1.

По време на кръвно хранене върху бозайник гостоприемник, заразена муха цеце

инжектира метациклични трипомастиготи в кожната тъкан. Паразитите навлизат в
лимфната система и преминават в кръвния поток.
2. Вътре в гостоприемника те се трансформират в трипомастиготи в кръвния поток,
пренасят се до други места в тялото и навлизат в други телесни течности (напр. Лимфа,
гръбначна течност).
3. Трипомастиготите се умножават по двоично делене.
4. Те циркулират в кръвта.
5. По време на кръвно хранене от заразен гостоприемник бозайник, мухата цеце се
заразява с трипомастиготи в кръвния поток.
6. В средното черво на мухата паразитите се трансформират в проциклични
трипомастиготи и се размножават чрез бинарно делене.
7. Процикличните трипомастиготи напускат средното черво и се трансформират в
епимастиготи.
8. Епимастиготите достигат слюнчените жлези на мухата, умножават се чрез двоично
делене и се развиват в метациклични трипомастиготи.
An infected triatomine insect vector (or “kissing” bug) takes a blood meal and releases trypomastigotes
in its feces near the site of the bite wound. Trypomastigotes enter the host through the bite wound or
intact mucosal membranes, such as the conjunctiva 1 . Inside the host, the trypomastigotes invade cells
near the site of inoculation, where they differentiate into intracellular amastigotes 2 . The amastigotes
multiply by binary fission 3 and differentiate into trypomastigotes, and then are released into the
circulation as bloodstream trypomastigotes 4 . Trypomastigotes infect cells from a variety of tissues and
transform into intracellular amastigotes in new infection sites. Clinical manifestations can result from
this infective cycle. The bloodstream trypomastigotes do not replicate (different from the African
trypanosomes). Replication resumes only when the parasites enter another cell or are ingested by
another vector. The “kissing” bug becomes infected by feeding on human or animal blood that contains
circulating parasites 5 . The ingested trypomastigotes transform into epimastigotes in the vector’s
midgut 6 . The parasites multiply and differentiate in the midgut 7 and differentiate into infective
metacyclic trypomastigotes in the hindgut 8 . Other less common routes of transmission include blood
transfusions, organ transplantation, transplacental transmission, and foodborne transmission (via
food/drink contaminated with the vector and/or its feces).
Лайшманиозата се предава чрез ухапване от заразени женски флеботоминови пясъчни
мухи. Пясъчните мухи инжектират инфекциозния стадий (т.е. промастиготи) от техния
хобот по време на хранене с кръв 1. Промастиготите, които достигат до пункционната
рана, се фагоцитират от макрофаги 2 и други видове мононуклеарни фагоцитни клетки.
Промастиготите се трансформират в тези клетки в тъканната фаза на паразита (т.е.
амастиготи) 3, които се размножават чрез просто делене и продължават да заразяват
други мононуклеарни фагоцитни клетки 4. Паразитът, гостоприемникът и други фактори
влияят върху това дали инфекцията става симптоматична и дали се получава кожна или
висцерална лайшманиоза. Пясъчните мухи се заразяват чрез поглъщане на заразени
клетки по време на хранене с кръв (5, 6). При пясъчните мухи амастиготите се
трансформират в промастиготи, развиват се в червата 7 (в задното черво за
лайшманиални организми във подвида Viannia; в средното черво за организми в
подродата Leishmania) и мигрират към хобот 8.
Cysts are resistant forms and are responsible for transmission of giardiasis. Both cysts and
trophozoites can be found in the feces (diagnostic stages) 1. The cysts are hardy and can survive
several months in cold water. Infection occurs by the ingestion of cysts in contaminated water,
food, or by the fecal-oral route (hands or fomites) 2. In the small intestine, excystation releases
trophozoites (each cyst produces two trophozoites) 3. Trophozoites multiply by longitudinal
binary fission, remaining in the lumen of the proximal small bowel where they can be free or
attached to the mucosa by a ventral sucking disk 4. Encystation occurs as the parasites transit
toward the colon. The cyst is the stage found most commonly in nondiarrheal feces 5. Because
the cysts are infectious when passed in the stool or shortly afterward, person-to-person
transmission is possible. While animals are infected with Giardia, their importance as a
reservoir is unclear.
Entamoeba
histolytica

