Introduction

Medical Parasitology

Intestinal and Blood parasites

Dr. Piyush Rajbhandari
10/9/2014
Medical parasitology

 Agents of diseases
 Epidemiology
overview  Life cycle
 Pathogenesis
 Basic clinical signs
 Laboratory diagnosis
 Antiparasitic drugs
 Prevention
Burden of Parasites

1 2 3
300 species
Of worms
70 species
of protozoa
90 species
common

a small proportion cause some of the most important diseases in the world
Classification
Classification
Key definitions
Medical parasitology: “the study and
medical implications of parasites that
infect humans”
Eukaryote: a cell with a well-defined
chromosome in a membrane-bound
nucleus. All parasitic organisms are
eukaryotes
A parasite:
a living organism that acquires
some of its basic nutritional
requirements through its
intimate contact with another
living organism”.
Parasites may be simple
unicellular protozoa or
complex multicellular metazoa

Protozoa: unicellular organisms, e.g.

Plasmodium (malaria)
Metazoa: multicellular organisms, e.g.
helminths (worms) and arthropods (ticks,
lice)
An endoparasite: “a parasite that lives
within another living organism” – e.g.
malaria, Giardia
An ectoparasite: “a parasite that lives on
the external surface of another living
organism” – e.g. lice, ticks
Life cycle
process of a parasite’s growth,
development & reproduction, in
one or more different hosts
depending on the species of
parasites

• Infective stage
• Infective route
• Infective mode
Host
Definitive host
supplies the parasite one in which the parasite reaches sexual maturity and
where the adult form of the parasite usually resides or
with nourishment in which sexual stages of reproduction occur
and shelter
Intermediate host
one in which the immature or larval form usually
resides, or in which the parasite undergoes asexual
reproduction

Reservoir host
any animal that harbors an infection that can be
transmitted to humans, even if the animal is a normal
host of the parasite

Dead-end host or incidental host

Intermediate host that does generally not allow
transmission to the definitive host, thereby preventing
the parasite from completing its development
• Parasite
Pathogenic parasites
→ according to which site they inhabit
• Intestinal and urogenital parasites
(protozoa and/or helminths)
• Tissue and blood parasites
(protozoa and/or helminths)
• other body sites
Nonpathogenic parasites (commensals)

Opportunistic parasites
parasites that cause no or mild to moderately serious infections in healthy
individuals, but particularly serious infections in the immun-ocompromised host
Pathogenic effects
• Trauma
destruction of cells, tissues or
organs by mechanical or
chemical means
• Nutrition robbing
diversion of the host's
nutritive substances

• Toxin production

• Interactions of the host

immune/inflammatory
responses
 Epidemiology
Methods of infection
• faeco-oral (Entamoeba histolytica, Ascaris lumbricoides)
• Undercooked food (Trichinella spiralis)
• via arthropod vector (Malaria)
• direct penetration (Strongyloides stercoralis)
• direct contact /person to person (Trichomonas vaginalis)

Methods of ecsape
• faeces
• sputum
• via arthropods
• blood & tissues

Biological transmission Vs Mechanical transmission

 Protozoa Taxonomic classification
Protozoa are microscopic one-
celled organisms that are
categorized according to their
method of movements.
 Forms and reproduction of protozoa

Shizogony Endodiogony Cysts - infective forms,

survive in the environment
Trophozoites - vegetative
forms

Reproduction:
Shizogony (asexual)
Binary fission (asexual)
Endodyogony
Sporogony (sexual)
Conjugation|
Binary fission
PROTOZOA
1. Amebae (Intestinal)
Entamoeba histolytica
Entamoeba dispar
Entamoeba hartmanni
Entamoeba coli
Entamoeba polecki
Endolimax nana
Iodamoeba bütschlii
Blastocystis hominis
2. Flagellates (Intestinal)
Giardia lamblia.
Chilomastix mesnili
Dientamoeba fragilis
Trichomonas hominis
Enteromonas hominis
Retortamonas intestinalis
3. Ciliates (Intestinal)
Balantidium coli
4. Coccidia, Microsporidia (Intestinal)
Cryptosporidium parvum
Cyclospora cayetanensis
Isospora belli
Sarcocystis hominis
Sarcocystis suihominis
Sarcocystis “lindemanni”
Microsporidia
Enterocytozoon bieneusi
Encephalitozoon intestinalis
PROTOZOA

