EMERGING &

REMERGING
PARASITIC
DISEASES
By Dr. Neha Samal
3rd
Year PG
INTRODUCTION
The world is facing
challenges from both new
diseases and re-emerging
ones

Understanding how once

dormant diseases are now
re-emerging is critical to
control the damage such
diseases can cause
GIROLAMO FRACASTORO
Speaking about Syphilis
 
 EMERGING INFECTIONS
Emerging infectious diseases 
are infections that
-have recently appeared within a
population or
-those whose incidence or
geographic range is rapidly
increasing (2 decades) or
-threatens to increase in the near
future

Emerging infections can be caused by:

Previously undetected or unknown infectious agents
RE-EMERGING INFECTIONS
Re-emerging infectious diseases are
diseases that once were major health
problems globally or in a particular
country, and then declined dramatically,
but are again becoming health problems
for a significant proportion of the
population
 FACTORS INFLUENCING
  EMERGENCE AND
RE-EMERGENCE
The factors that influence emergence or re-emergence of protozoal
and helminthic diseases are the same as those that affect other
infectious diseases:
 change in the parasite or the host that favors increased human
infection or disease expression
 environmental or demographic change that favors increased human
contact with the parasite
 increased recognition of a previously existing problem that had
escaped detection or had been underestimated.

In the case of parasitic infections, changes that affect the invertebrate

vector can also be very important.
 IT TAKES
MORE THAN
A PARASITE Urbanization Catastrophic
Climate change events
TO CAUSE
THE
DISEASE
Environment
Genetic
Nutrition change
Travel Antibiotic
&
Population Host Insecticide
Pathogen
density resistance

Immuno-
suppresion
The emerging and reemerging parasitic
diseases can be reviewed under
following headings:
i) Foodborne and Waterborne parasitic
diseases
ii) Vector borne parasitic diseases
iii) Zoonotic parasitic diseases
iv) Transfusion associated parasitic
diseases
FOODBORNE OR WATERBORNE
PARASITIC DISEASE
Disease /Name & Mode of Clinical Symptom Diagnostic Method
Type of parasite infection
Cryptosporidiosis Ingestion of Immunocompetent • Direct microscopy
(EID) food & water host- (Stool)
Cryptosporidium contaminated - Self-limiting, shows round 4–6 µm size
parvum with feces nonbloody frothy oocyst
- 1st identified by containing thick diarrhoea 5-6 times • Wet mount after
Clarke & Tyzzer walled oocysts - Abdominal pain, concentration
- huge waterborne By nausea, fever technique
outbreak in autoinfection: • Acid fast staining
Milwaukee USA Thin walled Immunocompromised • Direct fluorescent
(1993) >4 lakh oocyst host- antibody staining
people affected - More severe if CD4 • Antigen detection from
- India prevalence 2.4 SOURCE- count<100/µl stool
to 15% Rain water - Chronic diarrhoea, ICT (Triage panel)
- In lodges, severe weight loss, • ELISA
immunocompromise swimming pool, wasting & • PCR – 18srRNA, β
d hosts prevalence recreational abdominal pain Tubulin gene
12–46% in water - Extraintestinal
developing countries manifestations • Histopathology of
intestinal biopsy
specimen- BLUE
BEADS

Treatment- Glutamine based ORS, Nitazoxanide, Paromomycin

Disease /Name & Type of Mode of Clinical Symptom Diagnostic Method
parasite infection

