Introduction to Medical Parasitology

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Learning Objectives:
At the end of this chapter the student will be able
to:
– Define the common terminology in parasitology
– Describe classification of medically important parasites
– Discuss the geographical distribution, mode of transmission,
source of infection, and portal of entry of parasites
– Explain the general life cycles of parasites
– Discuss pathogenesis mechanism of parasites
– Explain host immunity & immuno – evasion mechanisms by
parasites
– Describe the diagnosis, treatment and prevention of parasitic
infections
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Introduction to Medical parasitology
1.1. Definition
➢ Medical parasitology:
➢ The study of the parasites of man and their medical
consequences or
➢ it is the study of organisms living in or on the human
body (host) and the Diseases they produce
➢ It is a subject that researches:
– the biological features of human parasites,
– the relationship between the human being and the parasites,
– the prevention and treatment of the parasitic diseases.
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1.2. Scope of Medical Parasitology
➢ Parasites should include:-

➢ viruses, bacteria, fungi,

➢ protozoa and metazoa (multi-celled organisms) which

infect their host.

➢ However, for historical reasons the first three have been

incorporated into the discipline of Microbiology.
Therefore, Medical parasitology consists of:-
 Protozoa(single celled animals),
 Arthropods: many arthropods feed on human blood &
tissue fluids.
 Helminths (worms)
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 • Phylum Sarcomastigophora
• Amoeba
Medical • Flagellates
Human/ Medical
Parasitology

• Phylum Apicomplexa
Protozoology
• Phylum Microsporodia
• Phylum Ciliophora
• Class Nematoda
Medical
• Class Trematoda
Helminthology • Class Cestoda

• Class Insecta
Medical • Class Arachnida
• Class Crustacea
Arthropodology • Class Chilopoda

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 Classification of parasites
➢ The classification of parasites is controversial. There is no
universally accepted system

➢ Parasites are classified into 2 sub-kingdoms: protozoa (unicellular)

and metazoa (multicellular)

➢ Protozoan parasites are classified according to means of

locomotion and reproduction

➢ Metazoa include the worms (helminths) and arthropoda

(insects) e.g. ticks, lice

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 Taxonomic classification of helminths
Sub kingdom Phylum Class Genus – examples

Metazoa Nemathelmints Ascaris (roundworm)

Round worms; appear Trichuris (whipworm)
round in cross section, Hookworm
they have body cavities, pinworm
a straight alimentary
canal and an anus Strongyloides

Platyhelminths Cestodes Taenia (tapeworm)

Flat worms; Adult tapeworms are
dorsoventrally flattened, found in the intestine of
no body cavity and, if their host
present, the alimentary
canal is blind ending

Trematodes Fasciolopsis (liver fluke)

Non-segmented, usually leaf- Schistosoma (not leaf
shaped!)
shaped, with two suckers but
no distinct head

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 Taxonomic classification of protozoa
Sub Phylum Sub-phylum Genus- Species-
kingdom examples examples

Protozoa Sarcomastig Sarcodina Entamoeba E. histolytica

ophora move by
pseudopodia
further divided into

Mastigophora Giardia G. lamblia

move by flagella

Apicomplexa Plasmodium P. falciparum,

no organelle P. vivax,
of locomotion P. malariae,
P. ovale

Ciliophora Balantidium B. coli

move by cilia

Microspora Enterocyto- E. bienusi

Spore-forming zoa
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Nomenclature of parasites
➢ Common name versus Scientific name

➢ Parasites named by binomial nomenclature

o Genus (capitalized)

o Species (not capitalized)

➢ Binomial name underlined or separately italicized

E.g.: Ascaris lumbricoides, Ascaris lumbricoides, A. lumbricoides

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Specifically, the significance of studying parasites is:

1) To identify the different kind of parasites and their correlated

diseases
2) Studying parasite environments and life cycles that may lead for
controlling measures
3) Knowing the parasites pathogenesis and the relationship with
their host
4) Studying the control method and the development of new vaccine
and drugs against parasites
5) Studying the diagnosis and detection methods
6) Treatment and prevention

❖ In over all to decrease parasitic disease morbidly and mortality or

to eliminate the parasitic disease in community
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 Parasites are our problems
➢Six major tropical parasitic diseases to which WHO
pays great attention include:
✓Malaria
✓Schistosomiasis
✓Filariasis
✓Leishmaniasis
✓Trypanosomiasis
✓leprosy
➢Five of them are parasitic diseases except leprosy
➢All the above diseases are prevalent and cause death
and illness in Ethiopia