Cysts and trophozoites are passed in feces (1). Cysts are typically found in formed stool,
whereas trophozoites are typically found in diarrheal stool. Infection by Entamoeba histolytica
occurs by ingestion of mature cysts (2) in fecally contaminated food, water, or hands.
Excystation (3) occurs in the small intestine and trophozoites (4) are released, which migrate to
the large intestine. The trophozoites multiply by binary fission and produce cysts (5), and both
stages are passed in the feces (1). Because of the protection conferred by their walls, the cysts
can survive days to weeks in the external environment and are responsible for transmission.
Trophozoites passed in the stool are rapidly destroyed once outside the body, and if ingested
would not survive exposure to the gastric environment. In many cases, the trophozoites remain
confined to the intestinal lumen (A: noninvasive infection) of individuals who are asymptomatic
carriers, passing cysts in their stool. In some patients the trophozoites invade the intestinal
mucosa (B: intestinal disease), or, through the bloodstream, extraintestinal sites such as the
liver, brain, and lungs (C: extraintestinal disease), with resultant pathologic manifestations. It
has been established that the invasive and noninvasive forms represent two separate species,
respectively E. histolytica and E. dispar. These two species are morphologically indistinguishable
unless E. histolytica is observed with ingested red blood cells (erythrophagocystosis).
Transmission can also occur through exposure to fecal matter during sexual contact (in which
case not only cysts, but also trophozoites could prove infective).

Единствените известни окончателни гостоприемници за Toxoplasma gondii са членове на

семейство Felidae (домашни котки и техните роднини). В изпражненията на котката се
отделят неспорулирани ооцисти (1). Въпреки че ооцистите обикновено се отделят само за
1–3 седмици, може да се отделят големи количества. Ооцистите се нуждаят от 1–5 дни, за
да спорулират в околната среда и да станат инфекциозни. Междинните гостоприемници в
природата (включително птици и гризачи) се заразяват след поглъщане на почвата, водата
или растителния материал, замърсени с ооцисти (2). Ооцистите се трансформират в
тахизоити малко след поглъщане. Тези тахизоити се локализират в нервната и мускулната
тъкан и се развиват в тъканни цисти брадизоити (3). Котките се заразяват след консумация
на междинни гостоприемници, съдържащи тъканни цисти (4). Котките също могат да се
заразят директно чрез поглъщане на спорообразни ооцисти. Животните, отглеждани за
консумация от човека и дивеч, също могат да се заразят с тъканни цисти след поглъщане
на спорообразни ооцисти в околната среда (5). Хората могат да се заразят по всеки от
няколкото начина:

 Яденето на необработено месо от животни, съдържащи тъканни кисти. (6)

