are
dead-end hosts, from which the parasite cannot continue its life cycle.
 A facultative parasite is an organism that can be parasitic but does not have to live as a
parasite. It is capable of living an independent life (apart from a host). An obligate
parasite has no choice. To survive, it must be parasitic.
 In general, parasitic infections are diagnosed by observing and recognizing various
 parasite life cycle stages in clinical specimens.
 Protozoa are classified taxonomically by their mode of locomotion. Amebas move by
pseudopodia, flagellates move by flagella, ciliates move by cilia, and sporozoans are
nonmotile.
 The trophozoite is the motile, feeding, diving stage in the protozoal life cycle, and the
cyst, oocyst, and spore are dormant stages. Protozoal infections are most often acquired
by ingestion or inhalation of dormant stages.
 Leishmaniasis is caused by various species of flagellated protozoa in the genus
Leishmania, and is usually transmitted via the bite of an infected sand fly.
 Trichomoniasis is caused by a flagellated protozoan named Trichomonas vaginalis,
and is transmitted by direct contact with vaginal and urethral discharges of infected
people.
 Primary amebic meningoencephalitis is caused by an ameboflagellate named
Naegleria fowleri.
 Helminths – parasitic worms – are divided into roundworms (nematodes) and
flatworms. Flatworms are further divided into tapeworms (cestodes) and flukes
(trematodes.
 The typical helminth life cycle consists of three stages: the egg, the larva, and the adult
worm.
 Helminth infections are usually diagnosed by observing (1) whole worms or segments
of worms in clinical specimens – most often, fecal specimens, or (2) larvae or eggs in
stained or unstained clinical specimens.
 Arthropods may be involved in human diseases in several ways: (1) they may be the
actual cause of the disease, (2) they may serve as an intermediate or definitive host in a
parasite’s life cycle, or (3) they may serve as a mechanical or biological vector in the
transmission of an infectious disease.
 Students should learn the type and name of the protozoal parasite that causes each of
the diseases described in the section entitled “Protozoal Infections of Humans,” as well
as the manner in which each of those diseases is transmitted.

A Closer Look at Helminths

1The following information about helminth infections supplements the material on helminths in
Chapter 21 of the book.

