CHAPTER 1: INTRODUCTION TO MEDICAL PARASITOLOGY

Introduction
Parasitology Area of biology concerned with the phenomenon of dependence on 1 living organism on another
Medical Parasitology Concerned primarily with parasites of humans and their medical significance
Tropical Medicine Branch of medicine that deals with tropical diseases and other special medical problems of tropical
regions
Tropical disease An illness, which is indigenous to or endemic in a tropical area, but may also occur in sporadic or
epidemic proportions in areas that are not tropical
Biological Relationships
Symbiosis Living together of unlike organisms
Commensalism 2 species live together and 1 species benefits from the relationship without harming or benefiting the
other
Mutualism 2 organisms mutually benefit from each other
Parasitism 1 organism, the parasite, lives in or on another, depending on the latter for its survival and usually at
the expense of the host
Parasites
Endoparasite Parasite living inside the body of a host
Ectoparasite Parasite living outside the body of a host
Infection Presence of an endoparasite in a host
Infestation Presence of an ectoparasite on a host
Erratic When parasite is found in an organ which is not its usual habitat
Obligate parasites They need a host at some stage of their life cycle to complete their development and to propagate
their species
Facultative parasite May exist in a free-living state or may become parasitic when the need arises
Accidental or incidental A parasite which establishes itself in a host where it does not ordinarily live
parasite
Permanent parasite Remains on or in the body of the host for its entire life
Temporary parasite Lives on the host only for a short period of time
Spurious parasite Free-living organism that passes through the digestive tract without infecting the host
Hosts
Definitive or final host One in which the parasite attains sexual maturity
Intermediate host Harbors the asexual or larval stage of the parasite
Paratenic host The parasite does not develop further to later stages; the parasite remains alive and is able to infect
another susceptible host
Reservoir hosts Allow the parasite’s life cycle to continue and become additional sources of human infection
Vectors
Vectors Responsible for transmitting the parasite from 1 host to another
Biologic vector Transmits the parasite only after the latter has completed its development within the host
Mechanical or phoretic Only transports the parasite
vector

Carrier Harbors a particular pathogen without manifesting any signs and symptoms
Exposure Process of inoculating an infective agent
Infection Connotes the establishment of the infective agent in the host
Incubation period Period between infection and evidence of symptoms
Pre-patent period Biologic incubation period; period between infection or acquisition of the parasite and evidence or
demonstration of infection
Autoinfection Results when an infected individual becomes his own direct source of infection
Superinfection or Happens when the already infected individual is further infected with the same species leading to
hyperinfection massive infection with the parasite
Sources of Infection
 Contaminated soil and water – most common sources
 Lack of sanitary toilets
 Use of night soil or human excreta as fertilizer
 Water
 Food
 Consumption of undercooked or raw freshwater fish
 Arthropods
 Mosquitoes
 Cats
 Another person, his beddings and clothing, immediate environment he has contaminated, one’s self
Modes of Transmission