 Консумиране на храна или вода, замърсени с изпражнения на котки или от
замърсени проби от околната среда (като замърсена с фекалии почва или смяна на
боклука на домашна котка). (7)
 Преливане на кръв или трансплантация на органи. (8)
 Трансплацентарно от майка на плод. (9)
При човешкия гостоприемник паразитите образуват тъканни цисти, най-често в
скелетните мускули, миокарда, мозъка и очите; тези кисти могат да останат през целия
живот на гостоприемника. Диагнозата обикновено се постига чрез серология, въпреки че
тъканни кисти могат да се наблюдават при оцветени биопсични проби (10). Диагностика
на вродени инфекции може да бъде постигната чрез откриване на ДНК на T. gondii в
околоплодната течност с помощта на молекулярни методи като PCR. (11)
Cysts are the stage responsible for transmission of balantidiasis   . The
host most often acquires the cyst through ingestion of contaminated food or
water   . Following ingestion, excystation occurs in the small intestine, and
the trophozoites colonize the large intestine   . The trophozoites reside in
the lumen of the large intestine and appendix of humans and animals, where
they replicate by binary fission, during which conjugation may occur   .
Trophozoites undergo encystation to produce infective cysts   . Some
trophozoites invade the wall of the colon and multiply, causing ulcerative
pathology in the colon wall. Some return to the lumen and disintegrate.
Mature cysts are passed with feces.
Immature eggs are discharged in the biliary ducts and passed in the stool   . Eggs
become embryonated in freshwater over ~2 weeks   ; embryonated eggs release
miracidia   , which invade a suitable snail intermediate host   . In the snail, the
parasites undergo several developmental stages (sporocysts   , rediae   , and
cercariae   ). The cercariae are released from the snail   and encyst as
metacercariae on aquatic vegetation or other substrates. Humans and other
mammals become infected by ingesting metacercariae-contaminated vegetation
(e.g., watercress)   . After ingestion, the metacercariae excyst in the
duodenum   and penetrate through the intestinal wall into the peritoneal cavity.
The immature flukes then migrate through the liver parenchyma into biliary ducts,
where they mature into adult flukes and produce eggs   . In humans, maturation
from metacercariae into adult flukes usually takes about 3–4 months; development
of F. gigantica  may take somewhat longer than F. hepatica.
Embryonated eggs containing miracidia are shed in feces of definitive hosts, which
are typically ruminants   . The eggs are then ingested by the first intermediate
host (snail)   . When the miracidia hatch   , they migrate through the gut wall
and settle into the adjacent vascular connective tissue, where they become mother
sporocysts   . The sporocysts migrate to the digestive gland where they give rise
to several daughter sporocysts. Inside each daughter sporocyst, cercariae are
produced   . Cercariae migrate to the respiration chamber where they are shed in
slime ball from the snail   . After a slime ball is ingested by the second
intermediate host (ant), the cercariae become free in the intestine and migrate to
the hemocoel where they become metacercariae   . When the infected ant is
eaten by a suitable definitive host   , the metacercariae excyst in the small
intestine. The worms migrate to the bile duct where they mature into adults   .
Humans can serve as definitive hosts after ingesting infected ants (e.g. on
contaminated food items)   .
Cysticercosis is an infection of both humans and pigs with the larval stages of the
parasitic cestode, Taenia solium. This infection is caused by ingestion of eggs shed in
the feces of a human tapeworm carrier   . These eggs are immediately infectious
and do not require a developmental period outside the host. Pigs and humans
become infected by ingesting eggs or gravid proglottids   ,   . Humans are
usually exposed to eggs by ingestion of food/water contaminated with feces
containing these eggs or proglottids or by person-to-person spread. Tapeworm
carriers can also infect themselves through fecal-oral transmission (e.g. caused by
poor hand hygiene). Once eggs or proglottids are ingested, oncospheres hatch in
the intestine   ,   invade the intestinal wall, enter the bloodstream, and migrate
to multiple tissues and organs where they mature into cysticerci over 60–70
days   ,   . Some cysticerci will migrate to the central nervous system, causing
serious sequellae (neurocysticercosis).

This differs from taeniasis, which is an intestinal infection with the adult tapeworm.
Humans acquire intestinal infections with T. solium after eating undercooked pork
containing cysticerci   . Cysts evaginate and attach to the small intestine by their
scolices. Adult tapeworms develop to maturity and may reside in the small intestine
for years   .

Taeniasis is the infection of humans with the adult tapeworm of Taenia

saginata or Taenia solium. Humans are the only definitive hosts for T. saginata and T.
solium. Eggs or gravid proglottids are passed with feces  ; the eggs can survive for
days to months in the environment. Cattle (T. saginata) and pigs (T. solium) become
infected by ingesting vegetation contaminated with eggs or gravid proglottids  . In
the animal’s intestine, the oncospheres hatch  , invade the intestinal wall, and
migrate to the striated muscles, where they develop into cysticerci. A cysticercus
can survive for several years in the animal. Humans become infected by ingesting
raw or undercooked infected meat  . In the human intestine, the cysticercus
develops over 2 months into an adult tapeworm, which can survive for years. The
adult tapeworms attach to the small intestine by their scolex   and reside in the
small intestine  . Length of adult worms is usually 5 m or less for T.
saginata (however it may reach up to 25 m) and 2 to 7 m for T. solium. The adults
produce proglottids which mature, become gravid, detach from the tapeworm, and
migrate to the anus or are passed in the stool (approximately 6 per day). T.
saginata adults usually have 1,000 to 2,000 proglottids, while T. solium adults have
an average of 1,000 proglottids. The eggs contained in the gravid proglottids are
released after the proglottids are passed with the feces. T. saginata may produce up
to 100,000 and T. solium may produce 50,000 eggs per proglottid respectively.
The adult Echinococcus granulosus  (sensu lato) (2—7 mm long)   resides in the
small intestine of the definitive host. Gravid proglottids release eggs   that are
passed in the feces, and are immediately infectious. After ingestion by a suitable
intermediate host, eggs hatch in the small intestine and release six-hooked
oncospheres   that penetrate the intestinal wall and migrate through the
circulatory system into various organs, especially the liver and lungs. In these
organs, the oncosphere develops into a thick-walled hydatid cyst   that enlarges
gradually, producing protoscolices and daughter cysts that fill the cyst interior. The
definitive host becomes infected by ingesting the cyst-containing organs of the
infected intermediate host. After ingestion, the protoscolices   evaginate, attach
to the intestinal mucosa   , and develop into adult stages   in 32 to 80 days.

