PARASITOLOGY

LEARNING OBJECTIVES
At the end of this section the student is expected to:
• Discuss the various types of parasites and hosts.
• Explain the relationship between a parasite and the host and their effects.
• Discuss in detail the classification of medically important parasites.
INTRODUCTION
Man and other living things on earth live in an entangling relationship with each other.
They don’t exist in an isolated fashion. They are interdependent; each forms a strand in
the web of life. Medical parasitology is the science that deals with organisms living in
the human body (the host) and the medical significance of this host-parasite
relationship.
ASSOCIATION BETWEEN PARASITE AND HOST
A parasite is a living organism, which takes its nourishment and other needs from a
host; the host is an organism which supports the parasite. The parasites included in
medical parasitology are protozoa, helminthes, and some arthropods.

Types of parasites
Ectoparasite – a parasitic organism that lives on the outer surface of its host, e.g.
lice, ticks, mites etc.
• Endoparasites – parasites that live inside the body of their host, e.g. Entamoeba
histolytica.
• Obligate Parasite - This parasite is completely dependent on the host during a
segment or all of its life cycle, e.g. Plasmodium spp.
• Facultative parasite – an organism that exhibits both parasitic and non-parasitic
modes of living and hence does not absolutely depend on the parasitic way of
life, but is capable of adapting to it if placed on a host. E.g. Naegleria fowleri
• Accidental parasite – when a parasite attacks an unnatural host and survives. E.g.
Hymenolepis diminuta (rat tapeworm).
• Erratic parasite - is one that wanders in to an organ in which it is not usually found.
E.g. Entamoeba histolytica in the liver or lung of humans.
Most of the parasites which live in/on the body of the host do not cause disease
(non-pathogenic parasites). In Medical parasitology we will focus on most of the disease
causing (pathogenic) parasites. However, understanding parasites which do not
ordinarily produce disease in healthy (immunocompetent) individuals but do cause
illness in individuals with impaired defense mechanism (opportunistic parasites) is
becoming of paramount importance because of the increasing prevalence of HIV/AIDS
in our country.

Types of hosts
• Definitive host – a host that harbors a parasite in the adult stage or where the parasite
undergoes a sexual method of reproduction.
• Intermediate host - harbors the larval stages of the parasite or an asexual cycle of
development takes place. In some cases, larval development is completed in two
different intermediate hosts, referred to as first and second intermediate hosts.
• Paratenic host – a host that serves as a temporary refuge and vehicle for reaching an
obligatory host, usually the definitive host, i.e. it is not necessary for the completion of
the parasites life cycle.
• Reservoir host – a host that makes the parasite available for the transmission to
another host and is usually not affected by the infection.
• Natural host – a host that is naturally infected with certain species of parasite.
• Accidental host – a host that is under normal circumstances not infected with the
parasite.
EFFECT OF PARASITES ON THE HOST
The damage which pathogenic parasites produce in the tissues of the host may be described in
the following two ways;
(a) Direct effects of the parasite on the host
• Mechanical injury - may be inflicted by a parasite by means of pressure as it grows larger, e.g.
Hydatid cyst causes blockage of ducts such as blood vessels producing infraction.
• Deleterious effect of toxic substances- in Plasmodium falciparum production of toxic
substances may cause rigors and other symptoms.
• Deprivation of nutrients, fluids and metabolites -parasite may produce disease by competing
with the host for nutrients.
(b) Indirect effects of the parasite on the host:
Immunological reaction: Tissue damage may be caused by immunological response of the host,
e.g. nephritic syndrome following Plasmodium infections.
Excessive proliferation of certain tissues due to invasion by some parasites can also cause tissue
damage in man, e.g. fibrosis of liver after deposition of the ova of Schistosoma.

