UNIVERSITY OF GONDAR

COLLEGE OF MEDICINE AND HEALTH

SCIENCES
SCHOOL OF BIOMEDICAL AND LABORATORY
SCIENCES
DEPARTMENT OF MEDICAL PARASITOLOGY
 INTRODUCTION
TO
MEDICAL PARASITOLOGY

2
 OUTLINE

– Definition of terms
– Scope of medical parasitology
– Explain host-parasite relationship

– General life cycle of parasites

– Parasitic diseases

– Nomenclature and classification of parasites

3
 Objectives

At the end of this chapter the student will be able to:

– Define common terms used in medical parasitology
– Describe Scope of Human parasitology
– Explain host-parasite relationship

– Discuss the geographical distribution, mode of transmission,

source of infection, and portal of entry of parasites
– Explain the general life cycles of parasites
– Describe classification of medically important parasites

4
 Introduction to Medical parasitology

Parasitology:

 Is the area of biology concerned with the phe-

nomena of dependence of one living organism
on another in which the parasite lives on or in its
host and the host provides physical protection and
nourishment.

5
Medical parasitology

• The study of the parasites of man and their medical con-

sequences. 
• It is a subject that researches:
 The biological features of human parasites
 The relationship between the human being and the
parasites
 The prevention and treatment of the parasitic diseases

6
 Scope of Medical Parasitology

According to the very broad definition of para-

sitology, parasites should include:-
viruses, bacteria, fungi,
protozoa and metazoa
For historical reasons, the first three have
been incorporated into the discipline of Mi-
crobiology
7
 • Phylum Sarcomastigophora
• Amoeba
Medical • Flagellates
The • Phylum Apicomplexa
r Protozoology • Phylum Microsporodia
e • Phylum Ciliophora
f
o • Class Nematoda
r Medical • Class Trematoda
e • Class Cestoda
Helminthology • Class Metacanthocephala
,
M
e • Class Insecta
d Medical • Class Arachnida
i • Class Crustacea
Arthropodology •
c Class Chilopoda
a
l 8
p
 The importance of parasitology

• Major tropical diseases to which WHO pays great attention in-

clude:
 Malaria,
Schistosomiasis
 Filariasis

Leishmaniasis
• Trypanosomiasis and
• Leprosy
• Five of them are parasitic diseases except leprosy
• All the above diseases are prevalent in Ethiopia 9
 The burden of some major parasitic infections

(Source: Roberts and Janvoy, 2009)

 Host-parasite relationship

 Symbiosis
• Two different organisms live together and interact,
• one partner lives in or on another one’s body.
 Interactions of Symbionts

 Phoresis
Phoresis exists when two symbionts are merely “traveling
together,” and there is no physiological or biochemical dependence
on the part of either participant. E.g. bacteria on the legs of a fly.

11
3 types:
 Mutualism (+,+) :

Permanent association between two different organisms that

life apart is impossible.
– Two partners benefit each other,
– The mutuals are metabolically dependent on one another;

– One cannot survive in the absence of the other.

e.g. Termites ( no cellulase; cannot digest cellulose) and their

intestinal myriad flagellates (synthesize cellulase) (for the
digestion of cellulose)
12
 Commensalism (+,0):
 Association of two different organisms.
 One partner is benefited while the other neither benefited
nor injured, such as E.gingivalis this ameba lives in the
mouth, where it feeds on bacteria, food particles, and dead
epithelial cells but never harms healthy tissues.
 Parasitism (+,-):
 Association of two different organisms.
 One partner is benefited while the other is injured, such as
ascaris lumbricoides and man.
13
 Features and types of parasites

Feature of parasites are:

 An animal organisms which live in or on the host in order to

obtain nourishment and shelter
 In parasitism, parasites are the benefited partner
 Smaller than their hosts

 Out number than the host

 Have shorter life span than their host
 Have greater reproductive potential than their host

 doubling time between generations and the number of off-

14
springs
 Types of Parasites

Parasites can be Classified :