CHAPTER 1: Introduction to Medical Parasitology

Contaminated food and Most common source of parasitic infection
water
Mouth Most likely portal of entry
Skin penetration Exposure of skin to soil or water
Arthropods Transmit parasites through their bites
Congenital transmission Some parasites can cross the placental barrier during pregnancy. Some may be transmitted through
mother’s milk.
Inhalation of airborne eggs
Sexual intercourse
Nomenclature
 Classified according to the International Code of Zoological Nomenclature
 Phylum  classes  orders  families  genera  species
 Further divisions: suborder, superfamily, subspecies
 Scientific names are latinized
 Family names are formed by adding -idea to the stem of the genus type
 Generic names consist of a single word written in initial capital letter
 Specific name always begins with a small letter
 The names of the genera and species are italicized or underlined when written
Life Cycle
 Most parasitic organisms: attain sexual maturity in their definitive hosts
 Some: spend their entire lives within the host with 1 generation after another
 Others: exposed to the external environment before being taken up by an appropriate host
 Larval stage – may pass through different stages in an intermediate host  final host
 As life cycle becomes more complicated  the lesser the chances for parasite survival
 Perpetuation of a species of parasite – depends on its ability to ensure transmission from 1 host to the next
 Parasite must therefore adapt to protect itself from the host’s defenses and the external environment
Epidemiologic Measures
Epidemiology Study of patterns, distribution, and occurrence of disease
Incidence Number of new cases of infection appearing in a population in a given period of time
Prevalence Number of individuals in a population estimated to be infected with a particular parasite species at a
given time (expressed as percentage)
Cumulative prevalence Percentage of individuals in a population infected with at least one parasite
Intensity of infection Burden of infection which is related to the number of worms per infected person
 May be measured directly or indirectly
 Also referred to as the worm burden
Morbidity Clinical consequences of infections or diseases that affect an individual’s well-being
Treatment
Deworming Use of anthelminthic drugs in an individual or a public health program
Cure rate Number of previously positive subjects found to be egg negative on examination of a stool or urine
sample using a standard procedure at a set time after deworming
Egg reduction rate (ERR) Percentage fall in egg counts after deworming
Selective treatment Involves individual-level deworming with selection for treatment based on a diagnosis of infection or
an assessment of the intensity of infection, or based on presumptive grounds
Targeted treatment Group-level deworming where the (risk) group to be treated (without prior diagnosis) may be defined
by age, sex, or other social characteristics irrespective of infection status
Universal treatment Population-level deworming in which the community is treated irrespective of age, sex, infection
status, or other social characteristics
Preventive chemotherapy Regular, systematic, large-scale intervention involving the administration of 1 or more drugs to
selected population groups with the aim of reducing morbidity and transmission of selected helminth
infections
Coverage Proportion of the target population reached by an intervention
Efficacy Effect of a drug against an infective agent in ideal experimental conditions and isolated from any
context
Effectiveness Measure of the effect of a drug against an infective agent in a particular host
 Measured by means of qualitative or quantitative diagnostic tests which detect eggs or
larvae in feces or urine after an optimal time interval
Cure rate Indicators that are commonly used to measure the reduction in prevalence and reduction in intensity
Egg reduction rate of infection respectively
Drug resistance Genetically transmitted loss of susceptibility to a drug in a parasite population that was previously
sensitive to the appropriate therapeutic dose
Prevention and Control
Morbidity control Avoidance of illness caused by infections
CHAPTER 1: Introduction to Medical Parasitology
 Information-education-
communication (IEC)
Environmental management
Environmental sanitation
Sanitation
Health education strategy that aims to encourage people to adapt and maintain healthy life practices
Planning, organization, performance, and monitoring of activities for the modification and/or
manipulation of environmental factors or their interaction with human being with a view to preventing
or minimizing vector or intermediate host propagation and reducing contact between humans and the
infective agent
Involves interventions to reduce environmental health risks including the safe disposal and hygienic
management of human and animal excreta, refuse, and waste water.
 Also involves control of vectors, intermediate hosts, and reservoirs
 Provision of safe drinking water and food safety
 Housing that is adequate
Provision of access to adequate facilities for the safe disposal of human excreta, usually combined
with access to safe drinking water

Eradication Permanent reduction to 0 of the worldwide incidence of infection caused by a specific agent as a
result of deliberate efforts
Elimination Reduction to 0 of the incidence of a specified disease in a defined geographic area as a result of
deliberate efforts

