Effects of Parasites On Host

● Mechanisms​ (​parasites cause injury​):

- creation of enzymes ​(secretion of ​lytic enzymes ​by parasites)
- lytic enzymes​: tissue destruction (mediation of interaction between parasite
and host)
- destroy ECM of connective tissues which is abundant
-
- invasion and destruction of host tissue
- ex. ​malaria
- invades RBC and develops into mature form which causes it to disrupt
- depriving the host of essential nutrients and substances
- ex. D. latum
- causes ​vitamin B12 deficiency

● Several factors that affect outcome of infection in the host

➢ genetic makeup ​of the host
○ depends on the ​DNA​ of the host
■ ex. ​malaria​ -duffy blood group A- and B- (resistant to malaria:
plasmodium vivax)
■ ex. ​blood group O​ (cannot have as severe cases of malaria than other
blood groups)
■ P. vivax​ D​ uffy binding protein​: required to infect vivax (cannot infect
if the blood group is A- & and B-)
➢ nutritional status of the host
○ underdeveloped countries are most affected
■ poor sanitation
■ increase population density
■ less marginal sources of water
➢ immunity of the host
○ interconnected with the ​genetic makeup of the host

● Possible outcomes of parasite to host interactions:

- all have ​modes of transmission
- morphologic form invades the human: ​infective stage
- diagnostic stage
1. fail to established​ to the host
2. host ​eliminates infection
3. host ​overcome but not successful
4. host ​damaged itself as it overcomes the host
5. kills​ the host

Host-Parasite Interactions
● physical barriers (​1st innate of defense against pathogens)
 ○ innate​: present at birth
- skin
- mucuous membranes
- components of body fluids
- physiologic function of the body

➢ innate immune response

○ body detects & eliminates pathogens through ​non-specific mechanisms
○ not antigen specific (​antigen: stimulate production of antibodies)
○ does not have a memory
○ ex. phagocytosis by macrophage and dendritic cells
➢ acquired immune response
○ has ​stimulation of body production
○ antigen specific ​(remembers when reinvaded)
○ host exposed to the parasites antigens -> stimulate immune response
■ T and B cells
➢ resistance to infection
○ permit survival of parasites upon entering blood and tissues
○ cuticle and integument > resist macrophage
○ toxoplasmogodi
➢ immune suppression
○ parasites can reduce immune function of macrophages > lower action of
macrophages and defective processing antigen
■ ex. brugia malayi: suppress infective stage during earliest host interface
○ antigenic variation
■ trypanosoma brucei infection
● variant surface glycoproteins: creates dense coat that prevents
adaptive immunity from antigens
■ plasmodium: antigenic diversity
● create variety of infections in diff population
○ host mimicry
■ echinosus granulosus larval stages carry P blood group antigens
■ schistosoma sp. can acquire antigenic molecules from the host
■ body could not differentiate self from non-self
○ intracellular sequestration
■ sequestration(rosetting ) attachment or adherence of infected rbc that
contains the late developmental or mature stage of parasite
■ can adhere on unaffected rbc
■ enter the cells
■ intracellular parasites: leishmania, plasmodium
■
adverse effects of immune response of the host
 - dysfunction of any host defense systems in damage tohost tissue and produce clinical
disease
- types of reaction
- type 1: IgE (immediate type hypersensitivity)
- mast cell and basophil: release histamine
- histamine: allergies/anaphylactic
- type 3: IgG, IgM and cellular antigens (cytotoxic reactions of antibody)
- cytolysis due to antigen antibody interaction
- type 2: IgG, IgM, soluble antigens (immune complex formation)
- deposits of antibody reaction
- type 4: t-cells-release cytokines (delayed-type hypersensitivity)
- sensitization: continuous contact of antigen cause reaction (eg. contact
dermatitis)

taxonomy of medically important parasites

- protozoans: unicellular eukaryotic organism
- phylum sarcomastigophora
- phylum ciliophora
- phylum apicomplexa
- intestinal coccidians: toxoplasma

- microspora: now under fungi

- helminthes: worms, metazoan parasites
- nematodes (roundworms)
- unsegmented body: continuous or straight
- possess mouth, esophagus, anus
- cestodes (tapeworms)
- segmented: body have segments
- contain scolex, neck and proglotids
- eg. taenia
- trematodes (flukes)
- unsegmented
- unlike nematodes, they are not elongated
- leaf-like or cylindrical
- eg. blood flukes: schistosoma
- eg. liver flukes: faxiola

overview of diagnostic para and specimen collection

- diagnosis of parasite infections through demonstration of parasite components (adults,