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 Burden of Parasitic diseases
Parasite Diseases No. people infected Deaths/yr
Plasmodium malaria 273 million 1.12 million

Soil transmitted helminths: 2 billion 200,000

• Roundworm (Ascaris) Pnemonitis, intestinal

obstruction
• Whipworm (Trichuris)
• Bloody diarrhoea, rectal
• Hookworm prolapse
(Ancylostoma and
Necator) Coughing, wheezing,
abdominal 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 13 million 14,000
(cardiovascular)
African trypanosomes African sleeping sickness 0.3 – 0.5 million 48,000
Leishamania Cutaneous, mucocutaneous 12 million; 2 million 50,000 12
and visceral leishmaniasis new cases/yr
 1.3. Concepts related to medical parasitology
1.3.1.Symbiosis
➢ Any association more or less permanent is called a symbiosis.
➢ Two different organisms live together and interact, one partner
lives in or on another one’s body.
✓3 types:
• Mutualism
• Commensalism
• Parasitism

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❖ Mutualism
➢Permanent association between two different
organisms that life apart is impossible,
➢Two partners benefit each other,
➢The mutuals are metabolically dependent on
one another;
➢One cannot survive in the absence of the other.
✓Eg. association between certain species of
flagellated protozoa(Trichonympha) living
in the guts of termites

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❖Commensalism
➢ Association of two different organisms
➢ One partner is benefited while the other neither benefited nor
injured,
➢ E.g. Entamoeba coli and man.

❖Parasitism
➢ Association of two different organisms
➢ One partner is benefited while the other is injured, such as most
pathogenic parasites and man.
➢E.g. Ascaris lumbricoides and man.

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 Symbiosis
severe To one

Parasitism
Unilateral benefit
benefit

harm

Commensalism, Mutualism
shelter & food reciprocal benefit

none
both

partial complete
dependency 16
Parasite and types of parasites
Parasite:
➢ Is an organisms that live in or on the body of another living
being (host) and obtain shelter and nourishment from it.
Parasites spend all or parts of their life with host.
➢ In parasitism, parasite is the benefited partner.
In another words:

➢ A small organism (Parasite) has the potential to harm a

larger organism (Host), and relies on the host for nutrients
and shelter (a Niche).
➢ Parasites spend all or parts of their life with host.

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Cont…
➢ Of central importance to the success of all parasites is
adaptability to changing environmental circumstances

– This is achieved to a great extent by the ability of these

organisms to alter structurally and biochemically, to
produce a number of stages (protozoa) or developmental
forms (helminths).

e.g. Egg----larva---adult

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Nature of parasites
➢ Are unicellular / multicelular
➢ Are smaller than their host
➢ Are numerous than the host.
➢ Have short life span
➢ Greater reproductive potential
➢ Physiologically and metabolically depend on the host.

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Types of Parasites

Parasite can be Classified:

I. According to their habitat
➢Endoparasite:
✓Lives inside the body of the host
✓May be just under the surface or deep in the
body
▪ E.g: Tapeworms, flukes, protozoans
➢Ectoparasite:
✓Stays on outside surface of the host
▪ E.g: ticks, fleas, bug, lice
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II. Based on dependency on the host
➢ Obligate Parasite
✓Requires finding and invading the host to
complete its life cycle
✓Most of the parasites we will cover are obligate
parasites
➢ Facultative Parasite
✓May become parasitic if it is given the chance
but does not require a host.
III. According to their Pathogenicity:
✓Pathogenic parasites
✓Non-Pathogenic (commensal)
✓Opportunistic parasites 21
IV. Amount of time spent
➢Permanent Parasite
– Lives entire adult life stage on or in a host
– Usually endoparasites
➢Temporary Parasite
– Spends only a short time on a host
– Usually ectoparasites

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 Other terminology

❖ Aberrant parasite:
✓ Found in locations in the host where they normally do not occur.
E.g., Ascaris larvae may migrate to the brain
❖ Incidental parasite:
✓ Occurs in hosts where it does not normally occur;
E.g., Fasciola normally does not occur in man but is incidental if
found in man’s liver.

❖Infective Stage:
✓ it is a stage when a parasite can invade human body and
continue to live there.
E.g. The infective stage of Ascarid is the embryonated egg.
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❖Infective Route:
✓ is the specific entrance through which the parasite invades the
human body.

E.g. Hookworms invade human body by skin. Man gets infection

with Ascaris by mouth

❖Infective Mode:
✓ means how the parasite invades human body.

