Lecture PowerPoint to accompany

Foundations in
Microbiology
Sixth Edition

Talaro
Chapter 23
The Parasites of Medical
Importance

Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
 Parasitology
• The study of eucaryotic parasites, protozoa
and helminths
• Cause 20% of all infectious diseases
• Less prevalent in industrialized countries;
increasingly common in AIDS patients

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 Typical Protozoan Pathogens
• Single-celled, animal-like microbes, most
having some form of motility
• Estimated 100,000 species, approximately 25
are important pathogens
• Life cycles vary
– Most propagate by simple asexual cell division of
the active feeding cell (trophozoite).
– Many undergo formation of a cyst.
– Others have a complex life cycle that includes
asexual and sexual phases.
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Infective Amebas

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 Entamoeba histolytica and Amebiasis
• Alternates between a large trophozoite, motile
by means of pseudopods and a smaller
nonmotile cyst
• Trophozoite has a large nucleus and lacks most
other organelles.
• Humans are the primary hosts.
• Ingested
• Carried by 10% of world population

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 Entamoeba histolytica
• Cysts are swallowed and arrive at the small intestine;
alkaline pH and digestive juices stimulate cysts to
release 4 trophozoites.
• Trophozoites attach, multiply, actively move about and
feed.
• Asymptomatic in 90% of patients
• Ameba may secrete enzymes that dissolve tissues and
penetrate deeper layers of the mucosa.
• Causing dysentery, abdominal pain, fever, diarrhea and
weight loss
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 Entamoeba histolytica
• Life-threatening manifestations are:
hemorrhage, perforation, appendicitis, and
tumorlike growths, amebomas.
• May invade liver and lung
• Severe forms of disease result in 10% fatality
rate.
• Effective drugs are iodoquinol, metronidazole,
and chloroquine.

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 Amebic Infections of the Brain
• Caused by Naegleria fowleri and Acanthamoeba
• Ordinarily inhabit standing water
• Primary acute meningoencephalitis is acquired
though nasal contact with water or traumatic eye
damage.
• Infiltration of brain is usually fatal.

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An Intestinal Ciliate: Balantidium coli
• An occupant of the intestines of domestic animals
such as pigs and cattle
• Acquired by ingesting cyst-containing food or water
• Trophozoite erodes intestine and elicits intestinal
symptoms.
• Healthy humans are resistant.
• Rarely penetrates intestine or enters blood
• Treatment – tetracycline, iodoquinol, nitrimidazine
or metronidazole

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The Flagellates

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Trichomonads: Trichomonas species
• Small, pear-shaped
• 4 anterior flagella and an undulating membrane
• Exist only in trophozoite form
• 3 infect humans:
– T. vaginalis
– T. tenax
– T. hominis

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 Trichomonas vaginalis
• Causes an STD called trichomoniasis
• Reservoir is human urogenital tract
• 50% of infected are asymptomatic.
• Strict parasite, cannot survive long outside of host
• 3 million cases yearly, a top STD
• Female symptoms – foul-smelling, green-to-yellow
discharge; vulvitis; cervicitis; urinary frequency and
pain
• Male symptoms – urethritis, thin, milky discharge,
occasionally prostate infection
• Metronidazole
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 Giardia lamblia and Giardiasis
• Pathogenic flagellate
• Unique symmetrical heart shape with concave
ventral surface that acts like a suction cup
• Cysts are small, compact, and multinucleate.
• Reservoirs include beavers, cattle, coyotes,
cats, and humans.
• Cysts can survive for 2 months in environment.
• Usually ingested with water and food
• ID 10 to 100 cysts
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• Cysts enter duodenum, germinate, travel to
jejunum to feed and multiply
• Causes giardiasis – diarrhea, abdominal pain
• Diagnosis is difficult because organism is shed
in feces intermittently.
• Treatment: quinacrine or metronidazole
• Agent is killed by boiling, ozone, and iodine.