I. According to their habitat
Endoparasite
• Lives inside the body of the host
• May be just under the surface or deep in the body.
e.g. Tapeworms, flukes, protozoans
Ectoparasite
• Stays on outside surface of the host
e.g. leeches, ticks, fleas
15
II. Based on dependency on the host
 Obligate Parasite

 The parasite depends completely upon its host for metabolism, shel-
ter and transportation.
 That is, they cannot complete their life cycle without spending at least
part of the time in a parasitic relationship.
e.g. plasmodium spp., trichomonas vaginalis
 Facultative Parasite
 Are not normally parasitic but can become so when they are accidentally
eaten or enter a wound or other body orifice.
 Are those that under favorable circumstances may lead either a parasitic
or free-living existence. e.g. Naegleria fowleri
16
III. Based -
on amount of time spent
 Permanent Parasite
 Lives entire adult life stage on or in a host
 Usually endoparasites
• One exception is eyelash mite
 Temporary (intermittent) Parasite
 Spends only a short time on a host
 Usually ectoparasites
e.g. such as a mosquito or bedbug, only feeds on the host
and then leaves.
17
IV. Based on the degree of pathogencity
 Pathogenic parasites- cause disease in the host .
 e.g. Entameoba histolytica

 Non-pathogenic parasite (commensal) - Parasite derives food

and protection from the host without causing harm to the host.
 e.g. Entamoeba coli
 Opportunistic parasites - those that cause mild disease in im-
munologically healthy individuals, but they can cause sever dis-
ease in immunosuppressed hosts.
 e.g. Coccidian parasites
18
 Other terminology

 Aberrant parasite:

– Found in locations in the host where they normally do not oc-

cur;
e.g. Ascaris larvae may migrate to the brain
 Incidental parasite:
 When a parasite enters or attaches to the body of a species of host
different from its normal one.
 Occurs in hosts where it does not normally occur;

e.g. Fasciola normally does not occur in man but is incidental

19
if found in man’s liver.
 Hosts and types of hosts

 Host:
 Hosts are organism which harbors the parasite. In parasitism, it is
the injured partner.
 Types of Hosts:

Definitive host:-
 A host that harbor the adult (mature) or sexual stage of the parasite
and fertilization takes place within the host.
E.g. man is a definitive host of Taenia saginata

20
 Intermediate host:-
 A host that harbors an immature or asexual stage of the parasite
and no fertilization takes place within the host.
E.G. Cattle are intermediate host of T.Saginata
 Some parasites require more than one intermediate host which
are then designated as first, second intermediate,

21
 Paratenic or transport host

– When the parasite lives in the host in which it can

not develops further. It function as transport or car-
rier host.
– E.G. Toxoplasm species in cattle
 Accidental or incidental host

 Infection of a host other than the normal host species

(the parasite are not usually found).

22
 Reservoir Host

 a wild or domestic animal which harbors a parasite and

acts as source of infection to human.

e.g. Hyrax is a reservoir host of L. aethiopica
 Carrier host
 A person who harbors parasites has no any clinical
symptom. An important source of infection in epidemi-
ology
e.g. human beings harboring cyst form of E.histolytica
23
 Vector and types of vectors

Vector:
Vectors are living organisms (usually arthropods) that transmit para-
sites to man.
Classification

1. Biological vectors:-
2. Mechanical ( Parathenic or transport) Vectors:

24
 1. Biological vectors:-

 An arthropod in whose body the infecting organism develops

or multiplies before becoming infective to the recipient indi-
vidual.

 Are those vectors which are essential in the completion of the life
cycle of the parasite and transmission of it between hosts.

 Types of biological vectors:

Propagative
 Multiplication of the pathogen without developmental
change.
E.G. Yersinia pestis in fleas 25
 Cyclodevelopmental
 Developmental change without multiplication.
E.G. Onchocerca volvulus in black flies. L1→l2 → l3

Cyclopropagative
 Multiplication and developmental change of the pathogen

E.G. Plasmodium vivax in anopheles mosquitoes.

