Introduction to Medical Parasitology

Victoria Basa-Dalay, MD, MSc

July 1, 2010

At the end of the Session , the student must be able to: Differentiate the three symbiotic relationships in Microbial World Define: Parasitology, Parasite, Host and other commonly used terms in Parasitology Discuss the taxonomic classification of parasites with examples Given the life cycle of a parasite: identify its important components Give its simple preventive and control measures

LEAD Rules of the Session

Listen to learn and learn to listen

Expect the unexpected Active participation is encouraged Discuss and Share your thoughts

BASIC TERMINOLOGY & PRINCIPLES

Symbiosis
An association between two different species of organisms Primarily aim for obtaining food from one or both member of the relationship Commonly known as Living together Has no overtones of benefit or harm Includes a wide diversity of associations

Symbiotic Relationships

Parasitism
Unilateral benefit

Degree of harm to host

Commensalism
Shelter and food

Benefit of the species

Mutualism
Reciprocal benefit

Symbiosis

closeness of association

Self-Assessment: Comment on this table

Type of Symbiotic Relationship Organism Host

Mutualism

+ (Benefited)

- (Not Harmed) +( Benefited)

Commensalism - (Not Harmed) Parasitism

++ (Benefited) - ( Not Harmed)

Parasitology
The science that deals with specialized group of animals which are physiologically dependent on other organisms for their Neva & Brown, 1994 survival. Medical Parasitology: The science that deals with parasites (organisms) that take up their abodes, temporarily or permanently, on or within its hosts (other living organisms) for the purpose of procuring food and protection, resulting in a relationship that can harm or lead to disease development in host .

Definition Parasite
Organisms ranging from microscopic to macroscopic Exhibit great diversity in morphology and physiology Animals depending on bigger organisms for food and shelter Has intimate almost always obligatory relationship with the host Always harmed the host

Ascaris lumbricoides
Competes for available nutrients since it absorbs sugars, proteins and fats from the food Obstructs the gut by bolus of worms Damages vital organs during erratic migration

SURVIVAL FACTORS OF PARASITES Parasites have successfully adapted to (all?) environmental niches in hosts Parasites best adapted are least pathogenic Typically with long-term/chronic/ intimate parasite-host relationships

Types of Parasites to REMEMBER Endo- vs Ecto-parasites Obligate vs Facultative Parasites Permanent vs Transient/ Temporary Parasites Erratic vs Spurious Parasites Zoonotic Parasites / Accidental Parasites

CONDITIONS NECESSARY FOR SUCCESSFUL ENDEMIC PARASITISM Reservoir of infection source of infection Means of transmission from infected to susceptible, new hosts Ability to invade and successfully reside in new hosts Ability to reproduce

Definition

Host
The bigger organism in which the parasite lives Provides the nourishment and protection /shelter needed by the parasites May transfer or harbor the organism temporarily or permanently Provide appropriate environment for growth and reproduction Maybe harmed, killed , not affected or they may even benefit in association with other organism

Types of Host
Definitive Host
Harbors the sexual or the mature stage of the parasite site where the sexual reproduction occurs, if present.
Eg. Man - Ascaris Dog - Dypilidium Mosquitoes - Plasmodium
Hosts Body: Man, Pig External Environment

DEFINITIVE HOST: Man or Pig

Types of Host
Intermediate Host
Harbors the asexual or the immature/ larval forms of the parasite Site where the asexual reproduction occurs
Eg. Snails - Echinostoma Pig - Trichinella and Taenia Man - Plasmodium Crustaceans Paragonimus
In Humans In Snails or Crustaceans

Types of Host
Vector An invertebrate animal which transmits a parasitic organism from one host to another Types of Vectors
Mechanical Vector Biological Vector
Humans Mosquito

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Types of Host
Vector
Mechanical Vector
An invertebrate animal which merely transfer parasitic organism from one host to another by their appendages Eg. flies, cockroaches