BASIC CONCEPTS IN MEDICAL PARASITOLOGY

In medical parasitology, each of the medically important parasites are discussed under
the standard subheadings of morphology, geographical distribution, means of infection,
life cycle, host/parasite relationship, pathology and clinical manifestations of infection,
laboratory diagnosis, treatment and preventive/control measures of parasites. In the
subsequent section some of these criteria are briefly presented.
Morphology - includes size, shape, color and position of different organelles in different
parasites at various stages of their development. This is especially important in
laboratory diagnosis which helps to identify the different stages of development and
differentiate between pathogenic and commensal organisms. For example,
Entamoeba histolytica and Entamoeba coli.
Geographical distribution - Even though revolutionary advances in transportation has
made geographical isolation no longer a protection against many of the parasitic
diseases, many of them are still found in abundance in the tropics. Distribution of
parasites depends upon:
a. The presence and food habits of a suitable host:
• Host specificity, for example, Ancylostoma duodenale requires man as a host
where Ancylostoma caninum requires a dog.
• Food habits, e.g. consumption of raw or undercooked meat or vegetables
predisposes to Taeniasis
b. Easy escape of the parasite from the host- the different developmental stages of a
parasite which are released from the body along with faeces and urine are widely
distributed in many parts of the world as compared to those parasites which
require a vector or direct body fluid contact for transmission.
c. Environmental conditions favoring survival outside the body of the host, i.e.
temperature, the presence of water, humidity etc.
d. The presence of an appropriate vector or intermediate host – parasites that do not
require an intermediate host (vector) for transmission are more widely distributed
than those that do require vectors
Once we are clear about the geographical distribution and conditions favoring survival in
relation to different parasites, effective preventive and control measures can more easily
be devised and implemented.
Life cycle of parasites - the route followed by a parasite from the time of entry to the
host to exit, including the extracorporeal (outside the host) life. It can either be simple,
when only one host is involved, or complex, involving one or more intermediate hosts. A
parasite’s life cycle consists of two common phases one phase involves the route a
parasite follows inside the body. This information provides an understanding of the
symptomatology and pathology of the parasite. In addition the method of diagnosis and
selection of appropriate medication may also be determined. The other phase, the route
a parasite follows outside of the body, provides crucial information pertinent to
epidemiology, prevention, and control.
Host parasite relationship - infection is the result of entry and development within the
body of any injurious organism regardless of its size. Once the infecting organism is
introduced into the body of the host, it reacts in different ways and this could result in:
a. Carrier state - a perfect host parasite relationship where tissue destruction by a
parasite is balanced with the host’s tissue repair. At this point the parasite and
the host live harmoniously, i.e. they are at equilibrium.
b. Disease state - this is due to an imperfect host parasite relationship where the
parasite dominates the upper hand. It can result either from lower resistance of
the host or a higher pathogenecity of the parasite.
c. Parasite destruction – occurs when the host takes the upper hand.
Laboratory diagnosis – depending on the nature of the parasitic infections, the
following specimens are selected for laboratory diagnosis:
a) Blood – in those parasitic infections where the parasite itself in any stage of its
development circulates in the blood stream, examination of blood film forms one
of the main procedures for specific diagnosis. For example, in malaria the
parasites are found inside the red blood cells. In Bancroftian and Malayan
filariasis, microfilariae are found in the blood plasma.
b) Stool – examination of the stool forms an important part in the diagnosis of
intestinal parasitic infections and also for those helminthic parasites that localize
in the biliary tract and discharge their eggs into the intestine.
In protozoan infections, either trophozoites or cystic forms may be detected; the
former during the active phase and the latter during the chronic phase. Example,
Amoebiasis, Giardiasis, etc.
In the case of helmithic infections, the adult worms, their eggs, or larvae are
found in the stool.
c) Urine – when the parasite localizes in the urinary tract, examination of the urine
will be of help in establishing the parasitological diagnosis. For example in
urinary Schistosomiasis, eggs of Schistosoma haematobium are found in the
urine. In cases of chyluria caused by Wuchereria bancrofti, microfilariae are
found in the urine.
d) Sputum – examination of the sputum is useful in the following:
• In cases where the habitat of the parasite is in the respiratory tract, as in
Paragonimiasis, the eggs of Paragonimus westermani are found.
• In amoebic abscess of lung or in the case of amoebic liver abscess bursting
into the lungs, the trophozoites of E. histolytica are detected in the sputum.
e) Biopsy material - varies with different parasitic infections. For example spleen
punctures in cases of kala-azar, muscle biopsy in cases of Cysticercosis,
Trichinelliasis, and Chagas’ disease, Skin snip for Onchocerciasis.
f) Urethral or vaginal discharge – for Trichomonas vaginalis
Indirect evidences – changes indicative of intestinal parasitic infections are:
a. Cytological changes in the blood – eosiniphilia often gives an indication
of tissue invasion by helminthes, a reduction in white blood cell count is
an indication of kala-azar, and anemia is a feature of hookworm
infestation and malaria.
b. Serological tests – are carried out only in laboratories where special
antigens are available.