2. Mechanical vector
 Are passive carriers of parasites
 Not essential in the life cycle or transmission of the parasite between
hosts.
 No parasitic development or reproduction occurs e.g. House fly
26
 Transmission of parasites
 Three key links for parasitic disease transmission
1. Source of infection
2. Mode of transmission
3. Susceptible host (people)

Source of exposure
1. primary Source
Infected persons
Carriers
Animals
27
The Sources of Exposure to Parasitic Infections

1. Contaminated soil:-
– Soils polluted with human excreta is commonly responsible for
exposure to infection with geohelminthes.
2.Contaminated water:-
Water may contain
 Viable cysts of amoeba, flagellates etc
 Cercarial stages of human blood fluke
 Cyclops containing larva of D. medinensis
 Fresh water fishes which are sources for fish tape worm
and intestinal flukes infection
28
 (E) crab or cray fishes that are sources for lung fluke and
(F ) water plants which are sources for fasciolopsis buski.

C. Raw or Insufficiently cooked meat of pork, beef and fish

E.g., Trichinella spiralis, Taenia species, D.latum.

D. Blood sucking arthropods:

 Malaria - anopheles mosquito,

 Leishmania - sand flies

 Trypanosoma - tsetse fly

29
E. Animals (a domestic or wild animals harboring the parasite)
e.g. Dogs- the hydatid cyst caused by E. granulosus

F. Human beings:-
A person his/her clothing, bedding or the immediate environment that he/she con-
taminated

 Autoinfection:
 Spread of infection from one part of the body to another with in a single host.
It is used to describe a host which is both intermediate and definitive without
parasite transmission from other animals
e.g. S. stercoralis, E. vermicularis and T. solium

30
 Mode of Transmission
A. Direct mode of Transmission:-
classified as:

I. Horizontal Direct mode of transmission:

Transmission is mainly effected through:-

 Feco-oral route: most intestinal parasites transmitted in this
way.
 Sexual intercourse
 Blood transfusion
 Direct skin penetration
31
II. Vertical Direct Mode of Transmission:
Transmission of the parasite is from the mother to child
through:
Congenital / transplacental
Transmammary (breast milk )

B. Indirect Mode of Transmission:-

– If the parasite has complex life cycle
 Requires biological vectors and/or
 One or more intermediate hosts
32
 Route of Transmission

I. By ingesting infective stage of parasites:

• In food, water or hands contaminated with faeces,
E.g. E. histolytica, E. vermicularis, etc.
• In raw or undercooked meat,
e.g. T. saginata, T. solium, T. spiralis
• In raw or undercooked fish, crab, or water vegeta-
tion
e.g. intestinal flukes
• Ingestion of intermediate host as a whole ( eg. Cyclops )
e.g. D. medinensis
33
II. Penetration of skin and mucus membrane :
• Penetration of the intact skin by filariform larvae of hookworm
and S. Stercoralis on coming in contact with the infected soil.
• Piercing of the skin by cercaria of schistosoma on coming in con-
tact with the infected water .
Iii. Through insect bite/inoculation by arthropod vectors
• Inoculation in to the blood
E.G. Filarial worms, trypanosoma sp., Plasmodium sp. Etc.

34
IV. Sexual Contact,

e.g. Trichomonas vaginalis

V. Transmammary,

e.g. S. stercoralis
VI. Inhalation of contaminated air,
e.g. E. vermicularis

VII. Transplacental,
e.g. T. gondii

VIII. Kissing,
e.g. Trichomonas gingivalis, T. tenax
35
 Effect of parasites on their host
The parasite can affect the host in a number of ways such as:
• Consumption of the nutritive elements of the host

