INTRODUCTION

TO
MEDICAL
PARASITOLOGY
NUMC 103
 OUTLINE
Definition of terms
Scope of medical parasitology
Concepts related to medical parasitology
Epidemiology of parasites.
General life cycle of parasites
Parasitic diseases
Host immunity & immuno – evasion of parasites
Nomenclature and classification of parasites
 Specific Learning 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

Discuss the general pathogenesis of parasites

Explain briefly host immunity & immuno – evasion

mechanisms by parasites

Describe classification of medically important parasites

 Introduction to Medical
Parasitology
1.1. Definition
Medical parasitology
(GK: para = beside & sitos = food)
The study of the parasites of man and their medical consequences . 
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 . 
1.2. Scope of Medical Parasitology
 According to the very broad definition of
parasitology, parasites should include:
 viruses, bacteria, fungi,
 protozoa and metazoa (multi-celled organisms)
which infect their host species.

 However, for historical reasons the first three have

been incorporated into the discipline of
Microbiology. 
 Therefore, Medical parasitology consists of:-

Protozoa (single celled animals),

Helminths (worms)

 Arthropods
 Classification of parasites
General classification: animal parasites are classified according to
international code taxonomy – Each parasite belong to a:
Kingdom
Phylum
Class
Order
Family
Genus
Species

Some have further divisions to:

Sub – order, super family, sub – species
in classification, scientific parasitic name is of 2 parts:
Genus name and species name. Ex: Plasmodium falciperum
Genetic name (one word): plasmodium
Species name (two words): plasmodium falciperum.
Genus: means group of close related species.
Species: means population with the same genetic characters.
 Taxonomic classification of helminths
Sub Phylum Class Genus – examples
kingdom

Metazoa Nematodes Ascaris (roundworm)

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

Platyhelminthes Cestodes Taenia (tapeworm)

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

Trematodes Fasciolopsis (liver fluke)

Non-segmented, usually leaf- Schistosoma (not leaf
 Taxonomic classification of protozoa
Sub Phylum Sub-phylum Genus- Species-
kingdom examples examples

Protozoa Sarcomastig- Sarcodina-- - move Entamoeba E. histolytica

ophora by pseudopodia
further divided into

Mastigophora Giardia G. lamblia

move by flagella

Apicomplexa Plasmodium P. falciparum,

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

Ciliophora Balantidium B. coli

move by cillia

Microspora Enterocyto-zoa E. bienusi

Spore-forming
 • Phylum Sarcomastigophora
• Amoeba
Medical • Flagellates
H • Phylum Apicomplexa
u Protozoology • Phylum Microsporodia
m • Phylum Ciliophora
a
n • Class Nematoda
Medical • Class Trematoda
• Class Cestoda
P Helminthology
• Class Metacanthocephala
a
r
a • Class Insecta
s Medical • Class Arachnida
i Arthropodology • Class Crustacea
t • Class Chilopoda
o
l
o
 The importance of parasitology
● Six major tropical diseases to which WHO pays great attention include:

■ malaria,

■ schistosomiasis,

■ filariasis,

■ leishmaniasis,

■ trypanosomiasis and

■ leprosy.
● Five of them are parasitic diseases except leprosy.
 Why were they selected?
Schistosomiasis - 200,000,000 infected
500,000-1,000,000 deaths/year
Malaria - 500,000,000 infected
2,500,000 deaths/year
Filariasis - 250,000,000 infected
Trypanosomiasis - 25,000,000 infected
65,000 deaths/year
Leishmaniasis - 1,200,000 infected
1.3. Concepts related to medical parasitology
1.3.1. Symbiosis
Any association more or less permanent is called
a symbiosis, with each member a symbiont.
Two different organisms live together and interact,
one partner lives in or on another one’s body.
3 types:
• Mutualism
• Commensalism
• Parasitism
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.
Commensalism
Association of two different organisms
One partner is benefited while the other neither
benefited nor injured, such as E. Coli and man.