E.g. cercariae of the blood fluke actively penetrate the skin of a

swimming man and the infective stage of Ascaris eggs are
swallowed by man.
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❖Geohelminth:
✓ refers to the helminths which complete their life cycles in
one host or not requiring the processes of the
development in intermediate hosts.
✓ They have only one host and a simple life cycle.
E.g. Ascaris, hookworm, pinworm etc...
❖Biohelminth:
✓ refers to the helminths which have to undergo the
development in intermediate hosts to complete their life
cycles.
E.g. Filarial, liver fluke, tapeworm etc…

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❖Alternation of Generation:
✓In life cycles of some parasites, there are the regular
alternation of sexual and asexual reproductions
E.g. Plasmodium species
❖Trophozoite:
✓ is a living stage of protozoa when they can move, take food
and reproduce. (It is usually the pathogenic stage.)
❖Cyst:
✓ is the resting stage of a protozoa with a protective wall. It is
usually the infective stage. Its functions are protection,
transmission and multiplication.

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Reading assignment

✓Diagnostic stage

✓Clinical incubation period

✓Biological period

✓Supper infection (hyper) infection

✓Auto-infection

✓Mixed (multiple) infection

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 1.3.3.Hosts and types of hosts
❖Host:
✓are organism which harbors the parasite.
✓In parasitism, it is the injured partner
❖Types of Hosts: -
❖ Definitive host
❖ Intermediate host
❖Definitive host:
▪ Where sexual reproduction takes place.
▪ Normally where the adult parasites live.
▪ Normally the larger of the hosts, usually a vertebrate.
▪ Convention - (parasites which only reproduce asexually)
▪ E.g. man for W. bancrofti

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 Cont…
❖Intermediate host:
✓ Sexually immature or larval stage of a parasite
✓ Asexual multiplication takes place
✓ Harbor the immature stages of a parasite;
e.g. snail intermediate host blood fluke ( Schistosoma spps)
➢ Some parasites:
▪ require more than one intermediate host which are then
designated as first, second intermediate

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❖Reservoir Host:
✓ Any animal that carries a parasite that can cause infections
in humans. Even if it is the normal host for that parasite.
✓E.g. Hyrax- Cutaneous Leishmaniasis in Ethiopia
❖Carrier Host:
✓ A person who harbors parasites has no any clinical
symptom. He/she is an important source of infection in
epidemiology
E.g. human beings harboring cyst form of E. histolytica
❖Accidental or Incidental Host:
✓Parasite is in the “wrong” species.
✓Parasite usually wanders around and causes great
damage because it doesn’t know where to go then
dies. E.g. hydatid cyst in man
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 Vector and types of vectors

❖Vector:
✓ an organism (usually an arthropod) which transfers infective
forms of a parasite from one host to the other.
❖Classification:
1. Biological vectors:-
2. Mechanical (Parathenic or transport) Vectors

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 Cont…
1. Biological vectors
✓ characterized by the development of the parasite before its transfer
to another host
➢Propagative
E.g. Yersinia pestis in fleas
➢Cyclopropagative
E.g. Plasmodium in Anopheles mosquitoes.
➢Cyclodevelopmental
E.g. Onchocerca volvulus in black flies.
2. Mechanical vector
✓no parasitic development of reproduction occurs
E.g. House fly
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1.4. Epidemiology of parasite
➢ Epidemiology: The study of the patterns of
diseases within populations
➢For parasites, this includes:
▪ Host range – what can it infect?
▪ Geographic range – where is it?
▪ Is it a zoonotic agent?
o Can it infect humans?
▪ Does it have a reservoir?
o A group of vertebrates maintaining the parasite

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1.4.1.Geographic Distribution

➢ Global distribution
✓ parasite occur globally,
✓ the majority occur in tropical regions,
➢Factors for Endemicity:
✓ Presence of a suitable host
✓ Habits of the host
✓ Escape from the host
✓ Favorable conditions outside of host
✓ Economic and social conditions
• poverty, poor sanitation and personal hygiene
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Transmission of parasites

❖Factors required: Three key links of parasitic disease

transmission
1. Source of infection

2. Mode of transmission

3. Susceptible people/host

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1. Sources of Exposure to Parasitic Infections
A. Contaminated soil:
✓ Soils polluted with human excreta is commonly
responsible for exposure to infection with geohelminthes
B. Contaminated water:
(a) viable cysts of Amoeba, flagellates etc,
(b) cercarial stages of human blood fluke,
(c) Cyclops containing larva of Dracunculus medinensis
(d) fresh water fishes which are sources for fish tape
worm, and intestinal flukes infection
(e) crab or cray fishes that are sources for lung fluke and
(f) Water plants which are sources for Fasciolopsis buski.