Biological Vector
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Life cycles of Human Parasites Direct Life cycle

No intermediate host is needed/required in transmitting the parasite from one host to another
A. Parasite may be
immediately infective upon leaving the host
In the Body of Host Host Host

External Environment

B. Parasite may still need

an external environment (soil) to develop into an infective stage

B. Trichiuris

A. Trichomonas

Life cycles of Human Parasites

Indirect Life cycle
At least one (1) intermediate host is needed or a vector is required in transmitting the parasite from one host to another
Eg. Fasciolopsis Plasmodium
In the Body of Host In the Snail and Water Plants

Components of the Life Cycle

Portal of Entry:
Mouth

Infective Stage:
Embryonated Egg

Mode of Transmission: Ingestion of the infective stage

Path of Migration: Habitat:

Small Intestine

Blood ungs Intestine External Environment : Soil ( 0 - 4 days)

Portal of Exit:Anus

Diagnostic Stage:
Egg in Feces

GENERALIZED PROTOZOAN LIFE CYCLE Trophozoite

Cyst

GENERALIZED PROTOZOAN LIFE CYCLE Trophozoite

Trophozoite

GENERALIZED SPOROZOAN LIFE CYCLE Trophozoite Sporozoite Schizont Gametocyte Gametes Oocyst Ookinete

Life Cycle of Ascaris lumbricoides

Prophylactic Treatment of Cases Cooking food properly Path of Migration: Early Treatment of Cases
Blood ungs Intestine

Mode of Transmission: Ingestion

Habitat:
Small Intestine

Proper excreta disposal

Avoid use of night soil

Early Treatment of Cases

Proper excreta disposal

Early diagnosis

Taxonomic Groupings of Parasites

Unicellular, eukaryotic parasites- Protozoan
Phylum Sarcomastigophora Phylum Apicomplexa Phylum Microspora Phylum Ciliophora

Multicellular parasites - Metazoan

Helminths
Phylum Aschelminthes Phylum Platyhelminthes

Arthropods
Phylum Arthropoda

Common terms used in Protozoans

Trophozite: the active,feeding and growing stage in most protozoans; the mature form Cyst: the sac-like stage in protozoans, usually the infective stage Oocyst: A thick-walled structure in which sporozoan zygotes develop and that serves to transfer them to new hosts like in mosquitoes.

Types of Parasites
According to Taxonomic Group Protozoans
Subphylum Sarcodina Move by pseudopodia Eg. Entamoeba Naegleria Acanthamoeba Subphylum Mastigophora Move by flagella Eg. Giardia, Trypanosoma, Leishmania, Trichomonas

Amoeba

Flagellates

Reproduce Asexually by Binary fission

Subphylum Sarcodina

Entamoeba histolytica
Disease: Amoebic dysentery/ colitis Mode of Transmission: ingestion of cysts from contaminated food or water Infective Stage: cysts Diagnostic Stages: cysts and trophozoites Habitat: colon Fx: anchovy sauce; flaskshaped ulcer Dx: Fecalysis Tx: Metronidazole

Subphylum Sarcodina

Naegleria fowleri
Disease: Acute Amoebic Meningoencephalitis in Normal Hosts Mode of Transmission: Penetration of the nasal mucosa to the brain Infective Stage: trophozoite Diagnostic Stages: trophozoites Habitat: brain Fx: Clinical presentations like fatal meningitis ( rapid onset) Dx: Trophozoites in CSF/ Brain tissue Tx: Amphotericin B

Types of Parasites
According to Taxonomic Group Protozoans
Subphylum Mastigophora Move by flagella Eg. Giardia, Trypanosoma, Leishmania, Trichomonas Reproduce Asexually by Binary fission

Flagellates

Subphylum Mastigophora

Giardia lamblia
Disease: Giardiasis Mode of Transmission: ingestion of cysts from contaminated water and food Infective Stage: cysts Diagnostic Stages: cysts and trophozoites Habitat: small intestine Fx: steatorheic stool; dysentery Dx: Fecalysis and Enterotest Tx: Metronidazole