Parasitism
Association of two different organisms
One partner is benefited while the other is injured,
such as ascaris lumbricoides and man.
1.3.2. Parasite and types of parasites
Parasite:
In parasitism, parasite is the benefited partner.
It is an animal organism which lives in or on the host
in order to obtain nourishment and shelter from the
host as well as does harms to the host.
 In another words,
a small organism (Parasite) has the
potential to harm a larger organism
(Host), and relies on said host for
nutrients and shelter (a Niche).
The parasite generally has a much
higher reproductive capability
compared to its host.
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
Tapeworms, flukes, protozoans
Ectoparasite
Stays on outside surface of the host
leeches, ticks, fleas, brood parasites
 II. Based on dependency on the host
Obligate Parasite
• Requires finding and invading the host to complete
its life cycle
• Most of the parasites we will cover are obligate
parasites

Facultative Parasite
• May become parasitic if it is given the chance but
does not require a host.
III. Amount of time spent
Permanent Parasite
• Lives entire adult life stage on or in a host
• Usually endoparasites
• One exception is eyelash mite

Temporary Parasite
• Spends only a short time on a host
• Usually ectoparasites
IV. According to their Pathogenicity:
• Pathogenic parasites
• Non-Pathogenic (commensal)
• Opportunistic parasites
 V. Based on their life cycle
Monoxenous parasites:
Those with direct life cycles (i.e., with one host).

Heteroxenous parasites:
Those with inderect life cycles requiring an intermediate host
(i.e., involves 2 or more hosts).

Heterogenetic Parasites:
One with alteration of generations e.g., Coccidial parasites
and Strongyloides
 VI. Based on host ranges
• Euryxenous parasites:
Those with a broad host range.

• Stenoxenous parasites:
Those with a narrow host range
 Other terminology

Aberrant parasite:
Found in locations in the host where they normally do not
occur;
e.g., Ascaris larvae may migrate to the brain

Insidental parasite:
Occurs in hosts where it does not normally occur;
e.g., Fasciola normally does not occur in man but is
incidental if found in man’s liver.
 1.3.3. 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
Intermediate host
Definitive host:
• What characterizes the primary host?
• Where sexual reproduction takes place.
• Normally where the adult parasites live.
• Normally the larger of the hosts, usually a
vertebrate.
• Convention - (parasites which only reproduce
asexually)
• Specificity - frequently, a large number of host
species can act as intermediate host and only one or a
few can act as a definitive host
Intermediate host:
• Sexually immature or larval stage of a parasite
• Asexual multiplication takes place
• may harbor many immature stages of a
parasite;
• e.g., Cercaria, Redia and Sporocysts
which are all immature stages of Fasciola
in the snail intermediate host.
Some parasites:
• require more than one intermediate host
which are then designated as first, second
intermediate
 Other terminology
Paratenic or Transport Host
• No development occurs but parasite remains alive and infective
to another host
• May go dormant
• May cause damage
• e.g., Toxoplasm species in cattle

Accidental or Incidental Host

• Parasite is in the “wrong” species.
• Parasite usually wanders around and causes great damage
because it doesn’t know where to go then dies.
 Types of Hosts
Reservoir Host
• Any animal that carries a parasite that can cause infections in
humans.
• Even if it is the normal host for that parasite.
• Related to the medical perspective of parasitology

Carrier host:
• A person who harbors parasites has no any clinical symptom.
He is an important source of infection in epidemiology
• e.g. human beings harboring cyst form of E.histolytica
1.3.4. Host specificity
• The number of species the parasite can use as a
definitive or intermediate host.
• Parasites show varying degrees of host
specificity
• A few parasites will infect only one species
• Most parasites will infect a few closely related
species (or similar anatomy)
• Some parasites can infect a large group of
animals
• A few parasites have little or no host specificity
 1.3.5. Vector and types of vectors
Vector: an organism (usually an arthropod) which
transfers infective forms of a parasite from one
host to the other.
Classification:
• Biological vectors:
• Mechanical (Parathenic or transport) Vectors:
Biological vectors:
• characterized by the development of the parasite
before its transfer to another host

Propagative:
E.g. Yersinia pestis in fleas
Cyclopropagative:
E.g. Plasmodium vivax in Anopheles
mosquitoes.
Cyclodevelopmental
E.g.Onchocerca volvulus in black
flies.
2. Mechanical vector
• no parasitic development of reproduction occurs
1.3.6. Other terminologies
• Infective Stage : it is a stage when a parasite can invade human
body and continue to live there. The infective stage of ascarid is
the embryonate egg.

• Infective Route : is the specific entrance through which the

parasite invades the human body. Hookworms invade human
body by skin. Man gets infection with ascaris by mouth.