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 Hemoflagellates: Vector-Borne Blood
Parasites
• Obligate parasites that live in blood and tissues of
human host
• Cause life-threatening and debilitating zoonoses
• Spread in specific tropical regions by blood-
sucking insects that serve as intermediate hosts
• Have complicated life cycles and undergo
morphological changes
• Categorized according to cellular and infective
stages
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 Trypanosoma species and
Tropanosomiasis
• Distinguished by their infective stage;
trypomastigote is an elongate, spindle-
shaped cell with tapered ends, eel-like
motility
• 2 types of trypanosomiasis:
– T. brucei – African sleeping sickness
– T. cruzi – Chagas disease – endemic to
Central and South America

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 Trypanosoma brucei and African
Sleeping Sickness
• Spread by tsetse flies
• Harbored by reservoir mammals
• Two variants of disease caused by 2 subspecies:
– T.b.gambiense – Gambian strain; West Africa
– T.b. rhodesiense – Rhodesian strain; East Africa
• Biting of fly inoculates skin with
trypomastigotes, which multiplies in blood and
damages spleen, lymph nodes and brain.

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• Chronic disease symptoms are sleep
disturbances, tremors, paralysis and coma.
• Trypanosomes are readily demonstrated in
blood, spinal fluid or lymph nodes.
• Treatment before neurological involvement
melarsoprol, eflornithine
• Control involves eliminating tsetse fly.

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 Trypanosoma cruzi
• Causes Chagas disease
• Reduviid bug (kissing bug) is the vector.
• Infection occurs when bug feces is inoculated into a
cutaneous portal.
• Local lesion, fever, and swelling of lymph nodes,
spleen, and liver
• Heart muscle and large intestine harbor masses of
amastigotes.
• Chronic inflammation occurs in the organs
(especially heart and brain).
• Treatment nifurtimox and benzonidazole

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Leishmania species and Leishmaniasis
• Leishmaniasis - zoonosis transmitted among
mammalian hosts by female sand flies that require
a blood meal to produce eggs
• Endemic to equatorial regions
• Promastigotes are injected with sand fly bite,
convert to amastigote and multiply; if macrophage
is fixed the infection is localized; systemic if
macrophage migrates.

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• Cutaneous-oriental sore, Baghdad boil -
localized ulcerated sore
• Espunda – skin and mucous membrane
infection of the head; chronic infection
• Systemic-visceral - high intermittent fever;
weight loss, enlarged spleen, liver, and
lymph nodes
– Kala azar is the most severe and fatal form if
untreated.

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 Apicomplexan parasites
• Sporozoans
• Lack locomotor organelles in the trophozoite state
• Alternate between sexual and asexual phases and
between different animal hosts
• Most form specialized infective bodies that are
transmitted by arthropod vectors, food, water, or
other means.
– Plasmodium
– Toxoplasma
– Cryptosporidium
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 Plasmodium: The Agent of Malaria

• Dominant protozoan disease

• Obligate intracellular sporozoan
• 4 species: P. malariae, P. vivax,
P. falciparum and P. ovale
• Female Anopheles mosquito is the primary vector;
blood transfusions, mother to fetus
• 300-500 million new cases each year
• 2 million deaths each year

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2 distinct phases of malarial parasite development:
• asexual phase – human host
– Infected female mosquito injects asexual sporozoite
which localizes in liver; it then undergoes
schizogony generating 2,000-40,000 merozoites
which enter circulation in 5-16 days depending on
species.
– Merozoites attach to and enter red blood cells,
convert to trophozoites and multiply; red cell bursts
releasing merozoites that differentiate into gametes.