Nematodes (roundworms)
Intestinal Nematodes
Ascariasis: Ascaris lumbricoides is the large intestinal roundworm of humans, reaching a
maximum length of approximately 35 cm (about 14 inches). Humans are the only hosts. Male
and female worms live in the small intestine. Female worms release eggs, which pass in the
feces. The eggs must reach moist, warm soil, where it takes about 2 weeks for the larvae within
the eggs to become infective. Humans become infected by ingesting eggs, often by ingesting
unwashed or inadequately washed vegetables. In the human body, the larva then matures into
an adult worm. Adult worms can live in the body for about 1 year. Ascariasis is most common in
areas where human feces (“night soil”) is used to fertilize crops.
Pinworm infection: Enterobius vermicularis (pinworm) infection is the most common
helminth infection in the world. Humans are the only hosts. Male and female worms, which
reach a maximum length of about 13 mm, live in the cecum (the first part of the colon). Female
worms migrate down through the colon, emerge from the anus, and release eggs onto the
perianal skin. The eggs are fully embryonated and infective within a few hours. Humans
become infected by ingesting the eggs. In the human body, the larva then matures into an adult
worm. Adult worms can live in the body for several months to several years.
Hookworm infection: Necator americanus (the new world hookworm) lives in the small
intestine, where it anchors itself to the intestinal mucosa by means of its well-developed mouth
parts (called cutting plates). Female worms release eggs, which pass in the feces. The eggs must
reach moist, shady, warm soil, where they hatch within 1 to 2 days. In the soil, it takes about 5
to 8 days for the immature larva to become a mature infective larva. The infective larvae
remain viable in the soil for several weeks. Humans become infected by penetration of the skin
(usually the soles of the feet) by the infective larvae. In the human body, the larva then matures
into an adult worm. Adult worms can live in the body for 4 to 20 years. Humans are the only
hosts.
Tissue Nematode
Dracunculiasis: The adult Dracunculus medinensis (guinea worm), which can be up to a
meter in length, migrates in the deep connective tissues and subcutaneous tissues of the body.
The female worm migrates to the ankle or foot (usually), where a blister forms. On contact with
water, the blister bursts, and a portion of the worm protrudes through the opening. Larvae are
discharged into the water. A larva is ingested by a small, freshwater crustacean called a Cyclops.
Within the Cyclops, it takes about 8 days before the larva becomes infective for humans.
Humans become infected by drinking water that contains the infected Cyclops. In the human
body, the larva matures into an adult worm. In this life cycle, the human is the definitive host
and the Cyclops is the intermediate host.
Filarial Nematodes
Filariasis: The adult worms (such as Brugia malayi and Wuchereria bancrofti) that cause
filariasis live in lymph nodes, where they can block the flow of lymph (leading to elephantiasis).
They reach lengths of up to 40 mm. Female worms release tiny, microscopic, prelarval stages
called microfilariae, which get into the bloodstream. When a mosquito takes a blood meal, it
ingests the microfilariae. Within the mosquito, the microfilariae mature into infective larvae.
When the mosquito again takes a blood meal, it injects the infective larvae into the human. In
the human body, a larva matures into an adult worm. In this life cycle, the human is the
definitive host and the mosquito is the intermediate host.
Onchocerciasis (river blindness): Adult Onchocerca volvulus worms live within fibrous
tissue nodules. Female worms release tiny, microscopic, prelarval stages called microfilariae,
which get into the skin, eyes, and bloodstream (occasionally). When a black fly (genus
Simulium) takes a meal of tissue juices, it ingests the microfilariae. Within the black fly, the
microfilariae mature into infective larvae. When the black fly again takes a blood meal, it injects
an infective larva into the human. In the human body, the larva matures into an adult worm.
Adult worms may live for 15 years in the human body, producing microfilariae for about 10
years. In this life cycle, the human is the definitive host and the black fly is the intermediate
host.
Cestodes (tapeworms) (Note: tapeworms are hermaphroditic, meaning that each tapeworm
contains both male and female reproductive organs; thus, it only takes one worm to produce
fertile eggs.)
Intestinal Cestodes
Fish tapeworm infection: The adult Diphyllobothrium latum tapeworm lives in the
human small intestine, where it can reach 10 m in length. Eggs released by the tapeworm are
passed in the feces. An egg must reach fresh water, where a ciliated organism called a
coracidium emerges from the egg. The coracidium is eaten by a Cyclops. Within the Cyclops, the
coracidium matures into a procercoid larva. If the Cyclops is eaten by a fish, the procercoid larva
matures into a plerocercoid larva in the muscle of the fish. If the raw or undercooked fish is
then eaten by a human, the plerocercoid larva matures into an adult worm. Adult worms may
live for up to 25 years in the human body. In this life cycle, the human is the definitive host, the
Cyclops is the first intermediate host, and the fish is the second intermediate host.
Dog tapeworm infection: The adult Dipylidium caninum tapeworm lives in the dog’s
small intestine, where it can reach 70 cm in length. Egg packets released by the tapeworm are
passed in the feces. If an egg is eaten by a larval flea, a cysticercoid larva develops within the
flea. If the flea is then ingested by a dog (or a cat or a human), the larva matures into an adult
worm. Adult worms usually live less than 1 year in the human body. In this life cycle, the dog is
the usual definitive host and the flea is the intermediate host. Humans are considered
accidental hosts.
Rat tapeworm infection: In nature, the life cycle of Hymenolepis diminuta usually
involves a rodent (the definitive host) and a beetle (the intermediate host). The adult
Hymenolepis diminuta tapeworm lives in the rodent’s small intestine, where it can reach 60 cm
in length. Eggs released by the tapeworm are passed in the feces. If an egg is eaten by a beetle,
a cysticercoid larva develops within the beetle. If the beetle is then ingested by a rodent (or a
human), the larva matures into an adult worm. Adult worms usually live less than 1 year in the
human body. Humans are considered accidental hosts.

