MEDICAL

PARASITOLOGY
PPT LECTURE 8
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 that supports the parasite.

The parasites included in medical parasitology are Protozoa, Helminthes

and some Arthropods.
Different kinds of Parasites:
Ectoparasite – a parasitic organism that lives on the outer surface of its
host. (Ex: lice, ticks, fleas, mites, etc).
Endoparasite – parasite that lives inside the body of their host. (Ex:
Entamoeba histolytica, Ascaris, Trichiuris, etc).
Obligate parasite – this parasite is completely dependent on the host
during a segment or all of its life cycle. (Ex: Plasmodium specie).
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.
(Ex: Naegleria fowleri).
Accidental parasite – when a parasite attacks an unnatural host and
survives. (Ex: Hymenolepis diminuta – rat tapeworm).
Erratic parasite – is one that wanders in to an organ in which it is not
usually found. (Ex: Entamoeba histolytica in liver or lungs of human).

Different kinds 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 serve as temporary refuge and vehicle for
reaching an obligatory host, usually the definitive host.
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.
There is a dynamic equilibrium which exists in the interaction of
organisms. Any organism that spends a portion or all of its life cycle
intimately associated with another organism of a different species is
considered as Symbiont (symbiote) and this relationship is called
symbiosis (symbiotic relationships).

Three common symbiotic relationships between two organisms:

Mutualism - an association in which both partners are metabolically
dependent upon each other and one cannot live without the help of the
other; however, none of the partners suffers any harm from the
association.
Commensalism - an association in which the commensal takes the
benefit without causing injury to the host. E.g. Most of the normal floras
of the humans’ body can be considered as commensals.
Parasitism - an association where one of the partners is harmed and the
other lives at the expense of the other. E.g. Worms like Ascaris
lumbricoides reside in the gastrointestinal tract of man, and feed on
important items of intestinal food causing various illnesses.
Effects 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.
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 – distribution of parasites depends upon:
a. The presence and food habits of a suitable host. Host specificity (Ex:
Ancylostoma duodenale requires man as host while Ancylostoma
caninum requires dog); Food habits,(consumption of raw or
undercooked meat predisposes Taenia spp.)
b. Easy escape of the parasite from the host- the different developmental
stages of a parasite which are released from the body along with feces
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.
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
b. Stool
c. Urine
d. Sputum
e. Biopsy material/tissue
f. Urethral/vaginal discharge
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: ƒ
• 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.
• Sanitary control of drinking water and food.
• Proper waste disposal – through establishing safe sewage systems, use
of screened latrines, and treatment of night soil.
• The use of insecticides and other chemicals used to control the vector
population.
• Protective clothing that would prevent vectors from resting in the
surface of the body and inoculate pathogens during their blood meal.
• Good personal hygiene.
• Avoidance of unprotected sexual practices.
CLASSIFICATION OF MEDICAL PARASITOLOGY
Parasites of medical importance come under the kingdom called protista
and animalia. Protista includes the microscopic single-celled eukaroytes
known as protozoa. In contrast, helminthes are macroscopic,
multicellular worms possessing welldifferentiated tissues and complex
organs belonging to the kingdom animalia. Medical 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.
HOW PARASITES CAUSE DISEASE
The manner in which parasites cause damage to their host varies from
one species of parasite to another, and often depends on the number of
parasites that are present. For helminthes, the number that are present is
often referred to as the “worm burden”.
Some parasites produce toxins, some produce harmful enzymes, some
invasive and migratory parasites cause physical damage to tissues and
organs, some cause the destruction of individual cells, and some cause
occlusion of blood vessels and other tubular structures.
Some parasites interfere with vital processes of the host, whereas others
deprive their host of essential nutrients.
PARASITIC PROTOZOA
In the five kingdom system of classification of living organisms,
Protozoa are in the kingdom Protista, together with algae. Most
Protozoa are unicellular, but some are multicellular.
Protozoa are classified taxonomically by their mode of locomotion:
Amoebas (amoeba)- move by means of pseudopodia (false feet).
Flagellates – move by means of whip-like flagella.
Ciliates – move by means of hair-like cilia.
Non-motile: Sporozoa – has no pseudopodia, no flagella, or cilia,
therefore exhibit no motility.
Most parasitic protozoal infections are diagnosed by observing
Trophozoites, Cysts, Oocysts, or spores in the specimen.
Trophozoites – is the motile, feeding, dividing stage in protozoal’s life
cycle.
Cysts, Oocysts, Spores – are dormant stages of protozoan parasites.
Protozoal infections are most often acquired by ingestion or inhalation
of dormant stages.
PROTOZOAL INFECTIONS OF HUMANS
Infections of the Skin:
Leishmaniasis – caused by various species of flagellated protozoa in
the genus Leishmania. The nonmotile, intracellular form of the parasite
is called amastigote. The motile, extracellular form of the parasite is
called promastigote. Principally a zoonosis and is transmitted via the
bite of infected sand fly.
Three forms of Leishmaniasis: Cutaneous, mucocutaneous (mucosal)
and visceral leishmaniasis.
The Cutaneous form starts with a papule that enlarges into a crater-like
ulcer. Individual ulcer may coalesce, causing severe tissue destruction
and disfigurement (mucocutaneous involvement).
MUCOCUTANEOUS LEISHMANIASIS
Visceral leishmaniasis, also known as Kala-azar, is characterized by
fever, enlarged liver and spleen, lymphadenopathy, anemia, leukopenia,
and progressive emaciation and weakness.
Microscopic appearance of Leishmania: amastigote and promastigote –
in blood smear
Protozoal infection of the Eyes:
Conjunctivitis and keratoconjunctivitis (inflammation of the cornea
and conjunctiva), caused by Acanthamoeba species.
Toxoplasmosis – caused by Sporozoan: Toxoplasma gondii.
Disease resemble Infectious mononucleosis, involves CNS, eyes, lungs,
muscles, or heart.