E.g. Hookworm
• Obstruction of passages

E.g. Heavy infection with adult Ascaris

 Intestinal obstruction
• Bleeding and mechanical damage

E.g. Schistosoma eggs

36
• Destruction of tissues

E.g. E.histolytica causes necrosis of liver

• Release of toxic substances

E.g. Rupture of Echinococcus garrulous cyst results anaphylactic

shock
• Opening pathway to secondary infections

E.g. Ulcer caused by Dracunculos medineusis infection exposes

to bacterial infections

37
 General Life Cycles of parasites

• Describes the cycle of development of the parasite,

• This may involve
• Passing through a number of developmental stages & envi-
ronment
• Parasitic and non-parasitic stages
 It is naive to try to control an infection without knowledge of how
an infectious agent, in this case a parasite, reproduces and gets
from one host to another

38
• The life of a parasite can be divided into a number of phases:
 Growth and maturation
 Reproductive (sexual and asexual) and
 Transmission phases

 All vitally important for the successful survival of the parasite

• Can be simple or complex depending on how many different hosts
it requires to complete its cycle.

39
40
 Simple or Direct Life Cycle (monoxenous)
• Only one host is required to complete its cycle
• The parasite often spends most of its life, usually as an adult, and where it
reproduces
• Transmitted from one host to another through the air, by a fomite, or in con-
taminated food or water.

41
 Indirect or heteroxenous life cycles

• Requires two or more hosts (a vector or intermediate host ) to reproduce or

grow in.
• Frequently this may involve passing through a number of developmental
stages & En’t.

42
 Why study life cycles ?

• Studying the life cycles of the parasite helps to understand:

 Pathogenesis and pathology of parasites
 The infective & diagnostic stage of the parasites
 Selection of appropriate medication/treatment

 Epidemiology, prevention, and control of the parasitic infection

(how to break the chain of transmission of the parasites),
 Fundamental research.

43
 Taxonomy and nomenclature of parasites

• Taxonomy

44
 Taxonomic classification of helminths
Sub kingdom Phylum Class Genus – examples

Metazoa Nematodes Ascaris (roundworm)

Round worms; appear round in cross Trichuris (whipworm)
section, they have body cavities, a Ancylostoma (hookworm)
straight alimentary canal and an anus Necator (hookworm)
Enterobius (pinworm or thread-
worm)
Strongyloides

Platyhelminthes Cestodes Taenia (tapeworm)

Flat worms; dorsoventrally flattened, Adult tapeworms are found in the intes-
no body cavity and, if present, the al- tine of their host
imentary canal is blind ending They have a head (scolex) with sucking
organs, a segmented body but no alimen-
tary canal
Each body segment is hermaphrodite

Trematodes Fasciolopsis (liver fluke)

Non-segmented, usually leaf-shaped, Schistosoma (not leaf shaped!)
with two suckers but no distinct head
They have an alimentary canal and are
usually hermaphrodite and leaf shaped
Schistosomes are the exception. They are
thread-like, and have separate sexes

45
 Taxonomic classification of protozoa
Sub kingdom Phylum Sub-phylum Genus- examples Species- examples

Protozoa Sarcomastig- Sarcodina-- - Entamoeba E. histolytica

ophora move by pseudopodia

further divided into

Mastigophora Giardia G. lamblia

move by flagella

Apicomplexa Plasmodium P. falciparum,

no organelle of P. vivax,
P. malariae,
locomotion
P. ovale

Ciliophora Balantidium B. coli

move by cillia

Microspora Enterocyto-zoa E. bienusi

Spore-forming
46
 Nomenclature of parasites

• Common name vs scientific name

• Parasites named by binomial nomenclature

– Genus (capitalized)
– Species (not capitalized)
• Binomial name underlined or separately italicized

Example: Ascaris lumbricoides, Ascaris lumbricoides

47
Major difference between protozoa and metazoa

Feature protozoa Metazoa

Number of cells Unicellular Multicellular

Mode of multipli- Asexual with excep- sexual with ex-

cation tions ceptions

Infection caused Multiplication Accumulation

by
Rate of multiplica- Fast slow
tion
48
longevity Short long