Humans are aberrant intermediate hosts, and become infected by ingesting

eggs   . Oncospheres are released in the intestine   , and hydatid cysts develop
in a variety of organs   . If cysts rupture, the liberated protoscolices may create
secondary cysts in other sites within the body (secondary echinococcosis).

Възрастните червеи /1/ живеят в лумена на тънките черва. Женската може да

произведе приблизително 200 000 яйца на ден, които се предават с
изпражненията /2/. Неоплодени яйца могат да бъдат погълнати, но не са
заразни. Ларвите се развиват до заразност в оплодените яйца след 18 дни до
няколко седмици /3/, в зависимост от условията на околната среда
(оптимално: влажна, топла, сенчеста почва). След поглъщането на
инфекциозни яйца /4/, ларвите се излюпват /5/, нахлуват в чревната лигавица
и се пренасят през портала, след което се извършва системна циркулация в
белите дробове /6/. Ларвите узряват по-нататък в белите дробове (10 до 14
дни), проникват в алвеоларните стени, изкачват се до бронхиалното дърво до
гърлото и се поглъщат /7/. Постигайки тънките черва, те се развиват в
възрастни червеи. Необходими са между 2 и 3 месеца от поглъщането на
инфекциозните яйца до формирането на възрастната форма. Възрастните
червеи могат да живеят от 1 до 2 години.

Gravid adult female Enterobius vermicularis deposit eggs on perianal folds   .

Infection occurs via self-inoculation (transferring eggs to the mouth with hands that
have scratched the perianal area) or through exposure to eggs in the environment
(e.g. contaminated surfaces, clothes, bed linens, etc.)   . Following ingestion of
infective eggs, the larvae hatch in the small intestine   and the adults establish
themselves in the colon, usually in the cecum   . The time interval from ingestion
of infective eggs to oviposition by the adult females is about one month. At full
maturity adult females measure 8 to 13 mm, and adult males 2 to 5 mm; the adult
 life span is about two months. Gravid females migrate nocturnally outside the anus
and oviposit while crawling on the skin of the perianal area   . The larvae
contained inside the eggs develop (the eggs become infective) in 4 to 6 hours under
optimal conditions   .

Rarely, eggs may become airborne and be inhaled and swallowed. Retroinfection,
or the migration of newly hatched larvae from the anal skin back into the rectum,
may occur but the frequency with which this happens is unknown.

Trichocephalus

trichiurus

The unembryonated eggs are passed with the stool  . In the soil, the eggs develop
into a 2-cell stage  , an advanced cleavage stage  , and then they embryonate  ;
eggs become infective in 15 to 30 days. After ingestion (soil-contaminated hands or
food), the eggs hatch in the small intestine, and release larvae   that mature and
establish themselves as adults in the colon  . The adult worms (approximately 4
cm in length) live in the cecum and ascending colon. The adult worms are fixed in
that location, with the anterior portions threaded into the mucosa. The females
begin to oviposit 60 to 70 days after infection. Female worms in the cecum shed
between 3,000 and 20,000 eggs per day. The life span of the adults is about 1 year.

Trichinella
spiralis

Trichinellosis is caused by the ingestion of undercooked meat containing encysted

larvae (except for T. pseudospiralis and T. papuae, which do not encyst)
of Trichinella species  . After exposure to gastric acid and pepsin, the larvae are
released from the cysts   and invade the small bowel mucosa where they develop
into adult worms  . Females are 2.2 mm in length; males 1.2 mm. The life span in
the small bowel is about four weeks. After 1 week, the females release larvae   
that migrate to striated muscles where they encyst  . Diagnosis is usually made
based on clinical symptoms, and is confirmed by serology or identification of
encysted or non-encysted larvae in biopsy or autopsy specimens.