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• Sexual phase – mosquito host
– Mosquito draws infected RBCs; gametes
fertilize forming diploid cell which forms
sporozoites in stomach.
– Sporozoites lodge in salivary glands; available
to infect human host

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 Plasmodium
• Symptoms include episodes of chills-fever-sweating,
anemia, and organ enlargement.
• Symptoms occur at 48-72 hour intervals as RBCs
rupture; interval depends on species.
• P. falciparum most malignant type; highest death rate
in children
• Diagnosis by presence of trophozoite in RBCs,
symptoms
• Increasing drug resistance
• Therapy is chloroquine, quinine, or primaquine.
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 Coccidian Parasites

• Zoonotic in domestic animals and birds

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Toxoplasma gondii and Toxoplasmosis
• Intracelllular apicomplexan parasite with extensive
distribution
• Lives naturally in cats that harbor oocysts in the GI
tract
• Acquired by ingesting raw meats or substances
contaminated by cat feces
• Most cases of toxoplasmosis go unnoticed except in
fetus and AIDS patients who can suffer brain and
heart damage.
• Treatment: pyrimethamine and sulfadiazine

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 Sarcocystis and Sarcocystosis
• Sarcocystis – parasites of cattle, swine, and sheep
• Domestic animals are intermediate hosts; they pick
up infective cysts while grazing on grass
contaminated with human feces.
• Humans are infected when the meat is consumed.
• Symptoms include diarrhea, nausea, and abdominal
pain.
• No specific treatment

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 Cryptosporidium: A Newly
Recognized Intestinal Pathogen
• An intestinal pathogen
• Infects a variety of mammals, birds, and reptiles
• Exists in tissue and oocyst phases
• 1990s – 370,000 cases in Milwaukee, WI due to
contaminated water; filtration required for removal
• Ingestion of oocysts which give rise to sporozoites
that penetrate intestinal cells
• Causes gastroenteritis, headache, sweating, vomiting,
abdominal cramps, diarrhea
• AIDS patients may suffer chronic persistent diarrhea.
• No effective drugs
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 Isospora belli and Coccidiosis
• Intracellular intestinal parasite with oocyst stage
• Transmitted in fecally contaminated food or drink
• Infection usually asymptomatic or self-limited
• Symptoms include malaise, nausea and vomiting,
diarrhea, fatty stools, abdominal cramping, and
weight loss.
• Treat with sulfadiazine and pyrimethamine, when
required

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 Cyclospora cayetanensis and
Cyclosporiasis
• Emerging protozoan pathogen; causes cyclosporiasis
• Oral-fecal transmission; fresh produce and water
• Oocysts enter small intestine and invade the mucosa.
• Symptoms of watery diarrhea, stomach cramps,
bloating, fever, muscles aches
• Diagnosis can be complicated.
• Treatment: trimethoprim and sulfamethoxazole

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 Babesia species and Babesiosis
• First protozoan found to cause a disease –
redwater fever of cattle
• First protozoan found to be associated with
a vector - tick
• Human babesiosis - relatively rare zoonosis
• Associated with infected rodents
• Infection resembles malaria.

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 A Survey of Helminth Parasites
• Adults are large, multicellular animals with specialized
tissues and organs.
• Adult worms mate and produce fertilized eggs that
hatch; larvae then mature in several stages to adults.
• The sexes may separate or are hermaphroditic.
• Adults live in the definitive host.
• Eggs and larvae may develop in the same host, the
external environment of the intermediate host.
• A transport host experiences no parasitic
development.
• Four basic patterns of life and transmission
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 Helminths
• Pathology arises from worms feeding on and
migrating through tissues, accumulation of worms and
worm products.
• Diagnosis based on blood cell count (eosinophilia),
serological tests; eggs, larvae, or adult worms in feces;
sputum, urine, blood, or tissue biopsies.
• Antihelminthic drugs suppress a helminthic metabolic
process that differs from the human process, inhibit
the worm’s movement, prevent it from holding
position, and act locally in the intestine.