• Infective Mode : means how the parasite invades human body,

such as the cercariae of the blood fluke actively penetrate the
skin of a swimming man and the infective ascaris eggs are
swallowed by man.
Geohelminth
• refers to the helminths which complete their life cycles
not requiring the processes of the development in
intermediate hosts.
• They have only one host and a simple life cycle, such
as ascarid, hookworm, pinworm and etc.
Biohelminth
• refers to the helminths which have to undergo the
development in intermediate hosts to complete their
life cycles, such as filaria, liver fluke, pork tapeworm
and so on.
Alternation of Generation:
In life cycles of some parasites,
there is the regular alternation of
sexual and asexual
reproductions.

eg.Plasmodium vivax
● Trophozoite is a living stage of protozoa when
they can move, take food and reproduce. (It is
usually the pathogenic stage.)
● Cyst is the resting stage of a protozoa with a
protective wall. It is usually the infective stage.
Its functions are protection, transmission and
multiplication.
Encystation
● Trophozoite Cyst
Excystation
 1.4. Epidemiology of parasite
Epidemiology: The study of the patterns of diseases within populations
For parasites, this includes:
Host range – what can it infect?
Geographic range – where is it?
Is it a zoonotic agent?
Can it infect humans?
Does it have a reservoir?
A group of vertebrates maintaining the parasite
Does it have a nidus?
A small ecosystem that possesses all the factors to maintain the parasite...
 1.4.1. Geographic Distribution
• Global distribution
parasites occur globally,
the majority occur in tropical regions

• Factors
• Favorable environmental conditions:
poverty, poor sanitation and personal
hygiene
 The burden of some major parasitic infections
Parasite Diseases No. people infected Deaths/yr

Plasmodium malaria 273 million 1.12 million

Soil transmitted helminths: 2 billion 200,000

 Roundworm (Ascaris) Pnemonitis, intestinal obstruction

 Whipworm (Trichuris) Bloody diarrhoea, rectal prolapse


 Hookworm Coughing, wheezing, abdominal
(Ancylostoma and pain and anaemia
Necator)
Schistosoma Renal tract and intestinal disease 200 million 15,000

Filariae Lymphatic filariasis and 120 million Not fatal but 40

elephantiasis million
disfigured or
incapacitated
Trypanasoma cruzi Chagas disease (cardiovascular) 13 million 14,000
African trypanosomes African sleeping sickness 0.3 – 0.5 million 48,000

Leishamania Cutaneous, mucocutaneous and 12 million; 2 million new 50,000

visceral leishmaniasis cases/yr
Factors Affecting Endemicity:
1. Presence of a suitable host
2. Habits of the host
3. Escape from the host
4. Favorable conditions outside of host
5. Economic and social conditions
 1.4.2. Transmission of parasites

Factors required: (Three key links of parasitic

disease transmission)
1. Source of infection
2. Mode of transmission
3. Susceptible people
 1.4.2.1. source of exposure
1. Primary Source
infected persons
carriers
animals
1. 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:
(a) viable cysts of Amoeba, flagellates etc,
(b) cercarial stages of human blood fluke,
(c) Cyclops containing larva of Dracunculus medinensis
(d) fresh water fishes which are sources for fish tape
worm, and intestinal flukes infection
(e) crab or cray fishes that are sources for lung fluke and
(f ) Water plants which are sources for Fasciolopsis buski.
3. Raw or Insufficiently cooked meat of pork, beef
and fish
 E.g., Trichinella spiralis, Taenia species,
D.latum.
4. Blood sucking arthropods:
 Malaria - anopheles mosquito,
 Leishmania - sand flies
 Trypanosoma - tsetse fly
5. Animals (a domestic or wild animals harboring
the parasite)
 e.g, 1. Dogs- the hydatid cyst caused by E.
granulosus
6. Human beings:
A person his/her clothing, bedding
or the immediate environment
that he/she contaminated
Autoinfection: e.g., S. stercoralis, E.
vermicularis, and T. solium
 1.4.2.2. 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
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
 1.4.2.3. Route of Transmission
A. By ingesting infective stage of parasites:
• In food, water or hands contaminated with feces,
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
vegetation e.g. intestinal flukes
• Water containing contaminants e.g., D. medinensis
B. Penetration of Skin When in Contact with:
• Faecally polluted soil, e.g., S.stercoralis, Hook worms
• Water containing infective stages of the parasite E.g., Cercaria of
Schistosome species

C. Through Insect Bite

• E.g., filarial worms, Trypanosoma sp, Plasmodium sp. etc.
D. Sexual Contact, e.g., Trichomonas vaginalis