Subphylum Mastigophora

Trypanosoma cruzi
Disease: Chaga;s Disease; AmericanTrypanosomiasis Mode of Transmission: bites of reduviid bug (Triatoma,) Infective Stage: metacyclic trypomastigote Diagnostic Stages: epimastigote Habitat: skin, mucous membrane; blood Fx: chagoma,Romana sign; megacolon; cardiomyopathy ( most serious Cx) Dx: Blood smear; body fluids Tx: benznidazole or nifurtimox

Subphylum Mastigophora

Trypanosoma brucei
Disease: African Trypanosomiasis, Sleeping Sickness Mode of Transmission: bites of infected tsetse fly( Glossina) Infective Stage: metacyclic trypomastigote Diagnostic Stages: epimastigote Habitat: body fluids; blood Fx: somnolence; siezure; coma Dx: Blood smear; body fluids NNN media Tx:Pentamidine isethionate
and Sudamin

Subphylum Mastigophora

Trichomonas vaginalis
Disease: Trichomoniasis Mode of Transmission: direct sexual contact Infective Stage: trophozoite Diagnostic Stages: trophozite Habitat: vagina and prostate Fx: vaginal prostatic discharge discharge and itchiness Dx: Wet smear of vaginal discharge Tx: Metronidazole

Types of Parasites
According to Taxonomic Group Protozoans
Phylum Apicomplexa No locomotory organ Have a complex life cycle
Eg. Plasmodium, Isospora, Toxoplasma. Cryptosporidium

Sporo oa

Phylum Microspora No locomotory organ Intracellular Parasite

Eg. Microsporidia

With alternating sexual and asexual reproduction

Phylum Apicomplexa

Plasmodium spp.
Disease: Malaria; Blackwater Fever Mode of Transmission: bites of infected female anopheline mosquito Infective Stage: sporozoites Diagnostic Stages: blood stages Habitat: blood Fx: tertian and quartan periodicity Dx: Blood smear Tx: Chloroquine; quinine;
quinghaosu

Phylum Apicomplexa

Cryptosporidium spp.
Disease: Malabsorption syndrome; Crypstosporidiosis Mode of Transmission: drinking or contact with contaminated water Infective Stage and Diagnostic Stages: small, sporulated oocyst with 4 sporozoites Habitat: Small intestine Fx: cachexia and severe diarrhea Dx: Fecalysis Tx: Nitazoxanide; fluid and electrolyte replacement

Types of Parasites
According to Taxonomic Group Protozoans
Phylum Ciliophora Move by beating of many cilia Mostly include variety of free-living and symbiotic species Eg. Balantidium coli Ciliates

Reproduce asexually by Binary Fission

Phylum Ciliophora

Balantidium coli
Disease: Balantidiasis Mode of Transmission: drinking or contact with contaminated water Infective Stage and Diagnostic Stages: cysts and trophozites Habitat: Large Intestine Fx: diarrhea among slaughter house workers Dx: Fecalysis Tx: Tetracycline*, with Metronidazole*

Types of Parasites
According to Taxonomic Group Phylum: Aschelminthes Helminths Elongated, cylindrical worms
Class: Nematoda
Intestinal and tissue inhabiting species

Unsegmented Sexes are separate Reproduction by:

Oviparous Eg. Ascaris, Enterobius Viviparous Eg. Trichinella, Filarial Worms Parthenogenetic Eg. Strongyloides

Infection by:
Ingestion of Eggs Eg. Ascaris, Trichuris Skin Penetration of larvae Eg. Hookworm Vector-borne Eg. Filarial Worms Ingestion of of encysted larvae Eg. Trichinella