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Nematode (Roundworm) Infestations
• Most abundant animal groups; 50 species that
affect humans
• Enlongated, cylindrical worms with protective
cuticles, circular muscles, a complete digestive
tract, and separate sexes
• Ascaris lumbricoides, Trichuris trichiura,
Enterobius vermicularis, hookworms,
Strongyloides stercoralis, Trichinella spiralis,
filarial worms
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 Ascaris lumbricoides
• A large intestinal roundworm
• Most cases in the U.S. occur in the southeastern states
• Indigenous to humans
• Ascaris spends its larval and adult stages in humans;
release embryonic eggs in feces, and are spread to other
humans; food, drink, or contaminated objects
• Ingested eggs hatch into larvae and burrow through the
intestine into circulation and travel to the lungs and
pharynx and are swallowed.
• Adult worms complete cycle in intestines and reproduce
– 200,000 eggs/day.
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 Ascaris lumbricoides
• Worms retain motility, do not attach.
• Severe inflammatory reactions mark the
migratory route.
• Allergic reactions can occur.
• Heavy worm loads can retard physical and
mental development.

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 Trichuris trichiura and Whipworm
Infection
• Whipworm
• Humans sole host
• Trichuriasis has its highest incidence in the tropics.
• Eggs hatch in intestines, larvae attach, penetrate the
outer wall and develop into adults.
• Females lay 3,000-5,000 eggs daily.
• Worms can pierce capillaries, cause localized
hemorrhage, and allow bacteria to leave intestine.
• Heavy infestations can cause dysentery, rectal
prolapse – can be fatal in children.
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 Enterobius vermicularis and
Pinworm Infection
• Pinworm or seatworm
• Enterobiasis most common worm disease of children in
temperate zones
• Eggs are picked up from surroundings and swallowed.
• After hatching in the small intestine, they develop into
adults.
• Anal itching occurs when mature females emerge from
intestine to release eggs.
• Self-inoculation is common.
• Tape test
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 Hookworms
• Characteristic curved ends and hooked mouths
• Necator americanus and Ancylostoma duodenale
• Humans shed eggs in feces, which hatch into
filariform larvae and burrow into the skin of the
lower legs.
• Larvae travel from blood to lungs, proceed up
bronchi and throat and are swallowed.
• Worms mature and reproduce in small intestine
and complete, the cycle.
• May cause pneumonia, nausea, vomiting, cramps
and bloody diarrhea
• Blood loss is significant – anemia.
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 Strongyloides stercoralis and
Strongyloidiasis
• Threadworm
• Tiny roundworms completes life cycle in humans
or moist soil.
• Larvae penetrate skin and migrate to lungs, are
swallowed and complete development in the
intestine.
• Can reinfect the same host without leaving the
body
• Heavy worm loads can cause pneumonitis and
eosinophilia, bloody diarrhea, liver enlargement,
bowel obstruction and malabsorption.
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Trichinella spiralis and Trichinosis
• Life cycle entirely within mammalian host
• Acquired from eating undercooked pork or bear
meat
• Larvae migrate from intestine to blood vessels,
muscle, heart, and brain, where it forms cysts
• First symptoms –flulike, diarrhea
• Second symptoms – muscle and joint pain, shortness
of breath, pronounced eosinophilia
• No cure after larva have encysted

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 Tissue Nematodes
• Complete their life cycle in human blood,
lymphatics, or skin
• Filarial worms; elongate, filamentous
bodies, spread by biting arthropods
• Cause chronic, deforming disease
• Wuchereria bancrofti – elephantiasis
• Onchocerca volvulus – river blindness
• Loa loa – eye worm

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 Wucherereia bancrofti and
Bancroftian Filariasis
• Tropical infection spread by mosquitoes
• Vector deposits larvae which move into
lymphatics and develop into adults.
• Chronic infection causes blockage of
lymphatic circulation and elephantiasis,
massive swelling in the extremities.