E. Transmammary, e.g., S. stercoralis

F. Inhalation of contaminated air, e.g., E. vermicularis,

P. carnii

G. Transplacental, e.g., T. gondii

F. Kissing, e.g., Trichomonas gingivalis, T. tenax

1.5 General Life Cycles of parasites
● Describes the cycle of development of the parasite
● This may involve:
■ Passing through a number of
developmental stages & environment
■ Parasitic and non-parasitic stages
● The life of a parasite can be divided into a
number of phases:
1. Growth and maturation,
2. Reproductive (sexual and asexual) and
3. Transmission phases
■ All are 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
 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
contaminated food or
water.
Indirect life cycles
heteroxenous
• requires 2 or more hosts (a
vector or intermediate
host ) to reproduce or grow
in
• Frequently this may
involve passing through a
number of developmental
stages & Evt.
1.5.1. Why study life cycles?
• Control
• Treatment
• Epidemiolog
y
• Fundamental
research.
1.6 Parasitic Infections &
Disease:
• Not all parasitic infections cause disease
of clinical significance.
• Both host and parasitic factors are
involved for the parasitic infection to
cause disease or not
 1.6.1. Host Factors
1. Genetic factors, E.g. Black population who lack Duffy antigen (Duffy
blood Group) resist P.vivax
2. Age,
3. Sex, e.g., T. vaginalis
4. Level of immunity: natural and acquired immunity
5. Nutrition (malnutrition or under nutrition)
6. Intensity and frequency of infections
7. Presence of co-existing disease or conditions, which reduces
immune response. e.g. Pregnancy, HIV
8. Life style and occupation
 1.6.2. Parasite factors
1. Strain of the parasite and adaptation to human
host
2. Parasite load ( number of parasite )
3. Site (s) occupied in the body
4. Metabolic processes of the parasite, particularly
the nature of any waste products or toxins
produced by the parasite during its growth and
reproduction..
1.6.3. How Parasites Cause Inquiry to their Host
• Competition for the host’s nutrients
- Eg. D. latum absorbs vitamin B-12, can cause anemia
- other tapeworms absorb large amounts of proteins and
sugars
Use of host’s fluids
- hookworm ingests blood, can be up to 250 ml/day
• Destruction of host tissues
- some injure upon entry, some after established
- eg. Swimmers itch, cercariae penetrate and cause
inflammation
- intestinal worms, after established cause small lesions in
gut, possible secondary infection
- Entamoeba actively digest epithelial cells in large
intestine
 Tissue changes
- may cause serious consequences to host
- hyperplasia,. E.g. Fasciola
- hypertrophy,
- metaplasia, change of tissue cell type to another type.
E.g. Paragonims (lung fluke)
- neoplasia, growth of cell to form a new structure. E.g.
Tumors
• Toxins and secretions
- some may cause pathogenic response, some may inhibit
immune function
- eg. Mosquito saliva

• Mechanical interference
- Elephantiasis (filarial worms) blocks lymphatic system
- Tapeworms in large numbers can block intestine
- Plasmodium can cause RBC’s to stick together and clog
capillaries
1.7. Host Immunity & Immuno – evasion of the parasite
1.7.1. Host Responses
a) Nonspecific immunity
• Macrophage endocytosis
• Common for bacteria and small protozoa
• Inflammation
• Acute – edema and increase of leukocytes
• Subacute – monocytes and lymphocytes present, with fibrocytes binding parasite with
collagen.
• Chronic – plasma cells present and form a granuloma
• Hyperplasia – parasite causes host to produce more cells
• Liver fluke simulating enlargement of bile duct
• Neoplasia (cancer) – rare parasites have been associated
with cancer, but mechanisms are still unknown.
b) Specific Immunity
• Humeral response: Formation of antibodies or
immunoglobulin s(Ig) by B cells.
• IgE fights helminths
• IgM and IgG important against protozoans
• Cell mediated response: uses T-cells
• Cytotoxic T cells inject invading parasites
• Also release cytokines, which promote
nonspecific immunity. (interconnected)
 1.7.2. Parasite Responses
• Antigenic variation
• Change surface glycoproteins regularly
• Being poorly antigenetic
• Don’t induce a response, or a most a mild one
• Hide within host cells
• Host can’t kill what it can’t find
• Camouflage
• Use bits of host cells and attach to parasite’s surface
• Depress host’s immune response
• Modulate produce of host T cell production
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