HOST-PARASITE RELATIONSHIPS penetrate the mucosa and adhere to the

 Adaptation causes changes in the molecular biology,
biochemistry, immunology, and structure of the parasite
 Parasites that are more specialized – show greatest
changes, most of which are essential for survival
 Most noticeable adaptations – founds in the locomotory
and digestive organs
o Free-living flatworms – (+) cilia on their
epidermis
o Cestodes and trematodes – (+) tegument
o Flatworms – (+) hooks and suckers
 The size and shape of the parasite are also adapted for
maintaining its hold in the host
o Adult ascaris worms – constant movement to
maintain position inside the intestinal wall
o (+) Thickened integument – to resist enzymes
and juices; protect against desiccation and
physical injury
o Intestinal flukes – (+) integument covered with
spines  prevent abrasion
o Special coverings of ova, larvae, and cysts 
protection during its free-living stage
 Reproductive systems of flatworms are highly elaborate
and complicated
o All tapeworms and flukes – HEMAPHRODITIC
(contain a complete set of male and female
organs capable of producing thousands of ova)
– EXCEPT: SCHISTOSOMA SPP.
 Parasitic existence may also result in profound
biochemical adaptations
o Loss of certain metabolic pathways common to
free-living organisms
o STREAMLINING – inability of the parasite to
synthesize certain cellular components and the
need of the parasite to obtain these from a host
 Some parasites have developed specialized
mechanisms needed for entry into the body or tissues
o Trophozoites of Entamoeba histolytica: secrete
cysteine proteinases  allow parasite to
underlying layer and surrounding tissues
o Cercariae of Schistosoma  (+) penetration
glands  produces enzyme capable of
digesting the skin
o All cestode embryos – (+) 6 hooklets
Effects of the Parasite on the Host
Mechanisms by which parasites cause injury to the host:
 Interference with the viral processes of the host through
parasitic enzymes – most common mechanism
o Secretory and excretory product elaborated
may allow them to metabolize nutrients
obtained from the host and store these for
energy production
 Invasion and destruction of host tissue
 Deprive the host of essential nutrients and substances
Effects of the Host on the Parasite
 The genetic make-up of the host
o Sickle-cell trait  protection against falciparum
malaria
o Duffy blood factor  increased susceptibility to
plasmodium vivax
 Nutritional status of the host
o Rich in protein – (x) intestinal protozoans
o Low protein diet – favors appearance of
symptoms of amebiasis and complications of
disease
o High carbohydrate – favors development of
some tapeworms
 Immune processes
o Absolute immunity to reinfection – occurs
rarely following protozoan infections
 Never in helminth infections
o Acquired immunity may be very important in
modifying the severity of disease in endemic
areas
IMMUNOLOGY OF PARASITIC INFECTIONS