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 Onchocerca volvulus and River
Blindness
• Transmitted by biting black flies
• Larvae develop into adults in subcutaneous
tissues.
• Adult females migrate via the blood to the
eyes, provoking inflammatory reactions.
• Coinfection with Wolbachia bacteria causes
river blindness.
• Treatment: tetracycline and ivermectin

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 Loa loa: The African Eye Worm
• Spread by bite of small flies
• Temperature-sensitive worm migrates
around/under the skin and may enter the
eye.
• Treatment – pull worm from a small hole in
conjunctiva or diethylcarbamazine

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 Trematodes or Flukes
• Flatworms with ovoid leaflike bodies
• Have digestive, excretory, neuromuscular, and
reproductive systems
• Lack circulatory and respiratory systems
• Animals such as snails or fish are usually the
intermediate hosts and humans are the
definitive hosts.

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 Blood Flukes: Schistosomes
• Schistosomiasis - prominent parasitic disease
• Schistosoma mansoni, S. japonicum,
S. haematobium
• Adult flukes live in humans who release eggs into
water; early larva (miracidium) develops in
freshwater snail into a 2nd larva (cercaria).
• This larva penetrates human skin and moves into the
liver to mature; adults migrate to intestine or bladder
and shed eggs, giving rise to chronic organ
enlargement.
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 Liver and Lung Flukes
• Zoonotic
Liver flukes:
• Opisthorchis (Chlonorchis) sinesis - cycles between
mammals and snails and fish; humans are infected by
eating inadequately cooked fish containing cercaria,
larvae crawl into bile duct, mature and shed eggs into
feces; snail are infected.
• Fasciola hepatica-cycles between herbivores, snails,
and aquatic plants; humans are infected by eating
raw aquatic plants; fluke lodges in liver.

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Lung fluke:
• Paragonimus westermani – cycles between
carnivorous animals, snails, and
crustaceans; humans infected by eating
undercooked crustaceans; intestinal worms
migrate to lungs.

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 Cestode (Tapeworm) Infestations
• Flatworms
• Long, very thin, ribbonlike bodies composed of
sacs (proglottids) and a scolex that grips the
intestine
• Each proglottid is an independent unit adapted to
absorbing food and making and releasing eggs.
• Taenia saginata
• Taenia solium

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 Taenia saginata
• Beef tapeworm
• Very large, up to 2,000 proglottids
• Humans are the definitive host.
• Animals are infected by grazing on land contaminated
with human feces.
• Infection occurs from eating raw beef in which the
larval form has encysted.
• In humans, larva attaches to the small intestine and
becomes an adult.
• Causes few symptoms; vague abdominal pain and
nausea; proglottids in stool
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 Taenia solium
• Pork tapeworm
• Infects humans through ingesting cysts or
eggs
• Eggs hatch in intestine, releasing tapeworm
larva that migrate to all tissues and encyst.
• Most damaging if they lodge in heart muscle,
eye, or brain
• May cause seizures, psychiatric disturbances

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 The Arthropod Vectors of Infectious
Disease
• Arthropods – exoskeleton and jointed legs;
includes arachnids and crustaceans; many
must feed on blood and tissue fluid of host
during life cycle; ectoparasites
• Those of medical importance transmit
infectious microbes in the process of
feeding – biological vectors

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Insects
• Mosquitoes – require an aquatic habitat; females
take blood meal transmitting disease: malaria,
filariasis, zoonoses
• Fleas – highly motile, flattened bodies; feed on
warm-blooded animals; carry zoonotic diseases:
plague, murine typhus
• Lice – small, soft; attach to head and body hair
feeding inconspicuously on blood and tissue fluid;
release feces that contaminate wound; epidemic
typhus, relapsing fever
• Flies – tsetse fly, sand fly

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Arachnids
• Ticks – cling on vegetation and attach to
host on contact; larvae, nymph and adults
get blood meal by piercing skin of host
– hard ticks – Dermacentor, Ixodes – small
compact, rigid bodies; transmit rickettsial,
borrelial, and viral diseases
– soft or argasid ticks – Ornithodoros- flexible
outer bodies; transmit relapsing fever

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