Introduction To Medical Parasitology

Introduction to Medical
Parasitology
Introduction to Medical Parasitology
• A branch of medical sciences dealing with organisms
(parasites) which live temporarily or permanently, on or
within the human body (host)
• Different types of parasites and hosts
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• Competition for authority that takes place between the
host and the parasite - host-parasite relationship
Medica; Parasitology - SBD2114

• Accordingly, the host may remain healthy or loses the
competition, and a disease develops
• Human parasites are
• Unicellular or multicellular
• Endoparasites or ectoparasites
2
cont.
• Endoparasites
• Intestinal, atrial or they may inhabit body tissues causing
serious health problems
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• Ectoparasites
• Arthropods that either cause diseases, or act as vectors

transmitting other parasites
• Environmental changes, human behavior and population

movement have a great effect on transmission,
distribution, prevalence, and incidence of parasitic
diseases in a community
3
cont.
• Parasites can invade the human body in different ways
• Oral route
• Skin
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• Arthropod vectors
• Sexual contact

• Host defense mechanisms consist of
• Innate immunity - mediates initial protection
• Adaptive immunity - more effective, once parasites have
evaded innate host defenses, adaptive responses are
promoted against a wide array of antigenic constituents
4
cont.
• Diagnosis of parasitic diseases -
• Parasitic diseases may be presented by a wide variety of
clinical manifestations according to the tissue invaded
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• Direct microscopy - stool, urine, blood, CSF and tissue
biopsies
• Immunodiagnostics - antigen and antibody detection

assays
• Molecular-based diagnostics - offer great sensitivity and
specificity
5
Medical Parasitology
• The science dealing with parasites that infect man,
causing disease and misery in most countries of the
tropics
• WHO estimates that one person in every four harbors
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parasitic worms
• Parasitology is a dynamic field because the
relationships between parasites and their hosts are

constantly changing
6
Medical Parasitology cont.
• Parasite - a living organism that lives in (endoparasite) or
on (ectoparasite) another organism, obtaining
nourishment and protection while offering no benefit in
return
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• Consequently, the host suffers from various diseases,
infections, and discomforts
• However, in some cases, the host may show no signs at all

of infection by the parasite
7
Types of parasites
• According to the nature of the host-parasite interactions
and the environmental factors, there are different types of
parasites
• Obligatory parasite - completely dependent on its host and
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can’t survive without it e.g. hookworms
• Facultative parasite - can change its life style between free-
living in the environment and parasitic according to the

surrounding conditions. e.g. Strongyloides stercoralis
• Accidental parasite - affects an unusual host e.g. Toxocara
canis in man
• Temporary parasite - visits the host only for feeding and then
leaves it. e.g. Bed bug visiting man for a blood meal.
• Permanent parasite - lives in or on its host without leaving it
e.g. Lice. 8
Types of parasites cont.
• Opportunistic parasite - capable of producing disease in an
immunedeficient host (like AIDS and cancer patients). In the
immuno-competent host, it is either found in a latent form or
causes a self limiting disease e.g. Toxoplasma gondii
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• Zoonotic parasite - primarily infects animals and is transmittable
to humans. e.g. Fasciola species

9
Types of hosts
• Hosts are classified according to their role in the life cycle
of the parasite into
• Definitive host (DH) - harbours the adult or sexually mature
stages of the parasite (or in whom sexual reproduction
occurs)
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• e.g. Man is DH for Schistosoma haematobium, while female
Anopheles mosquito is DH for Plasmodium species

• Intermediate host (IH) - harbours larval or sexually immature
stages of the parasite (or in whom asexual reproduction
occurs)
• e.g. Man is IH of malaria parasites. Two intermediate hosts
termed 1st and 2nd IH may be needed for completion of a
parasite's life cycle,
• .
10
Types of hosts cont.
• Reservoir host (RH) - harbours the same species and same
stages of the parasite as man.
• It maintains the life cycle of the parasite in nature and is
therefore, a reservoir source of infection for man.
• e.g. sheep are RH for Fasciola hepatica
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• Paratenic or transport host - in whom the parasite does not
undergo any development but remains alive and infective to

another host
• Paratenic hosts bridge gap between the intermediate and
definitive hosts
• For example, dogs and pigs may carry hookworm eggs from one
place to another, but the eggs do not hatch or pass through any
development in these animals
• Vector is an arthropod that transmits parasites from one host
to another 11
• e.g. female sand fly transmits Leishmania parasites
Host Parasite relationship
• In biology, the relationship between two organisms is
mainly in the form of symbiosis, defined as "life together",
i.e., the two organisms live in an association with one
another
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• 3 types of relationships based on whether the symbiont
has beneficial, harmful, or no effects on the other