Dwarf tapeworm infection: Adult Hymenolepis nana tapeworms live in the human small
intestine, where they can reach 4 cm in length (a very small tapeworm; hence, the name
“dwarf” tapeworm). Eggs released by the tapeworm are passed in the feces. If an egg is
ingested by another human, a cysticercoid larva develops within the human. The cysticercoid
larva then matures into an adult worm. Usually, humans are the only hosts; an intermediate
host is not required. However, it is possible for an insect to ingest an egg, for the cysticercoid
larva to develop within the insect, and then, for a human to ingest the insect.
Beef tapeworm infection: The adult Taenia saginata tapeworm lives in the human small
intestine, where it can reach 8 m in length. Eggs released by the tapeworm are passed in the
feces. The egg contains a six-hooked embryo, called an oncosphere. If an egg is ingested by a
cow or bull, the oncosphere matures into a cysticercus larva in striated muscle of the animal.
Humans become infected by ingestion of raw or undercooked beef containing a cysticercus
larva. In the human body, the cysticercus larva matures into an adult worm. Adult worms can
live for up to 25 years in the human body. In this life cycle, the human is the definitive host and
the cow or bull is the intermediate host.
Pork tapeworm infection: The adult Taenia solium tapeworm lives in the human small
intestine, where it can reach 5 m in length. Eggs released by the tapeworm are passed in the
feces. The egg contains a six-hooked embryo, called an oncosphere. If an egg is ingested by a
pig, the embryo matures into a cysticercus larva in striated muscle of the animal. Humans
become infected by ingestion of raw or undercooked pork containing a cysticercus larva. In the
human body, the cysticercus larva matures into an adult worm. Adult worms can live for up to
25 years in the human body. In this life cycle, the human is the definitive host and the pig is the
intermediate host. There is another medical problem associated with T. solium, however. If
humans ingest the eggs, cysticercus larvae develop in various tissues within the body, e.g., the
brain. Larvae in the brain can lead to seizures and other CNS problems. This disease—in which
the larvae of T. solium are present in human tissues and organs—is known as cysticercosis.
Tissue cestode
In nature, the life cycle of Echinococcus granulosus usually involves a dog (the definitive
host) and a sheep (the intermediate host). The adult Echinococcus granulosus tapeworm lives in
the dog’s small intestine, where it can reach 6 mm in length (very small). Eggs released by the
tapeworm are passed in the feces. Each egg contains an oncosphere. If an egg is eaten by a
sheep, the oncosphere develops into a larva (a fluid-filled cyst called a hydatid cyst)
somewhere in the internal organs of the sheep. The fluid within the hydatid cyst contains many
daughter cysts and scolices (tapeworm heads). If the sheep’s viscera (internal organs),
containing the hydatid cyst, are fed to a dog, each scolex can mature into an adult worm. Adult
worms can live for up to 20 months in the dog’s intestine. If a human ingests an egg, a hydatid
cyst develops somewhere in the human body. Humans are considered accidental hosts. Hydatid
cysts must be very carefully removed from the human body by surgery. If the cyst is punctured
during surgery, and the contents of the cyst spill out into a body cavity, each daughter cyst can
mature into another hydatid cyst.
Trematodes (flukes)
Blood Flukes: The blood flukes—Schistosoma haematobium, Schistosoma mansoni, and
Schistosoma japonicum—cause the disease known as schistosomiasis. Adult male and female
worms, which are between 1 and 2 cm in length, live together in pairs within the human body
in blood vessels that surround either the urinary bladder (in the case of S. haematobium) or the
intestine (in the case of S. mansoni and S. japonicum). The eggs that are released by the female
worms can penetrate through the blood vessel walls and migrate through tissues. Eggs of S.
haematobium gain access to the lumen of the urinary bladder, and eggs of the other two
species gain access to the lumen of the intestine. Eggs passed either in urine or feces must
reach fresh water. In the water, a ciliated organism called a miracidium emerges from the egg.
The miracidium penetrates into a snail, where it matures into a mother sporocyst. The mother
sporocyst produces daughter sporocysts, each of which matures into a cercaria. The mature
cercariae are released from the snail into the water. Humans become infected by penetration
of the skin by a cercaria. Within the human body, the cercaria matures into an adult worm.
Adult worms may live throughout the lifetime of the infected human. In this life cycle, the
human is the definitive host and the freshwater snail is the intermediate host.