HELMINTH/WORM TERMINOLOGY Adults: sexually reproductive stage in the life cycle stage Larvae: developmental or asexually reproductive stage in the life cycle Eggs: spherical/ oval stage that protects the zygote &/or embryo in the life cycle Cysts: usually an encapsulated larval stage found in tissues of an intermediate host

HELMINTH/WORM TERMINOLOGY Monoecious/hermaphroditic: both sexes in one body Dioecious: with sexes separate; males & females Parthenogenesis: ability to produce offspring without fertilization of eggs

Worm-terms, continued Oviparous: production of eggs, discharged from uterus of female Ovoviviparous: production of eggs which hatch prior to discharge from uterus of female Viviparous: production of embryos/L1 larvae, no rigid encapsulation of embryo

Nematodes of Medical Importance

Habitat Gastrointestinal tract Small Intestine Genera Ascaris,Ancylostoma Necator,Trichinella, Capillaria Trichiuris, Enterobius Onchocerca, Loa, Gnathostoma, Trichinella Wuchereria, Brugia Angiostrongylus

Large Intestine Skin/ Tissue nematodes Blood and Lymphatic Nematode CNS Nematode

Class: Nematoda

Hookworm.
Disease: Ancylostomiasis, Necatoriasis Mode of Transmission: Skin penetrationof filariform larvae Infective Stage: Filariform Larvae Diagnostic Stages: Ova Habitat: Small Intestine Fx: Ground itch; Iron deficiency anemia Dx: Fecalysis Tx: Mebendazole

GENERALIZED NEMATODE LIFE CYCLE Adults Eggs Embryos L1 L2 larva L3 larva L4 larva L5 juvenile

Filarial Worm Life Cycle DH (Man) Vector(Mosquitoes) Adults microfilariae L1 L2 larva L4 larva L5 larva L3 larva

Wuchereria bancrofti
Disease: Lymphatic filariasis Mode of Transmission: bites of infected mosquitoes Infective Stage: Third stage larvae (L3) Diagnostic Stage: Microfilariae (L1) Habitat: Lymphatic system; skin and glands Fx: elephantiasis Dx: Blood smear Tx: Mebendazole

Comparison of Nematode Eggs

Types of Parasites
According to Taxonomic Group Helminths Phylum: Platyhelminthes
Class: Trematoda
Flattened, leaf-shaped or cylindrical worms ( Schistosoma) Unsegmented Hermaphroditic Reproduction by:
Oviparous Eg. Schistosoma

Infection by:
Ingestion of metacercariae Eg. Fasciola, Echinostoma, Paragonimus, Clonorchis Skin Penetration of cercariae Eg. Schistosoma

Trematodes/Flukes Generalized Fluke Life Cycle Adults in Man (DH)

Egg Miracidium (embryo)

First IH (Snail)
Sporocyst &/or Redia larva Cercaria

Second IH ( vegetations, crabs, fish, snail)

Metacercaria

Typical Trematode Life Cycle

2nd IH

1st IH

Flatworm helminths, continued

Schistosomes/Bloodflukes
Generalized schistosomal life cycle

Man (DH)
Male & Female Adults
Egg Miracidium embryo

Snail (IH)
Sporocyst larvae

Cercaria

Life Cycle of Schistosoma sp.

Comparison of Schistosoma vs. other flukes Life Cycle

Trematode Eggs

Types of Parasites
According to Taxonomic Group Phylum: Platyhelminthes Helminths
Class: Cestoda
Elongated, flattened, ribbon-like worms Segmented Hermaphroditic Reproduction by:
Oviparous Eg. Taenia

Infection by:
Ingestion of encysted larvae Eg. Taenia, Echinococcus Poutrice Eg. Diphyllobothrium

Sub-groups of Cestodes
Pseudophylidea

Cyclophyllidea

Generalized Pseudophyllidean Life Cycle Adults in DH SI

Egg Coracidium Procercoid larva

Copepod First IH Fish Second IH

Plerocercoid larva

Adults in DH SI

Pseudophyllidean (Diphyllobothrium latum) life cycle

Generalized Cyclophyllidean Life Cycle Adults in DH SI

Egg with Onchosphere/Hexacanth Embryo Larva (Cysticercoid, cysticercus, coenurus, hydatid) in IH

Adults in DH SI

Taenia species life cycle

Cestode Affecting Man

Species Taenia saginata Taenia solium

Size 35 Qm. Range, 31-43 Qm.