12
Host Parasite relationship cont.
• Once the infecting organism is introduced into the body of
the host, it reacts in different ways and this could result in
• Carrier state - a perfect host parasite relationship where
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tissue destruction by a parasite is balanced with the host’s
tissue repair. At this point the parasite and the host live
harmoniously, i.e. they are at equilibrium

• Disease state - this is due to an imperfect host parasite
relationship where the parasite dominates the upper hand. It
can result either from lower resistance of the host or a higher
pathogenecity of the parasite
• Parasite destruction – occurs when the host takes the upper
hand
13
Types of Symbiotic Association
• Mutualism
• A relationship in which both partners benefit from the
association.
• Usually obligatory, since in most cases physiological
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dependence has evolved to such a degree that one mutual
cannot survive without the other
• Filarial nematodes such Wuchereria bancrofti and Onchocerca

volvulus which cause serious human diseases, are mutually
infected with Wolbachia, and they can be cured of their
bacterial infections by treating patients with antibiotics, and
the worms die too
14
Types of Symbiotic Association cont.
• Commensalism
• One partner benefits from the association, but the host is
neither helped nor harmed
• May be facultative, in the sense that the commensal may not
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be required to participate in an association to survive
• Humans harbor several species of commensal protozoans,
that colonize in the intestinal tract

• Entamoeba dispar, Entamoeba hartmanni,
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Types of Symbiotic Association cont.
• Parasitism
• One of the participants, the parasite, either
harms or lives at the expense of the host
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• Parasites may cause mechanical injury, such as
boring a hole into the host or digging into its skin

or other tissues, stimulate a damaging
inflammatory or immune response
16
Life cycle
• Life cycles of parasites
1. Simple/Direct
• Only one host and are described as monoxenous
• Life cycle of Ascaris lumbricoides
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• Generally spends most of its life in or on the host, and may
reproduce within the host
• Because offspring must be transmitted to other hosts,

however, the parasite or its progeny must have some way
of leaving the host, surviving in the external environment
for some period, and locating and infecting a new host
• Parasites with simple life cycles have both parasitic and
free-living life stages
• The proportion of the total life cycle spent in each stage
varies according to the parasite 17
Life cycle cont.
2. Complex/Indirect
• Multiple hosts are involved and described as
heteroxenous
• Life cycle of Fasciola spp
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• Primary or definitive host of a heteroxenous species
is the one in which adult parasites live and reproduce

sexually
• Secondary or intermediate host (IH) is the host
where immature life stages of the parasite live
18
Life cycle cont.
• Some parasites are transmitted directly from one host to
another, often by insects, described as vectors
• One particularly effective vector for vertebrate parasites is
the mosquito, which plays a role in transmission of
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numerous parasites including heartworm, the viruses that
cause yellow fever and encephalitis, and Plasmodium, the
protozoan that causes malaria

19
Sources of Infection
• Parasitic infections originate from various sources and are
transmitted by various routes
• Major sources of infection are
• Soil
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• Embryonated eggs which are present in soil may be
ingested, e.g. roundworm, Whipworm
• Infective larvae present in soil may enter by penetrating

exposed skin, e.g. hookworm, Strongyloides
20
Sources of Infection cont.
• Water
• Infective forms present in water may be swallowed, e.g.
cysts of Amoeba and Giardia
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• Water containing the intermediate host may be
swallowed, e.g. infection with guinea worm occurs when
the water that is drunk contains its intermediate host

Cyclops
• Infective larvae in water may enter by penetrating exposed
skin, e.g. Cercariae of Schistosomes
21
• Food
• Contamination with human or animal feces, e.g. amoebic
cysts. pinworm eggs,
toxoplasma oocysts
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• Meat containing infective larvae, e.g. Trichinella spiralis

22
• Insect Vectors
• Biological Vectors
• Mosquito - Malaria, filariasis
• Sandflies - Kala-azar
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• Tsetseflies - Sleeping sickness
• Reduviid bugs - Chagas’ disease

• Ticks - Babesiosis
• Mechanical vectors
• Housefly - Amoebiasis
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• Animals
• Domestic
• Cow - beef tapeworm, Sarcocystis
• Pig - pork tapeworm, Trichinella spiralis
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• Dog - hydatid disease, leishmaniasis
• Cat - toxoplasmosis

• Wild
• Wild game animals - trypanosomiasis.
• Wild felines - Paragonimus westermani
• Fish - fish tapeworm
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• Self – Autoinfection
• Finger to mouth transmission, e.g. pinworm
• Internal reinfection, e.g. Strongyloides
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25
Modes of transmission
• Oral Transmission
• The most common method of transmission
• Through contaminated food, water, soiled fingers
• Many intestinal parasites enter the body in this manner, the
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infective stages being
• Cysts - Entamoeba histolytica and other intestinal protozoa
• Embryonated eggs - Whipworm or pinworm