Microsporidiasis Ingestion (or • Debilitating chronic • Light microscopy

(EID) rarely diarrhoea, spore detection
• Enterocytozoon bieneusi inhalation or malabsorption - modified trichrome
• Encephalitozoon ocular • Keratoconjunctivitis, stain
intestinalis contact) of blurred & decreased - modified acid fast
• Vittaforma corneae spores vision stain
• Nosema ocularum • Genitourinary, - Gram stain (Brown-
-1st human case -1959 myoskeletal, Brenn modification),
- Maximum no reported in respiratory infections - Giemsa, PAS
AIDS patients from North • Electron
America (2% to 50%) microscopy
- patients receiving organ • Cell culture—In
transplants, elderly
Vero, RK13 and
debilitated persons
MRC-5 cell lines
- India, 1st case of enteric
• Antibody assays-
microsporidiosis -2001 &
IFA, ELISA,
ocular microsporidiosis
western blot PCR
2003
• In-situ
PGI, Chandigarh 2012- most
hybridization
common parasites detected
(15%)- stool samples of HIV
patients
Treatment-Albendazole, Topical
itraconzole, ART
Disease /Name & Type Mode of Clinical Diagnostic Method
of parasite infection Symptom
Cyclosporiasis Ingestion of - Self limiting • Stool examination-Shows
(EID) food and diarrhoea, round unsporulated oocysts
Cyclospora cayetanensis water weight loss, (twice the size of
• Prevalent in Central and contaminate nausea cryptosporidium)
South America and South d with - HIV patients- • Acid fast stain—variable
Asia sporulated biliary tract • UV epifluorescence
• India – mostly travellers oocyst in soil involvement microscopy—
• Food borne outbreaks- autofluorescence oocysts
imported foods, • rt-PCR- HSP70
Treatment-
raspberries, basil, • Histopathology of
Cotrimoxazole,
mesclun lettuce intestinal biopsies
Nitazoxanide
Blastocystosis Ingestion of Intense
- Ciprofloxacin • Stool microscopy-
(EID) parasite cyst- abdominal vacuolar forms
Blastocystis hominis drinking disorder with • ELISA
Zoonotic disease of water pain, diarrhoea • PCR- subtype or genus
anaerobic protozoan parasite - Extraintestinal specific primers
infection
Children, immigrant
workers, soldiers, travellers
from developing tropical
countries- 20-50% Treatment-
Metronidazole
Disease Mode of Clinical Symptom Diagnostic Method
infection
Toxoplasmosis - Ingestion of -Direct microscopy (Detect
sporulated tachyzoites in blood and tissue cyst
Toxoplasma oocysts- in tissue biopsy):
gondii contaminated Giemsa, PAS, silver stains,
soil, food, or immuno-peroxidase stain,
water (m/c) fluorescent antibody test
- Ingestion of Antibody detection
tissue cyst -IgG in serum- 4x increase-recent
containing -IgM in serum- acute or congenital
bradyzoites infection
undercooked -IgG avidity test- low avidity-
meat recent infection
- By blood -IgA & E- acute & congenital
transfusion, infection
needle stick -Sabin feldman dye test- specific,
injuries, organ cannot differentiate between recent
transplantation, & past
transplacental - Detection of toxoplasma Ag
transmission or - PCR- genotyping- I to III
laboratory Treatment- - Animal inoculation- mice
accidents - Pyrimethamine, - Tissue culture
Tachyzoites Cotrimoxazole, - Imaging methods- CT, MRI
Atovaquone
Disease /Name & Mode of Clinical Symptom Diagnostic Method
Type of parasite infection
Cysticercosis- Ingestion of Localization of the • Radiodiagnosis— CT, MRI
Taenia solium food or water cyst in CNS, • Antibody detection in serum
larvae contaminated subcutaneous tissue, or CSF— ELISA, Western
(Cysticercosis with eggs of muscle or eyes blot (EITB)- LLGP
cellulosae) Taenia solium NCC- asymptomatic antigenic fractions
- USA, Canada, or hydrocephalus, • Antigen detection in serum
Australia- ReIDs chronic meningitis, or CSF- ELISA
- India- NCC- FND, seizures • Histopathology- muscles,
EIDs- Bihar, eyes, subcutaneous tissues
Odisha, UP, Punjab or brain biopsies
• Fundoscopy- detect larvae
• Del brutto diagnostic criteria
Treatment- Albendazole, Praziquantel, Anti-epileptics
Trematodiasis
(EID)