Shape Spherical with thick striated shell.

Color Walnut brown.

Stage of Development When Passed Embryonated. 6hooked oncosphere present inside a thick shell.

Specific Features and Variations Thick, striated shell. Eggs of T. solium and T. saginata are indistinguishable and species identification should be made from proglottids or scoleces. "Taenia" spp. should be reported if only eggs are found. Polar filaments.

Hymenolepis nana

47 Qm x 37 Qm. Range, 40-60 Qm x 30-50 Qm.

Oval. Shell consists of 2 distinct membranes. On inner membrane are two small "knobs" or poles from which 4 to 8 filaments arise and spread out between the two membranes. Round or slightly oval. Striated outer membrane and thin inner membrane with slight poles. Space between membranes may appear smooth or faintly granular. Spherical or oval. 515 eggs (or more) are enclosed in a sac or capsule.

Colorless, almost transparent.

Embryonated. 6hooked oncosphere inside shell.

Hymenolepis diminuta*

72 Qm. Range, 70-86 Qm x 60-80 Qm.

Yellow.

Embryonated. 6hooked oncosphere inside shell.

Resembles H. nana but lacks polar filaments. Poles are rudimentary and often hard to see.

Dipylidium caninum*

35-40 Qm. Range, 3150 Qm x 27-48 Qm.

Colorless.

Embryonated. 6hooked oncosphere inside shell.

Usually found in lower animals, only occasionally found in humans.

Eggs are contained in a sac or capsule which ranges in size from 58 Qm to 60 Qm x 170 Qm. Occasionally capsules are ruptured and eggs are free. Egg resembles hookworm egg but has a thicker shell and an operculum.

Diphyllobothrium latum

66 Qm x 44 Qm. Range, 58-76 Qm x 40-51 Qm.

Oval or ellipsoidal with an inconspicuous operculum at one end and a small "knob" at the other end.

Yellow to brown.

Unembryonated. Ger minal cell is surrounded by a mass of yolk cells which completely fills inner area of shell. Germinal cell is usually not visible.

Cestode Eggs

Types of Parasites
According to Taxonomic Group
Phylum Arthropoda 4 Morphologic Characteristics: Segmented body parts: head, thorax and abdomen Three to Four pairs of jointed appendages Covered by hard chitinous exoskeleton Bilaterally symmetrical body

Medical Significance of Arthropods to Man

As direct agents of diseases
Dermatitis due to insect bites ( Caterpillars, bugs, etc) Injury to sense organs (wasps and bees ) Infestation of insect larvae - myiasis Entomophobia- fear of insects (eg. Cockroaches) Envenomization ( Sting of scorpions) Ectoparasites ( Scabies, Pediculosis and Crab louse infn)

A vectors or disease transmitters

Mechanical vectors Biological vectors

Types of Host
Vector
Mechanical Vector
An invertebrate animal which merely transfer parasitic organism from one host to another by their appendages Eg. flies, cockroaches

Biological Vector
T ro p h o zo i t es

Ga m et o c y te s

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Eg. Mosquito in Malaria

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Types of Parasites
According to Taxonomic Group Phylum Arthropoda
Class Pentastomida eg. Tongue worm Class Crustacea : crabs, crayfish, copepods Class Arachnida : spiders, scorpions, ticks, mite Class Insecta : Order Anoplura : human lice Order Hemiptera : reduviid bug Order Diptera : Housefly Order Hymenoptera : ants, bees, wasps Order Siphonaptera : fleas Order Diptera : mosquitoes, flies Class Chilopoda : centipedes Class Diplopoda: millipedes

