UNIT – ONE

INTRODUCTION
TO
MEDICAL PARASITOLOGY
 OUTLINE
Definition of terms

Concepts related to medical parasitology

Epidemiology of parasites.

General life cycle of parasites

Parasitic diseases

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

Describe classification of medically important parasites

Introduction to Medical parasitology
1.1. Definition
 Medical parasitology

The study of the parasites of man and their medical

consequences .
 The studies includes:

 the biological features of human parasites,

 the relationship between the human being and the

parasites,
the prevention and treatment of the parasitic diseases .
 Cont…

 Therefore, Medical parasitology consists of:-

Protozoa (single celled animals),

Helminths (worms)

 Arthropods
 • Phylum Sarcomastigophora
• Amoeba
Medical • Flagellates
Human Parasitology

• Phylum Apicomplexa
Protozoology
• Phylum Microsporodia
• Phylum Ciliophora
• Class Nematoda
Medical • Class Trematoda
• Class Cestoda
Helminthology

• Class Insecta
Medical • Class Arachnida
• Class Crustacea
Arthropodology • Class Chilopoda
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.

1.3.1.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
Parasite 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

Eg. Helmenths and protozoa

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. According to their Pathogenicity:
Pathogenic parasites

Non-Pathogenic (commensal)

Opportunistic parasites
 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.

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;
 Some parasites:

 Require more than one intermediate host which

are then designated as first, second
intermediate,
 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
1. Biological vectors:-
2. Mechanical (Parathenic or transport) Vectors:
1. Biological vectors:-
 characterized by the development of the parasite before
its transfer to another host

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 ascaris is

the embryonate egg.
 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.
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
 1.4.1 Geographic Distribution of Medical
parasitology
 Global distribution

 parasite occur globally

 the majority occur in tropical regions

Factors

 Favorable environmental conditions

 poverty, poor sanitation and personal hygiene

Factors (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

 source of exposure
1. primary Source

infected persons

carriers

animals
Sources of Exposure to Parasitic Infections
1. Contaminated soil:-
 Soilspolluted 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 Dracunculus medinensis
 Fresh water fishes which are sources for fish tap
worm, and intestinal flukes infection
 Crab or cray fishes that are sources for lung fluke and
 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 flyb

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

7. Autoinfection: - e.g., S. stercoralis, E. vermicularis,
and T. solium
 Mode of Transmission
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)

II- Indirect Mode of Transmission:-

If the parasite
 has complex life cycle
 requires biological vectors and/or
 one or more intermediate hosts
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 vegetation
e.g. intestinal flukes
 Water containing Cyclope e.g., D. medinensis
II. 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 .

III. Through Insect Bite,

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

 Transmammary, e.g., S. stercoralis

 Inhalation of contaminated air, e.g., E. vermicularis, P.

carnii
 Transplacental, e.g., T. gondii

 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 &

enviroment
Parasitic and non-parasitic stages.

 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

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 or heteroxenous life cycles
 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.
 1.5.3.Why study life cycles?
Control.
Treatment.
Epidemiology.
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 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 do 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,. Eg Fasciola
- hypertrophy,
 metaplasia, change of tissue cell type to another type.

Eg. Paragonims (lung fluke)

- neoplasia, growth of cell to form a new structure. Eg.
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
Taxonomy and nomenclature of parasites
Taxonomy
 Taxonomic classification of helminths
Sub kingdom Phylum Class Genus – examples

Metazoa Nematodes Ascaris (roundworm)

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

Platyhelminthes Cestodes Taenia (tapeworm)

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

Trematodes Fasciolopsis (liver fluke)

Non-segmented, usually leaf- Schistosoma (not leaf shaped!)
shaped, with two suckers but no
distinct head
They have an alimentary canal and
Taxonomic classification of protozoa
Sub kingdom Phylum Sub-phylum Genus- examples Species- examples

Entamoeba E. histolytica
Protozoa Sarcomastig Sarcodina-- -
move by
-ophora pseudopodia
further divided into

Mastigophora Giardia G. lamblia

move by flagella

Apicomplexa Plasmodium P. falciparum,

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

Ciliophora Balantidium B. coli

move by cillia

Microspora Enterocyto- E. bienusi

Spore-forming zoa
Nomenclature of parasites

Common name vs scientific name

Parasites named by binomial nomenclature

Genus (capitalized)

Species (not capitalized)

Binimial name underlined or separately italicized

Example: Ascaris lumbricoides, Ascaris lumbricoides