• Larval forms - most intestinal nematodes, such as the
roundworm
26
Modes of transmission cont.
• Skin Transmission
• Hookworm infection is acquired when the larvae enter the
skin of persons walking barefooted on contaminated soil
• Schistosomiasis is acquired when the cercarial larvae in water
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penetrate the skin
• Many parasitic diseases, including malaria and filariasis are
transmitted by blood sucking arthropods through active skin

penetration
27
• Vector Transmission
• Parasites undergo development or multiplication in the
body of true vectors - biological vectors
• Some arthropods may transmit infective parasites
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mechanically or passively without parasitic multiplication
or undergoing development in them
• Ex: housefly may passively carry amoebic cysts from

faeces to food
• Such vectors which act only as passive transmitters -
mechanical vectors
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• Direct transmission
• By person-to-person contact
• Gingival amoebae (Entamoeba gingivalis) - transmission is
direct from one person to another by kissing
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• Trichomoniasis - by sexual intercourse
• Pinworm infection - Inhalation of air-borne eggs

29
Transmission of parasites
• In tropical and developing countries the following are
among the factors that contribute to the spread and
increase in incidence of parasitic infections
• Inadequate sanitation and unhygienic living conditions
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leading to faecal contamination of the environment
• Lack of health education
• Insufficient water and contaminated water supplies

• Failure to control vectors due to ineffective interventions,
insecticide resistance, lack of resources, and suspension of
surveillance and control measures (e.g. during war and
conflict)
• Poverty, malnutrition and for some parasites, increased
susceptibility due to co-existing HIV infection
30
Transmission of parasites cont.
• Failure of drugs to treat parasitic infections effectively
• Climatic factors
• Population migrations causing poor health, loss of natural
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immunity, exposure to new infections, and people being
forced to live and work closer to vector habitats and reservoir
hosts, often in overcrowded conditions, e.g. refugee camps

31
Parasitic disease
• Not all parasitic infections cause disease of clinical
significance
• Both parasitic and host factors are involved
• Parasitic Factors
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• Strain of parasite and adaptation to a human host
• Number of parasites (parasite load)

• Site(s) occupied in the body
• Metabolic processes of the parasite, particularly the nature of
any waste products or toxins produced by the parasite during
its growth and reproduction
32
Parasitic disease cont.
• Host Factors
• Genetic factors
• Age and level of natural immunity
• Intensity and frequency of infection
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• Immune responses to the infection
• Presence of co-existing disease or condition which reduces

natural immune responses, e.g. pregnancy, or infection with
HIV
• Whether there is malnutrition
• Life style and work of the person infected
33
Effects of parasites on host
1. Direct effects of parasite on the host
• Mechanical injury - may be inflicted by a parasite by means of
pressure as it grows larger, e.g. Hydatid cyst causes blockage
of ducts such as blood vessels producing infraction
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• Deleterious effect of toxic substances- in Plasmodium
falciparum production of toxic substances may cause rigors
and other symptoms

• Deprivation of nutrients, fluids and metabolites -parasite may
produce disease by competing with the host for nutrients
2. Indirect effects of the parasite on the host
• Immunological reaction - Tissue damage Ex: nephritic
syndrome following Plasmodium infections
34
Laboratory diagnosis
• Depending on the nature of the parasitic infections, the
following specimens are selected for laboratory diagnosis
1. Blood
• Development stages circulates in the blood stream
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• Examination of blood film forms one of the main procedures
for specific diagnosis
• For example, in malaria the parasites are found inside the red

blood cells
• In Bancroftian filariasis, microfilariae are found in the blood
plasma
2. Stool
• Diagnosis of intestinal parasitic infections
• In protozoan infections - trophozoites or cystic forms
35
• In helmithic infections - adult worms, eggs, or larvae are
found
Laboratory diagnosis cont.
3. Urine
• Urinary tract infecting
• Urinary Schistosomiasis - eggs of Schistosoma haematobium
are found in urine.
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4. Sputum

• Respiratory tract infecting parasites
• Paragonimiasis - eggs of Paragonimus westermani
• Amoebic abscess of lung / amoebic liver abscess bursting into
the lungs - trophozoites of E. histolytica
36
Laboratory diagnosis cont.
5. Biopsy material
• Varies with different parasitic infections
• Ex
• Spleen punctures - kala-azar,
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• Muscle biopsy – Cysticercosis and Chagas’ disease