egg, larvae cysts, trophozoite)
- common specimens to identify parasites
- stool
 - aspirates (duodenal, liver)
- blood, buffy coat and lymphatic fluid
- urine
- common: schistosoma haematodium, entenbius vermicularis,
trichomknas vaginalis
- eye (loaloa-visible in the eye) and skin scrapings(onchocerca volvolus found in
the heel of the foot)
- biopsy specimens
- trichinella spiralis cause by rats (eggs sit in the muscle)
- other body fluids (csf, vagina fluid, amniotic fluid)
- csf: acanthamoeba and niegleria fowleri
-
● stool
○ most common method
○ demonstration of egg, larvae, adults
○ best collected in
■ clean wide mouthed containers made of waxed cardboard
■ plastic tight fitting lead to ensure retention of moisture and to prevent
accidental spillage
○ properply labeled; submitted together with a lab request
○ important factors to be considered
■ intake of drugs/medicinal substances: disturb the G.I tract
● antacids
● anti-diarrheas
● barium
● bismuth
● laxatives
○ stool examination defferd
○ amount of stool submitted: requires
○ thumb sized specimen of formed stool
○ about 5-6 tablespoons of watery stool
■ cyst(double cell wall: chitin)
○ stool processing and handling
■ watery and diarrheic stool: examine within 30 mins
■ formed stool: up to 24 hours
■ temporary storage of fecal samples in a refrigerator (3-5degrees) is
acceptable
■ trophozoited are killed by refrigeration though hekminthand protozans
are not easily killed
■ do not put in incubators and never freeze
○ stool preservatives
■ proper conc: 1:3 stool preservative
 ● formalin (fixatives: preserve morphology and prevent further
development helminth eggs and larvae)
○ recover protozoa and helminths (ova)
○
● Schaudinn’s solution: base (zinc sulfate, copper sulfate, mercuric
chloride)
● polyvinyl alcohol
○ both can be combined
○ retrieve trophozoite and cyst of protozoa and helminths
ova and eggs
● methiolate iodine formalin
○ updated preservative
○ retrieves helminths, nematodes
● sodium acetate formalin
○ used in concentration technique and for permanent
staining
● ova and parasite examination
○ macroscopic examination (physical analysis)
■ color, consistency, texture,
○ microscopic examination
■ techniques
● direct fecal smear
○ add iodine/NSS/portion of unfixed stool
● concentration techniques
○ layer out or concentrate the parasites from the fecal matter
● kato-katz technique
○ cellophane fecal thick smear
○ uses mesh wire or screen to remove other fecal elements
retaining the parasite
○ qualitative and semi-quantitative detection of parasites
● kato-thick smear
○ predecessor of kato-katz technique
○ “thick smear technique”
● Stoll’s dilution technique
○ used to count nematode and trematode egg
■ preparation of permanent stained smears: confirmation of intestinal
protozoan
● use of iron hematoxylin (red stain) or trichome (green stain)
○ other techniques for stool
■ larval culture: for hookworm and threadworm larva
● eg. harada mori (incubate; recover nematode larva)
 ● eg. Baermann technique (checking the active
migration/movement of larva): separates larva from the fecal
matter
■ perianal swab: for Enterobius and Taenia
● scotch tape swab: other way for isolating enterobius vermicularis
egg
● blood
○ malarial parasites
■ thick smear: quantity
■ thin smear: identify the species (plasmodium)
○ Knott’s concentration technique - for microfilaria
○ Buffy coat smear: for hemoflagellates
● sputum
○ parasites recovered:
■ migrating larvae of Ascaris lumbricoides, strongyloides
■ paragonimus ova
■ echinoccocus granulosus hooklets from pulmonary hydatid cysts
■ protozoa
● e. histolytica
● cryptosporidium parvum oocysts
● e. gingivalis
■ first morning specimen test
■ patients cannot ecpectorate: use inductants
● urine
○ first morning specimen test
● tissue aspirates
○ duodenal aspirate: spring test
● cutatenous skin aspirates
● csf
● tissue biopsy
○ trichinella spiralis
● and rectal biopsy
○ presence of deposited eggs of schistosoma

PROTO​​ZOANS

Entamoeba histolytica
- most invasive entamoeba
- only one to cause colitis and liver abcess
Life cycle of E. histolytica
● invasive: consist of tissue necrosis (caused by trophozoites; cause duodenal ulcer)
● non-invasive colonization: cyst stays in the ilium/intestinal lumen (ASYMPTOMATIC
carrier: no symptoms but bring parasites)
● extraintestinal: outside the usual habitat (brain, lungs, liver, heart)
○ G.I tract usual habitat

- ingestion of cyst and trophozoite: combination of infective and diagnostic stage

- trophozoites are destroyed in gastric juices, cyst retains
- excystation (E. histolytica)​: transformation to from cyst to trophozoite (small
intestine)
- go to large intestine to multiply (binary fission)
- produce again another cyst
- cyst and trophozoite together pass out
- E. gingivalis: does not undergo encystation; only trophozoite stage
- excystation: small intestine
- binary fission: large intestine
- encystation: large intenstine