Protozoal Infection of the gastrointestinal Tract:

Amoebiasis (Entamoeba histolytica, Entamoeba coli, Entamoeba
naegleria)
Balantidiasis (Balantidium coli)
Giardiasis (Giardia lamblia)
Cryptosporidiosis (Cryptosporidium parvum)
Protozoal Infections of the Genitourinary:
Trichomoniasis – sexually transmitted disease affecting both men and
women. Usually symptomatic in women, causing vaginitis with a
profuse, thin, foamy, malodorous, greenish-yellowish discharge.
In men, trichomoniasis can lead to prostatitis, urethritis or infection of
the seminal vesicles.
Trichomoniasis is caused by flagellated protozoan, Trichomonas
vaginalis.
Protozoal Infections of the Circulatory system:
African Trypanosomiasis (African Sleeping sickness) – caused by:
Trypanosoma brucei (ssp. Gambiense, ssp. Rhodesiense)- transmitted
by bites of Tse-tse fly.
American Trypanosomiasis (Chagas disease)- caused by
Trypanosoma cruzi. Manifestation of Fever, body malaise,
hepatomegaly and splenomegaly, lymphadenopathy – transmitted by
bites of Reduviid bug.
Malaria – systemic disease characterized with body malaise, fever,
chills, headache and nausea. Transmitted by Anopheles mosquito.
Caused by Plasmodium species: Plasmodium falciparum,
Plasmodium vivax, Plasmodium ovale and Plasmodium malariae.
HELMINTHS
The word helminth means parasitic worm. Various procedures used to
diagnosed helminth infections are performed in Parasitology laboratory.
Involved microscopic observation of stages of eggs and larvae in the life
cycle of parasites.

Helminths are divided into: Roundworms (Nematode), Tapeworm

(Cestodes) and Flukes (Trematodes).

Stages of the typical helminth life cycle are the egg, the larva, and the
adult worm.
NEMATODES
TAPEWORMS FLUKES
HELMINTH INFECTIONS OF HUMANS
SKIN:
Onchocerciasis (also known as “river blindness”); helminth causative
agent – Onchocerca volvulus, tiny microfilariae, prelarval stages are
found in the skin.

MUSCLE AND SUBCUTANEOUS TISSUES:

Trichinosis – helminth causative agent: Trichinella spiralis, a tissue
roundworm.
Dracunculiasis – helminth: Dracunculus medinensis (guinea worm)
ONCOCERCA VOLVULUS TRICHINELLA SPIRALIS
EYES:
Loaiasis – causative helminth: Loa loa (African eyeworm)

RESPIRATORY SYSTEM:
Paragonimiasis – causative helminth: Paragonimus westermani (lung
fluke).

CIRCULATORY SYSTEM:
Filariasis – (Elephantiasis) – causative helminth: Wuchereria bancrofti,
Brugia malayi.
Schistosomiasis (Bilharziasis) – causative helminth: Schistosoma
mansoni, Schistosoma japonicum, Schistosoma hematobium.
CENTRAL NERVOUS SYSTEM:
Cysticercosis – causative helminth: Tanea solium, Taenia saginata.
Larval stage found in the brain.
Hydatid cyst disease – causative helminth: Echinococcus granulosus,
Echinococcus multilocularis. Larval stage found in the brain.

GASTROINTESTINAL TRACT:
Ascariasis – Ascaris lumbrocoides (large intestinal roundworm)
Hookworm infection – Ancylostoma duodenale, Necatur americanus.
Pinworm infection (Enterobiasis) – Enterobius vermicularis
Whipworm (Trichuriasis) – Trichuris trichiura
Strongyloidiasis – Strongyloides stercoralis
Beef tapeworm (Taeniasis) – Taenia saginata
Dog tapeworm (Dipylidiasis) – Dipylidium caninum
Dwarf tapeworm infection - Hymenolepis nana
Fish tapeworm infection – Diphyllobothrium latum
Pork tapeworm (Cysticercosis) – Taenia solium
Rat tapeworm infection – Hymenolepis diminuta
Fasciolopsiasis – Fasciolopsis buskii (intestinal fluke)
Fascioliasis – Fasciola hepatica (liver fluke)
Clonorchiasis – Clonorchis sinensis (Chinese or Oriental liver
fluke)