Treatment- Praziquantel, Sx removal of worms from biliary tract

VECTOR BORNE PARASITIC
DISEASE
Disease /Name & Mode of Clinical Diagnostic Method Treatment
Type of parasite infection Symptom
Malaria Bite of High fever, Microscopic tests: - Artemisinin
(ReIDs) female malaise - Peripheral blood combination
1960- eradicated- anopheles headache, smear therapy
DDT shortages mosquito, myalgia, - Fluorescence (ACT)
Operational infected vomiting microscopy - Chloroquine
problems with ARF, (Kawamoto’s - quinine is
sporozoites cerebral technique recommende
Plasmodium malaria, - Quantitative buffy d in first
falciparum/ vivax/ pulmonary coat examination trimester
malariae/ ovale edema Nonmicroscopic tests: whereas ACT
- Antigen detection is given in
P. knowlesei- earlier tests (RDTs) or ICTs second and
considered parasite — detects parasitic third
of monkeys LDH, HRP-II, trimester
EIDs aldolase
South-east Asia- - Antibody detection—
Malaysia ELISA
Andamans- - Culture—RPMI 640
resemblance P. vivax medium
- Molecular diagnosis
—PCR using PBRK1
primer
Disease /Name Mode of Clinical Diagnostic Method
& Type of infection Symptom
parasite
Leishmaniasis Bite of infected Visceral - Microscopy (detects LD bodies)
Leishmania Sandly Leishmaniasis- Giemsa stain
donovani Phlebotomus Kala-azar Splenic aspiration- most sensitive,
L. Infantum argentipes with Fever, Hepato- Bone marrow aspiration, Liver biopsy
promastigote in splenomegaly, Peripheral blood smear (in HIV
L. chagasi saliva lymphadenopat infected people)
L. major hy, skin - Culture (detects promastigotes)
L. Braziliensis pigmentation, NNN medium, Schneider’s liquid
L. Tropica pancytopenia medium
PKDL - Antibody detection in serum –
L. donovani- EIDs Cutaneous ELISA, IFA
increasing cases in Leishmanias- CFT using WKK antigen of tubercle
bihar, WB, UP, Oriental sore bacilli
Jharkhand ICT using rk39 antigen
- Nonspecific tests
Napier’s aldehyde test, Chopra
antimony test
- PCR
- Leishmanin test (montenegro test)
- Animal inoculation—golden
hamster
Treatment- Antimony compounds, Miltefosine,
Liposomal Amphotericin B, Paramomycin
Disease /Name & Mode of Clinical Symptom Diagnostic Method
Type of parasite infection