E. histolytica
➢ trophozoite
○ 1-4
○ karyosome: contains dense RNA material; small central mass of chromatin
○ peripheral chromatin: fine and evenly distributed
○ pseudopods: unidirectional, active, progressive (finger like)
○ cytoplasm: granular (ground glass appearance)
○ ingested RBC
➢ cyst
○ shape: spherical
○ chromatoidal body: sausage-shaped, cigar/coffin-shaped
○ small and centrally located karyosome
○ glycogen mass: source of food/glucose

Pathogenesis

● Mechanisms for virulence

- production of enzymes or cytoxic substances
- contact deoen

● Cases may manifests:

- asymptomatic
- no signs and symptoms
- carrier
 - amebic colitis
- cause by abdominal pain and diarrhea
- bloody, mucus in stool
- fulminant colitis: severe bloody diarrhea + fever + abd. pain
- ameboma
- mass-like lession with abdominal pain and a history of dysentery
- mistaken for carcinoma
- may be ​asymptomatic
- amebic liver abscess
- common extra-intestinal form of amebiasis
- abscess: a liver fluid
- present with fever, right upper quadrant pain

Diagnosis

● DFS
● FECT
● PCR
○ undergoes research

Treatment
● metronidazole
● diloxanide furoate

Epidemiology
● amebia

Prevention and control

- sanitation
- safe water
- hygiene
- proper food prep
- vaccines (not available in the philippines)

E. dispar and E. moshkovskii

- similar in morphology with E. histolytica
- non pathogenic

Entamoeba coli
- cyst
- nuclei: 1-8
- 8 (metacystic stage)
- chromatoidal bar: broomstick-like appearance, splinter-like,
 - trophozoite
- blunt pseudopod
- nonprogressive, sluggish
- multi-directional
- nucleus: eccentric
- dirty-looking cytoplasm
- ingest bacteria, yeast, other debris
-

Entamoeba hartmanii
- trophozoite
- dirty looking cytoplasm due to bacteria
- pseudopod: posterior area
- diffused glycogen mass

Entamoeba polecki
- nucleus: eccentric
- chromatoidal bar: angular, pointed (cyst)
- trophozoite
- eccentric nucleus
- resembles e. coli
- blunt
- dirty looking

Endolimax nana
- ovoid
- cross eyed (4 nuclei)
- large, blotlike

Iodamoeba butschlii
- uninucleated
- large glycogen vacuole
- brown under Lugol’s iodine

Entamoeba gingivalis
- no cyst stage
- mouth/oral cavity (tartar/gingival pockets)
- ingest bacteria and debris
- dirty looking
- nonprogressive

FREE LIVING PATHOGENIC

 - lives in the environment
- found in the lakes, pool
- Naegleria fowleri
- PAM: Primary amenoc
- brain and spinal cord
- can be through inhalation
- Cyst
-
- acanthamoeba
- ingested/inhalation

Naeglria fowleri
- has 3 stages
- cyst and troph acquired in the environment
- stage 1. cyst
- round, thick-walled
- live longer in the environment
- nucleus: one large centrally located
-
- stage 2. trophozoite (amoeboid)
- elongated
- jerky movement (motility)
- anterior end (broader)
- posterior end (tapered)
- pseudopod (sluggish, blunt)
- nucleus: 1 (one, large centrally located)
- absence of peripheral chromatin
- granular chromation (presence of vacuoles)
- stage 3. flagellated: locomotory function
- stage 4. promitosis
- membrane
- cyst and trophozoite are infective stages
- passes on the nasal mucosa and goes to the brain
- disease manifestation and pathology
- primary amebic meningoencephalitis
- true pathogen: patient has no history of diseases

Balamuthia
● Balamutia mandrillaris
○ similar to acanthamoeba

Balantidium coli
- conjugation: way of reproduction
 - transfer of materials during temporary union
- encystation: not all trophozoite goes back to cysts
- trophozoite that dont go back to cysts stays in the colon causing ulceration
- happen in the large intestine
- mature cysts
- after excystation, pass through the feces
- capable of extraintestinal invasion
- appendicitis
- mesenteric nodes
- liver
- urinary tract or lungs
- causes ​intestinal perforation
- trophozoite
- well defined cytostome (oral apparatus)
- acquire food
- covered with cilia from the oral region
- tapered anterior, broad posterior
- macro and micro nucleus (contains the genetic material)
- macro: kidney shaped
- micro: inside the macronucleus
- has two contractile vacuole
- osmoregulatory organelle
- mucocysts
- beneath the cell membrane
- extrusive organelle
- cyst
- round and spherical to slightly ovoid
- double cell walled
- macro and micronucleus
- nucleus are separated