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C. Raw or Insufficiently cooked meat of pork, beef and fish
E.g., Trichinella spiralis, Taenia species, D. latum.
D. Blood sucking arthropods:
 Malaria - anopheles mosquito
 Leishmania - sand flies
 Trypanosoma - tsetse fly
E. Animals (a domestic or wild animals harboring the
parasite),
E.g. Dogs- the hydatid cyst caused by E. granulosus
F. Human beings:
o A person his/her clothing, bedding or the immediate
environment that he/she contaminated
E.g. E. vermicularis

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All are dangerous!

All are sources for parasitic infection

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Mode of Transmission

A. Direct mode of Transmission:

classified as:
I. Horizontal Direct mode of transmission: Transmission is
mainly achieved through:
✓ Feco-oral route: most intestinal parasites transmitted in this
way.
✓ Sexual intercourse
✓ Blood transfusion
✓ Direct skin penetration

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II. Vertical Direct Mode of Transmission: Transmission of the
parasite is from mother to child through:
✓ Congenital / transplacental
✓ Transmammary (breast milk)
B. Indirect Mode of Transmission:
➢If the parasite:
✓ has complex life cycle
✓ requires biological vectors and/or
✓ one or more intermediate hosts
E.g. Plasmodium spps

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Route of Transmission

I. By ingesting infective stage of parasites:

✓In food, water or hands contaminated with faeces,
E.g. E. histolytica, E. vermicularis, etc.
✓ In raw or undercooked meat
E.g. T. saginata, T. solium, T. spiralis
✓ In raw or undercooked fish, crab, or water vegetation
E.g. intestinal flukes
✓ Water containing Cyclope
E.g. D. medinensis

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II. Penetration of Skin When in Contact with:
✓Faecally polluted soil, e.g., S.stercoralis, Hook
worms
✓Water containing infective stages of the parasite
E.g. Cercaria of Schistosoma species
III. Through insect Bite:
E.g., filarial worms, Trypanosoma spp, Plasmodium
spp. etc.

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 Cont…
❖Sexual Contact: e.g. Trichomonas vaginalis

❖Transmammary: e.g. S. stercoralis, T. gondii

❖Inhalation of contaminated air: e.g. E. vermicularis

❖Transplacental: e.g. T. gondii

❖Kissing: e.g. Entamoeba gingivalis, Trichomonas tenax

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1.5. General Life Cycles of parasites
➢ Describes the cycle of development of the parasite,
➢ This may involve
o Passing through a number of developmental stages &
environment
o Parasitic and non-parasitic stages.
➢ The life of a parasite can be divided into a number of phases:
o Growth and maturation,
o Reproductive (sexual and asexual) and
o Transmission phases.
o All are vitally important for the successful survival of the
parasite.
➢ Can be simple or complex depending on how many different
hosts it requires to complete its cycle

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1. Simple or Direct Life Cycle (monoxenous)
➢ only one host is required to complete its cycle
➢ the parasite often spends most of its life, usually as an adult,
and where it reproduces
➢ Transmitted from one host to another through the air, by a
fomite, or in contaminated food or water.

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 2. Indirect or heteroxenous life cycles
➢ requires 2 or more hosts (a vector or intermediate host ) to
reproduce or grow in
➢ Frequently this may involve passing through a number of
developmental stages & environment.

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 1.5.3.Why study life cycles???
➢ Control.
➢ Treatment
➢ Epidemiology
➢ Fundamental research

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1.6. Parasitic Infections & Disease
➢ Not all parasitic infections cause disease of clinical
significance.
➢ Both host and parasitic factors are involved for the
parasitic infection to cause disease or not.