Trypanosomiasis African- Bite of African-Chancre, - Peripheral blood

infected Tsetse fly- intermittent fever, microscopy (thick or
Trypanosoma brucei trypomastigotes malaise, myalgia, thin smear)-
(African) gambiense released tachycardia, trypomastigote
Trypanosoma b. lymphadenopathy, - Culture- NNN
rhodesiense American- CNS involvement- medium or Yager’s
T. Cruzi (South- Feces of reduviid prolonged daytime liver infusion tryptose
American) bugs somnolence, medium
extrapyramidal signs, - Antibody detection in
T. Lewisi- Gujrat coma serum—ELISA, IFA,
American- CFT, RIPA
T. evansi- Surra in Chagoma, Romana’s - Antigen detection
horses- ReIDs sign, from serum, urine- by
Cases increasing- Fever, myocarditis, CLIA
India- Punjab 1st 1881 meningoencephalitis - PCR – kinetoplast or
Nagpur- 2005 nuclear DNA
- Animal inoculation-
Mice
- Xenodiagnosis—
nymph of reduviid
bugs
Treatment- African-Pentamidine, suramine, arsenical melalsoprol
American-Benznidazole, Nifurtimox
ZOONOTIC PARASITIC DISEASE
Disease /Name Mode of Clinical Diagnostic Method Treatment
& Type of infection Symptom
parasite
Babesiasis Bite of Malaise, Thin or thick blood smear- Clindamycin
EIDs Ixodid ticks- fatigue, Maltese cross formation on + oral
1st case- Gujrat sporozoites weakness, blood film quinine
2005, MP are released fever- Serology- IFA
Severe Animal inoculation, PCR
B. microtis, B. anaemia, ARF,
divergens DIC, CHF,
ARDS
Echinococossis Ingestion of Depends on - Hydatid fluid PAIR
(ReIDs) food location & size microscopy - brood
1970-1st case contaminated Hydatid cyst- capsules & protoscolices DOC-
Cases now with dog Hepatomegaly, - Histological examination Albendazole
faeces- E. Abdominal - cyst wall and attached
prevalent in- granulosus tenderness, brood capsules
AP, Kashmir, eggs portal - Antibody detection-
Chandigarh, hypertension, ELISA- B2t Ag
Tamilnadu Man- dead ascites - Imaging methods-X-ray,
end host Chronic cough, USG (Water lily sign),
E. granulosus dyspnoea CT, MRI
E. multiocularis Neurological - PCR- mitochondrial DNA
symptoms - Skin test (Casoni test)
Disease /Name & Mode of Clinical Diagnostic Method Treatment
Type of parasite infection Symptom
Trichenellosis Ingestion of Watery - Demonstration of - Rest, anti-
EIDs raw or diarrhoea, larvae in muscle pyretics
Trichenella uncooked Abdominal biopsies— By direct
spiralis Pork or pain slide technique and H - Albendazo
animal meat and E stain le
T. nelsoni containing Encephalitis - Serology (antibody
1st case In Punjab Stage 1 myocarditis detection)—ELISA - Glucocorti
2010- Uttarakhand- larvae - Coproantigen coids
Kachmoli detection
Man - Bachman intradermal
accidental test
host - Animal inoculation in
rats
- Blood eosinophilia,
elevated muscle
enzyme
Angiostrongyliasis Ingestion of Eosinophilic - CSF pleocytosis Self limiting
EIDs raw meningo- - Eosinophilia
A.cantonensi undercooked encephalitis - ELISA- Ab detection Albendazole
1st ocular case snails and seizure,crani
slugs al nerve
2006 palsies
TRANSFUSION ASSOCIATED
PARASITIC DISEASE
 Despite of stringent donor eligibility criteria, improved donor
screening and introduction of sophisticated technology, the risk
of transmission of various emerging and reemerging infections
cannot be checked

 Most common- parasitic complication of transfusion-

MALARIA survive for at least a week in components
stored at room temperature or at 4°C

Parasitaemia of as low as 10/µL can give rise to transfusion

transmitted malaria
 Babesia - survive at 4°C in a unit of RBCs - 35 days
transmitted through
- infected packed red cells, frozen-thawed-deglycerolized RBC
and platelet concentrates
 Trypanosomal parasite can remain viable at least 21 days
in whole blood and RBC units stored at 4°C

 Toxoplasma - survive for several weeks in stored whole blood

 Microfilaria persist in the recipient’s circulation for

more than 2 years
(do not develop into adult filarial worms)
 CONCLUSION
• These infections will continue to emerge and
reemerge leading to unpredictable epidemics and
challenges for the medical public health care
personnel/ scientists

• Specific MEASURES must be taken to prevent

their occurrence-

1. Human behavioural change- potential factor to reduce disease

2. Forgotten Factor- Disease control programmes

3. Safe drinking water and effective sanitation

4. Food safety- avoid exotic and unusual cuisine, easy cooking
methods, raw preparations enforce legislation

5. Clinical awareness of exotic disease- travel clinic setups

6. Awareness of zoonotic disease risks

7. Guidelines for antiparasitic drugs- Timely

Urgent need to develop newer

advanced surveillance tools,
diagnostic tests, vaccines and
therapeutics

accurate and rapid detection of all types of

Emerging and Reemerging
pathogens
 Y O U
NK
T HA