CHAPTER 1: Introduction to Medical Parasitology

  Function of the immune system: To protect the body
from invasion by potential pathogens
 Dysfunction  either (1) permissive environment for
infection or (2) unchecked activation which can harm the
organism on the other
 Eukaryotic organisms are similar in make-up and
physiology  immunity to parasites (esp. eukaryotes) is
complicated
 Parasites have evolved strategies to evade the immune
system; some are so successful that they can not only
survive but THRIVE in the bloodstream.
 When the parasite (1) successfully establishes itself in
the host and is (2) not eliminated by many host defense
systems and is (3) able to continue its life cycle 
PARASITIC INFECTION
 NOT ALL interactions between the host and parasite
relationship result in injury and pathology
 Other outcomes:
o P fails to become established
o P is established; H eliminates the infection
o P is established, H begins to overcome
infection but is not totally successfully
o P is established; H damages itself in trying to
eliminate the organism
o P is established; kills the host
 Ability of the parasites to cause infections has evolved
through the process of NATURAL SELECTION.
 The host’s ability to defend itself against a parasite’s
invasion is also selected for.
 Some life cycles are so complicated that the parasite
has adapted means to survive immune assault in not
just 1 but a variety of hosts
 Some parasites become specific to some hosts over
time
 Accidental infection of erstwhile non-susceptible hosts
may eventually lead to establishment of a new reservoir,
intermediate, or definitive host which in time may even
become the dominant host for that organism.
Host-Immune Response
Host-Parasite Interactions
 NATURAL PHYSICAL BARRIERS – first line of defense
against pathogens
A. SKIN – provides effective surface protection
 Adaptive mechanisms of some helminths 
A.
overcome these defenses
 Filariform larvae of hookworms and
Strongyloides – can synthesize a protein that
aids in the entry through the skin
 Schistosoma spp cercariae – (+) glands in
the anterior part that secretes lytic enzymes
 penetrate skin
B. MUCOUS MEMBRANES lining the respiratory, GI,
and genitourinary tracts – provide external barriers
to parasite entry as well
C. TIGHT JUNCTIONS between epithelial cells –
serve to prevent passage of all but the smallest
molecules
D. LOW PH of vaginal secretions and gastric juices –
present a hostile environment to many
microorganisms
 Trophozoites of Trichomonas vaginalis –
unable to survive the acidic environment of
vagina
 Giardia lamblia – once intestinal secretions
envelope it, its motility is greatly diminished
 Evasion: Protected from the acidic
environment by thick egg shells (e.g.
embryonated eggs of Ascaris, Trichuris,
Taenia spp.)
 Cystic wall of intestinal protozoa are also
resistant to acidic pH (Entamoeba, Giardia)
E. CHEMICAL COMPONENT OF BODY FLUIDS
 Lipase content of breast milk – toxic to
Giardia lamblia in vitro
 Lysozyme found in tears and saliva –
destroy microorganisms along with secreted
IgA immunoglobulins in these fluids
F. PHYSIOLOGIC FUNCTIONS
 Peristalsis
 Motion of cilia
 Human reflexes
 Coughing – enables expectoration of
aberrantly situated adult Ascaris
lumbricoides, eggs of Paragonimus
westermani
 Flushing action of urine – decreases the
numbers of Trichomonas vaginalis
 If parasite is able to overcome physical barriers, a
second host defense comes into play
 Penetration of body’s barriers  series of events that
facilitate sensing of the invading parasite via
PATHOGEN-ASSOCIATED MOLECULAR PATTERNS
– pattern recognition responses which enable the body
to mount an immune response that acts toward
eliminating or limiting the infection.
 Host possess both innate and acquired immune
defenses
 Both defenses rely on humoral and cell-mediated
mechanisms of action
INNATE IMMUNE RESPONSE happens when body detects
and eliminates pathogens through non-specific mechanisms
that use mechanical, chemical, and cytokine-mediated
methods with little or no delay from the time of invasion
 PHAGOCYTOSIS by macrophages and dendritic cells
 Subsequence pathogen elimination through oxidative
killing and use of toxic peptides
 Some intracellular pathogens – able to invade and
multiply inside macrophages (Leishmania spp.,
Toxoplasma gondii, and Trypanosoma cruzi)  CELL-
MEDIATED immune mechanisms are required to
identify and destroy them
 TOLL-LIKE RECEPTORS (TLRs) – recognize specific
molecules that are non-native to the body  1 of the
earliest recognition mechanisms for pathogens
CHAPTER 1: Introduction to Medical Parasitology
 o Largely responsible for triggering the initial (1) By direct cytotoxicity on the parasite; or
inflammatory response (2) Indirectly by acting on natural killer cells or
o Function as pyrogens and synthesize the antibody producing B-lymphocytes
inflammatory response proteins  increase the o Migrating larvae of Toxocara canis are killed
number and function of phagocytic cells through cell-mediated activity
 Binding of a specific ligand to a TLR  cascade of b. TH2 LYMPHOCYTES – produce IL-4, IL-5, and IL-6
reactions down a common signaling pathway   enhance proliferation and differentiation of B-
lymphocytes into plasma cells  responsible for
produces cytokines (interferon y % IL-1)  activate
immunoglobulin production
natural killer cells and macrophages  further  Antibodies that are produced bind with
production of inflammatory cytokines and co-stimulatory specific parasite antigens and can activate
molecules complement
 ACQUIRED IMMUNITY: The host, once infected, is  IgE, IgG, IgM, and IgA
exposed to the parasite antigens  stimulate the host
to mount an acquired specific response against the 
antigen
 Complex series of immunoregulatory events: activation,
induction through proliferation, differentiation, and
effector function  acquired immunity
 Effector function – may be at the end point of a
response or it might serve a regulatory function that
modulates other functions
 Parasitic antigens may originate from the surface, from
secretions and excretions, and from somatic tissues of
the parasite.
 Initial contact with antigen (“IMMUNOLOGIC PRIMING”)
 subsequent antigen exposure  more rapid and
vigorous immune responses  IMMUNOLOGIC
MEMORY
 The response of acquired immunity is either antibody-
dependent or cell-mediated
 Most of the time, immunity is directed against the
ANTIGEN that induced the response.
 Cross-reactivity does occur
 Antigen – may be present in just 1 developmental stage
or in just 1 species of the parasite; may be detected in
all of the stages of parasite development or in all
members of a genus
An immune response does not always equate with
protection, and that conversely, immunity to 1 pathogen
may confer immunity to another closely related species

B. ACQUIRED IMMUNE RESPONSE

 Major Histocompatibility Complex (MHC) gene products
help regulate T-lymphocyte activities
 Human Leukocyte Antigen (HLA) – also a factor
 (1) Parasitic antigens are processed and presented to
the CD4 T-helper lymphocytes (either belong to the Th1
or Th2 subsets
o Subsets of T-helper cells – responsible for
producing different lymphokines

a. TH1 LYMPHOCYTES – produce Interferon-y and IL-

2  activate cytotoxic lymphocytes (with CD8
surface molecules) and macrophages
o  cell-mediated immune response
o Parasite-specific antigens induce clonal
expansion of parasite-specific T-lymphocytes.
How?

CHAPTER 1: Introduction to Medical Parasitology