Learning Activities:
Post summative assessment:
Matching Questions:
_____ 1. African trypanosomiasis, American trypanosomiasis, giardiasis A. Amoebas
and trichomoniasis are caused by protozoa in the category of B. Ciliates
protozoa known as _______________. C. Flagellates
_____ 2. Protozoa in the category known as ________________ move D. Sporozoa
by means of pseudopodia.
_____ 3. Cryptosporidiosis, malaria and toxoplasmosis are cause by protozoa
in the category of protozoa known as _________________.
_____ 4. In the category of protozoa known as __________________, only
one protozoan causes human disease.
_____ 5. A disease known as PAM is caused by a protozoan in the category
of protozoa knowns as _______________.

_____ 6. In the malarial parasite’s life cycle humans become infected when A. gametocytes
a female Anopheles mosquito injects _________________ while B. merozoites
taking a blood meal. C. sporozoites
_____ 7. In the malarial parasite’s life cycle, female Anopheles mosquitoes D. trophozoites
become infected when they ingest male and female _____________
 (at least one of each) while taking a blood meal.
_____ 8. In the malarial parasite’s life cycle, ________________ are released
from infected liver cells.
_____ 9. In the malarial parasite’s life cycle, merozoites initially mature
into _______________ within red blood cells.
_____ 10. In the malarial parasite’s life cycle ___________________ are produced
within female Anopheles mosquitoes.

True/False Questions:
_____ 1. In a parasite’s life cycle, the definitive host harbors the adult or sexual stage of the parasite or
the sexual phase of the life cycle.
_____ 2. The amoebae that cause amoebic keratitis and PAM are good examples of obligate parasites.
_____ 3. In the malarial parasite’s life cycle, humans serve as definitive hosts.
_____ 4. When causing infections, parasitic protozoa and helminths are endoparasites.
_____ 5. Scabies is caused by an insect.
_____ 6. In a parasite’s life cycle, it is possible for a particular arthropod to serve as both a host and a
biologic vector.
_____ 7. It is possible to acquire crptosporidiosis, cyclosporiasis and toxoplasmosis by ingesting oocysts.
_____ 8. Trichomonas vaginalis cannot survive very long outside of the human body because it has no
cysts form.
_____ 9. Toxoplasmosis could be acquired by eating raw or rare meat.
_____ 10. African trypanosomiasis and American trypanosomiasis are transmitted by the same type of
arthropod vector.

Answers:
Matching Questions True/False Questions
1. C 1. True
2. A 2. False (the amoebae that cause these diseases are good examples
3. D od facultative parasites).
4. B 3. False (in the malarial parasite’s life cycle, humans serve as
5. A intermediate hosts and mosquitoes serve as definitive
6. C hosts).
7. A 4. True
8. B 5. False (scabies is caused by an arachnid, specifically a mite; arachnids
9. D are not insects).
10. C 6. True
7. True
8. True
9. True
10. False (African trypanosomiasis is transmitted by a tsetse fly, whereas
American trypanosomiasis is transmitted by a reduviid bug).

Reference:
Engelkirk, P. G. and G. R. W. Burton. 2011. Burton’s Microbiology for the Health Sciences. Lippincott
Williams & Wilkins. Baltimore, MD, 398 pp.