Treatment – many parasitic infections can be cured by specific chemotherapy. The

greatest advances have been made in the treatment of protozoal diseases.
For the treatment of intestinal helminthiasis, drugs are given orally for direct action on
the helminthes. To obtain maximum parasiticidal effect, it is desirable that the drugs
administered should not be absorbed and the drugs should also have minimum toxic
effect on the host.
Prevention and control - measures may be taken against every parasite infectiving
humans. Preventive measures designed to break the transmission cycle are crucial to
successful parasitic eradication. Such measures include:
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Reduction of the source of infection- the parasite is attacked within the host, thereby
preventing the dissemination of the infecting agent. Therefore, a prompt diagnosis
and treatment of parasitic diseases is an important component in the prevention of
dissemination.
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Sanitary control of drinking water and food.
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Proper waste disposal – through establishing safe sewage systems, use of screened
latrines, and treatment of night soil.
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The use of insecticides and other chemicals used to control the vector population.
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Protective clothing that would prevent vectors from resting in the surface of the body
and inoculate pathogens during their blood meal.
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Good personal hygiene.
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Avoidance of unprotected sexual practices.
CLASSIFICATION OF MEDICAL PARASITOLOGY
Parasitology is generally classified into:
• Medical Protozoology - Deals with the study of medically important protozoa.
Medical Helminthology - Deals with the study of helminthes (worms) that affect
man.
• Medical Entomology - Deals with the study of arthropods which cause or transmit
disease to man.
Importance of protozoa
 Protozoa serve as an important link in the food chain and ecological balance of many
communities in wetland & aquatic environments.
 They are also important in biological sewage treatment, which involves both anaerobic
digestion and/or aeration.
 In addition, protozoa are important laboratory organisms in research areas, by which their
asexual reproduction enables clones to be established with the same genetic make-up.
 These are useful in the study of cell cycles and nucleic acid biosynthesis during cell
division.
 The sources of the parasites are different. Exposure of humans to the parasites
 may occur in one of the following ways:

Sources of parasites
1. Contaminated soil (Geo-helminthes), water (cercariae of blood flukes) and food
(Taenia in raw meat).
2. Blood sucking insects or arthropods (as in filarial worms).
3. Domestic or wild animals harboring the parasite (as in echinococcus in dogs).
4. Person to person (as in Enterobius vermicularis, Hymenolopis nana).
5. Oneself (auto-infection) as in Enterobius vermicularis.
They enter the body through different routes including: mouth, skin and the
respiratory tract by means of inhalation of airborne eggs.

The helminthes are classified into three major groups. These are:
1. Trematodes (Flukes)
2. Nematodes (Round worms)
3. Cestodes (Tape worms)
The Trematodes and Cestodes are groups of flat worms.

IMPORTANCE OF ARTHROPODS IN PARASITOLOGY

Arthropods affect the health of man by being:
(a) Direct agents for disease /discomfort.
The following effects may be seen by the direct effect of arthropods.
• Annoyance – comes from disruptive activities of insects, such as
flying around or landing on the head, and from feeding, possibly
causing blood loss, though they don’t remove sufficient blood to
cause a medical problem in humans.
• Entomophobia – is an irrational fear of insects. One extreme form
of entomophobia is delusory parasitosis, in which individuals
become convinced that they are infested with insects when no
actual infestation exists. This may cause undue alarm and anxiety,
leading to unwarranted use of insecticides, and in severe cases,
requiring professional treatment.
• Envenomization – is the introduction of a poison into the body of
humans and animals. Arthropods may also inoculate poison to the
host. E.g. Scorpion
• Allergic reactions – a hypersensitive response to insect proteins.
All of the mechanisms associated with envenomization can also
cause exposure to allergens. In fact, human deaths from bee and
wasp stings usually are associated with a hypersensitive reaction
rather than direct effect of a toxin.
• Dermatosis and dermatitis – dermatosis is a disease of the skin
and dermatitis is an inflammation of the skin. Both dermatosis and
dermatitis can be caused by arthropod activities. Many mite
species, such as scabies mites produce acute skin irritations.
(b) Agents for disease transmission
Arthropods can carry disease causative agents in the following two ways.
• Mechanical carrier
Here they lodge the disease causative agent without altering its
development or multiplication
e.g. house fly

• Biological carrier
When arthropods become biological carriers for transmission of
disease, it means that certain stages in the life cycle of parasite
takes place in the body of the insect.
e.g. Anopheles mosquitoes.
Biological carrier is any of the following types:
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Propagative- where there is multiplication of the parasite with
no developmental change
e.g. Yellow fever virus in Aedes mosquito.
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Cyclopropagative – in this type both multiplication and
developmental change are going on.
e.g. Plasmodium species in Anopheles mosquito
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Cyclodevelopmental – here there is developmental change
of the parasite but no multiplication
E.g. Wucherera bancrofiti in Culex mosquito
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Transovarian- when the pararasite passes to progeny
arthropods through the ova
 E.g. Ricketsia typhi in ticks
If we are clear about the importance of arthropods as a source of human
infection, it is important to accurately identify and classify them for crucial
treatment, prevention, and control of infection

CLASSIFICATION OF ARTHROPODS
There are three medically important classes of Arthropods:
1. Class Insecta- consists of mosquitoes, fleas, bugs, lice and flies, etc.
2. Class Arachnida- consists of ticks, mites and scorpion.
3. Class Crustacea- consists of cyclops.