Importance of Studying Medical Parasitology

To know the different parasites affecting man To know how to prevent transmission of these parasitic infections to man

Life Cycle of Ascaris lumbricoides

Prophylactic Treatment of Cases Cooking food properly Path of Migration: Early Treatment of Cases
Blood ungs Intestine

Mode of Transmission: Ingestion

Habitat:
Small Intestine

Proper excreta disposal

Avoid use of night soil

Early Treatment of Cases

Proper excreta disposal

Early diagnosis

Types of Parasites
According to their Mode of Transmission and their Preventive Measures
1. Contact Transmitted 2. Soil-transmitted 3. Arthropod-transmitted (Vector-borne) 4. Snail-transmitted 5. Food/Animal-transmitted 6. Water-transmitted

Types of Parasites
According to their Mode of Transmission and their Preventive Measures
1. Contact Transmitted Infection is transmissible directly from person to person
Eg. Enterobius vermicularis Trichomonas vaginalis Sarcoptes scabei Pediculus capitis

Preventive measures: Avoid contact with infected individuals Immediate treatment with infecd individuals

Types of Parasites
According to their Mode of Transmission and their Preventive Measures
2. Soil-transmitted Preventive measures: The infective stage Proper disposal of become infective after a human feces period of incubation in Avoid use of night soil the soil. as fertilizer Eg. Ascaris lumbricoides Protection of skin from Trichuris trichiura contact with Ancylostoma duodenale contaminated soil
Necator americanus Strongyloides stercorales

Types of Parasites
According to their Mode of Transmission and their Preventive Measures
3. Arthropod-transmitted Infective stage develops in the arthropod intermediate host which transmits the infection by biting or when ingested by man
Eg. Plasmodium spp. Wuchereria Trypanosoma

Preventive measures: Destruction of the arthropod breeding places Use of chemical prophylaxis

Types of Parasites
According to their Mode of Transmission and their Preventive Measures
4. Snail-transmitted Preventive measures: Infective stage develops Destruction of snail in the snail intermediate vectors host or second Avoid contact with intermediate host after infected or contaminated partial development in the bodies of waters snail
Eg. Schistosoma Echinostoma

Types of Parasites
According to their Mode of Transmission and their Preventive Measures
5. Food/Animal-transmitted Preventive measures: Infective stage develops in Proper cooking of food animals whose flesh is an like meat and fish important food item of man
Eg. Trichinella spiralis Taenia solium Capillaria philippinensis Paragonimus westermani

Types of Parasites
According to their Mode of Transmission and their Preventive Measures
6. Water-transmitted Preventive measures: Infective stage of the Boiling of drinking water parasite develops in the external environment and usually reaches man through ingestion of contaminated water.
Eg. Giardia lamblia Entamoeba histolytica

Types of Parasites
According to their Mode of Transmission and their Preventive Measures
1. Contact Transmitted Preventive measures: HEALTH EDUCATION 2. Soil-transmitted - an essential component 3. Arthropodof control regardless of transmitted the the category of 4. Snail-transmitted transmission of the 5. Food/Animalparasite belongs to. transmitted 6. Water-transmitted

Self-Assessment Questions
Given the following parasites, name their respective mode of transmission:
1. Schistosoma spp. 2. Trichomonas 3. Ascaris 4. Giardia 5. Capillaria 6. Entamoeba 7. Taenia solium 8. Wuchereria 9. Sarcoptes scabei 10.Plasmodium
1. Snail-transmitted 2. Contact-transmitted 3. Soil-transmitted 4. Water-transmitted 5. Food- transmitted (fish) 6. Water-transmitted 7. Food-transmitted (pork) 8. Vector-borne 9. Contact-transmitted 10. Vector-borne

Sharing Time
What are the important things that I learned from this session?

I will make you wise and show you where to go. I will guide you and watch over you! says the ord.

Psalm 2:8

Thank You!