6. Urethral or vaginal discharge
• For Trichomonas vaginalis
37
Indirect evidences
• Changes indicative of intestinal parasitic infections
1. Cytological changes in the blood
• Eosiniphilia often gives an indication of tissue invasion by
helminthes in blood
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• Reduction in white blood cell count is an indication of kala-
azar
• Anemia is a feature of hookworm infestation and malaria

2. Serological tests
• Carried out only in laboratories where special antigens are
available
38
Treatment
• Many parasitic infections can be cured by specific
chemotherapy
• Greatest advances have been made in the treatment of
protozoan diseases
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• To obtain maximum parasiticidal effect, it is desirable that

the drugs administered
• Should not be absorbed through the gut of the human
• Drugs should have minimum toxic effect on the host
39
Prevention and Control
• Measures should be taken against every parasite infecting
humans
• Preventive measures designed to break the transmission
cycle are crucial to successful parasitic eradication. Such
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measures include:
• Source reduction

• Prompt diagnosis and treatment of parasitic diseases
• Sanitary control of drinking water and food
• Proper waste disposal
• Use of insecticides and other chemicals – vector control
• Protective clothing that would prevent vectors attack
• Good personal hygiene
• Avoidance of unprotected sexual practices
40
Classification and general characters
• Classification of parasites is controversial as there is no
universally accepted system
• Most acceptable taxonomic classification of human parasites
includes Endoparasites and Ectoparasites
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• Endoparasites are sub-classified into Helminthic parasites
(multicellular organisms) and Protozoan parasites (unicellular
organisms)

• Helminthic parasites are either flat worms (Trematodes),
segmented ribbon like worms (Cestodes) or cylindrical worms
(Nematodes)
41
Classification and general characters
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42
Endoparasites
• Most parasites of humans live inside the host
• These are helminthes, protozoa, or sometimes larval stages
of arthropods
• Both helminthic and protozoan parasites can infect
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different tissues and organs of the human body

• Virtually any organ can be affected
• Trichinella spp. and Toxoplasma gondii - muscles
• Larvae of Echinococcus spp. and liver flukes - liver
• Schistosoma hematobium - urinary bladder
• Most of the protozoans - blood
43
Ectoparasites
• Human ectoparasites live on the host
• Include fleas, lice, mosquitoes, bugs, mites, ticks etc
• In general, ectoparasites attach to the skin to feed and do
not remain on the host for their entire lives
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• Some of these organisms lie in a grey area between
endoparasites and ectoparasites

• Scabies mites - are generally considered ectoparasites though
the female scabies mite does burrow into the skin
• Fly larvae may feed on dead tissue in a wound, but some
species never invade healthy tissue
44
Classification of medical parasitology
• Medical Protozoology - Deals with the study of medically
important protozoa
• Medical Helminthology - Deals with the study of
helminthes (worms) that affect man
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• Medical Entomology - Deals with the study of arthropods
which cause or transmit disease to man.

• Describing animal parasites follow certain rules of
zoological nomenclature and each phylum may be further
subdivided as follows
45
PROTOZOA • Trypanosoma brucei
• Single-celled organisms • Trypanosoma cruzi
• Leishmania donovani
1. Amoebae
• Entamoeba histolytica 5. Coccidia
Blood and tissue
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• Entamoeba hartmani
• Entamoeba coli • Plasmodium species
• Endolimax nana • Toxoplasma gondii

• Iodamoeba butschlii Intestinal
• Blastocystis hominis • Isospora belli
• Cryptosporidium parvum
2. Ciliates
• Cyclospora cayetanensis
• Balantidium coli
3. Flagellates 6. Microsporidia
• Encephalitozoon sp.
• Giardia lamblia
• Enterocytozoon sp.
• Trichomonas vaginalis 46
• Trichomonas hominis
4. Haemoflagellates
HELMINTHS • Echinococcus granulosus
• Multi-cellular worms • Hymenolepis nana
• Do not generally multiply in • Hymenolepis diminuta
human 4. Nematodes (Roundworms)
Intestinal
10/1/2017
1. Trematodes (Flukes)
Blood flukes • Trichuris trichiura (whipworm)
• Schistosoma haematobium • Strongyloides stercoralis

• Schistosoma mansoni • Ascaris lumbricoides (roundworm)
• Schistosoma japonicum • Enterobius vermicularis
Tissue flukes (threadworm, pin worm)
• Paragonimus westermani • Ancylostoma duodenale
(hookworm)
• Clonorchis sinensis
• Necator americanus (hookworm)
• Fasciola hepatica
Tissue
2. Cestodes (Tapeworms) • Wuchereria bancrofti 47
• Taenia saginata • Brugia species
• Taenia solium • Loa loa

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Introduction to Medical

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

• Environmental changes, human behavior and population

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

• Carrier state - a perfect host parasite relationship where

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

Medica; Parasitology - SBD2114

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