Blood, Tissue Other Body Sites

Sporozoa (Malaria and babesiosis) Amebae
Plasmodium vivax Naegleria fowleri
Plasmodium ovale Acanthamoeba spp.
Plasmodium malariae Hartmanella spp.
Plasmodium falciparum Balamuthia mandrillaris (Leptomyxid ameba)
Babesia spp. Entamoeba gingivalis

Flagellates (Leishmaniae, Trypanosomes) Flagellates

Leishmania tropica complex Trichomonas vaginalis
Leishmania mexicana complex Trichomonas tenax
Leishmania braziliensis complex
Leishmania donovani complex Coccidia
Leishmania peruviana Toxoplasma gondii
Trypanosoma brucei gambiense
Trypanosoma brucei rhodesiense Sporozoa
Trypanosoma cruzi Pneumocystis carinii
 Helminths (Worms) Taxonomic classification
Eukaryotic, multicellular
animals that usually have
digestive, circulatory, nervous,
excretory, and reproductive
systems.

have bilateral symmetry,

head and tail end of the body,
and tissue differentiation
(endoderm, mesoderm, and
ectoderm)..
Sexual reproduction strategies
Male and female reproductive organs are found in separate
individuals.

One animal has both male and female sex organs (most
hermaphrodites copulate with other animals, a few
copulate with themselves).

Female helminths:
Oviparous – lay eggs without embryonic development.
Ovoviviparous – embryos develop inside eggs.
Viviparous – the larva develops inside the body of the
mother.

Eggs: unsegmented (no larva inside the egg) & segmented

(larva inside the egg)
NEMATODES (Roundworms)
1. Intestinal
Ascaris lumbricoides
Enterobius vermicularis
Ancylostoma duodenale
Necator americanus
Strongyloides stercoralis
Trichuris trichiura
Capillaria philippinensis
3. Blood and Tissues (Filarial Worms)
Wuchereria bancrofti
Brugia malayi
Brugia timori
Loa loa
2. Tissue
Trichinella spiralis
Visceral larva migrans (Toxocara canis or
Toxocara cati)
Ocular larva migrans (Toxocara canis or
Toxocara cati)
Cutaneous larva migrans (Ancylostoma
braziliense or Ancylostoma
caninum)
Dracunculus medinensis
CESTODES (Tapeworms)

1. Intestinal
Diphyllobothrium latum
Dipylidium caninum
Hymenolepis nana
Hymenolepis diminuta
Taenia solium
Taenia saginata

2. Tissue (Larval Forms)

Taenia solium
Echinococcus granulosus
Echinococcus multilocularis
Multiceps multiceps
Spirometra mansonoides
Diphyllobothrium spp.
TREMATODES (Flukes)
1. Intestinal
Fasciolopsis buski
Echinostoma ilocanum
Heterophyes heterophyes
Metagonimus yokogawai
2. Liver/Lung
Clonorchis (Opisthorchis) sinensis
Opisthorchis viverrini
Fasciola hepatica
Paragonimus westermani
Paragonimus mexicanus

3. Blood
Schistosoma mansoni
Schistosoma haematobium
Schistosoma japonicum
Schistosoma intercalatum
Schistosoma mekongi
Burden of some major parasitic infections
Parasite Diseases No. people infected Deaths/yr
Plasmodium malaria 273 million 1.12 million
Soil transmitted helminths: 2 billion 200,000

• Roundworm (Ascaris) Pneumonitis, intestinal

obstruction
• Whipworm (Trichuris)
• Bloody diarrhoea, rectal prolapse
• Hookworm
(Ancylostoma and Coughing, wheezing, abdominal
Necator) pain and anaemia
Schistosoma Renal tract and intestinal 200 million 15,000
disease

Filariae Lymphatic filariasis and 120 million Not fatal but 40

elephantiasis million
disfigured or
incapacitated
Trypanasoma cruzi Chagas disease (cardiovascular) 13 million 14,000
African trypanosomes African sleeping sickness 0.3 – 0.5 million 48,000
Leishamania Cutaneous, mucocutaneous and 12 million; 2 million new 50,000
visceral leishmaniasis cases/yr
 Epidemiology
• Global occurrence, the majority occur in tropical
regions poverty, poor sanitation and personal
hygiene

• Often entire communities may be infected with

multiple, different organisms which remain
untreated because treatment is neither accessible
nor affordable

• Effective prevention and control requires "mass

intervention strategies” and intense community
education.
General improved sanitation:
Vector control
Mass screening and drug administration programmes
Introduction
Medical Parasitology
Take home message