1.6.1. Parasite factors

1. Strain of the parasite and adaptation to human host
2. Parasite load ( number of parasite )
3. Site (s) occupied in the body
4. Metabolic processes of the parasite, particularly the
nature of any waste products or toxins produced by the
parasite during its growth and reproduction
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1.6.2. Host Factors
1. Genetic factors:
E.g. Black population who lack Duffy antigen resist P. vivax
2. Age
3. Sex: e.g., T. vaginalis
4. Level of immunity: natural and acquired immunity
5. Nutrition (malnutrition or under-nutrition)
6. Intensity and frequency of infections
7. Presence of co-existing disease or conditions, which reduces
immune response. e.g. Pregnancy, HIV
8. Life style and occupation

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1.6.3. How do Parasites Cause Injury to their Host?
➢ Competition for the host’s nutrients:
✓ E.g. Hookworm feed blood 250ml/day and D. latum consumes Vitamin B12

➢ Destruction of host tissues:

o Some injure upon entry, some after established:
o E.g.
✓Swimmers itch, cercariae penetrate and cause inflammation
✓intestinal worms, after established cause small lesions in
gut, possible secondary infection
✓Entamoeba actively digest epithelial cells in large intestine

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➢ Tissue changes:
✓ May cause serious consequences to host

✓ Hyperplasia/ Hypertrophy: E.g Fasciola

✓Metaplasia: change of tissue cell type to another

type. E.g. Paragonims (lung fluke)

✓Neoplasia : S. haematobium ---- urinary bladder

cancer
➢Immuno-pathological lesion
✓Schistosoma liver cirrhosis; when hydatid fluid is
released from the rupture of a hydatid cyst
anaphylaxis often results 51
➢ Toxins and secretions:
✓ some may cause pathogenic response, some may inhibit
immune function E.g. Mosquito saliva, hydatid cyst

➢ Mechanical interference:
✓ Elephantiasis (filarial worms) blocks lymphatic system

✓ Tapeworms in large numbers can block intestine

✓ Ascaris cause intestinal obstruction

✓ Plasmodium can cause RBC’s to stick together and clog

capillaries

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1.7. Host Immunity & Immuno – evasion of
the parasite
❑ Host immunity
➢ It refers to the ability of a host to defend itself against a
parasite
➢ Its intensity and specificity are usually at a lower level than
those produced by bacteria and viruses
➢ Resistance to parasites involves three interrelated
mechanisms:
– Nonspecific immunity
– Specific immunity: cellular and humeral

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Host Responses…
❖Nonspecific immunity:
➢ Effector cells such as macrophages, neutrophils, eosinophils and
platelets can kill both protozoa and worms
➢ They secrete cytotoxic molecules such as reactive oxygen radicals and
nitric oxide
✓ Macrophage endocytosis
o Common for small protozoa
✓ Inflammation
o Acute – edema and increase of leukocytes
o Subacute – monocytes and lymphocytes present, with fibrocytes
binding parasite with collagen.
o Chronic – plasma cells present and form a granuloma
✓ Hyperplasia – parasite causes host to produce more cells
o Liver fluke simulating enlargement of bile duct
✓ Neoplasia (cancer) – rare parasites have been associated with
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cancer, but mechanisms are still unknown.
Host Responses…
Specific Immunity
✓ Humeral response: Formation of antibodies or
immunoglobulin s(Ig) by B cells.
o IgE fights helminths
o IgM and IgG important against protozoans
➢ It enhances the phagocytic and cytotoxic potential of
effector cells, and can prevent the invasion of new host
cells
✓Cell mediated response: uses T-cells
o TH1 cells provide protection against intracellular protozoa by
secreting interferon-γ (IFNγ), which activates macrophages
o Cytotoxic T cells inject invading parasites
• Also release cytokines, which promote nonspecific immunity
o TH2 cells are necessary for the elimination of intestinal worms
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 Adaptive immunity to parasites
Parasite Immune response Effector mechanism

TH2 cells --> IL-4, IL-5 Eosinophils kill IgE-coated

Helminths
--> IgE, eosinophils parasites (form of ADCC)

T cells produce IFN-g --> Phagocytes kill parasites

Leishmania
activation of phagocytes living in endosomes

CD8+ T cells --> IFN-g, TNF  activate

plasmodium secretion of cytokines macrophages, neutrophils
Role of antibody? to kill parasites
 All protozoal infections
➢Are accompanied by a number of immunological
changes:
– production of specific antibodies
• usually IgM followed by IgG
– cell-mediated responses
➢Immunological responses have little or nothing
to do with protection
➢all protozoa are antigenically complex
T cell exhaustion in protozoan disease
➢ During acute infections
– host develops a successful T cell immune response
– characterized by:
• rapid proliferation
• strong polyfunctionality
– cytotoxicity
– production of IFNg, TNF, and IL-2
➢ During chronic infection
– T cells become progressively exhausted
• cells lose the ability to produce TNF
– Gradually lose
• Ability to mount an effective recall response to infection
• Their polyfunctionality ability
 T cell exhaustion in protozoan disease
➢ Gradual up regulation of inhibitory receptors
– PD-1, LAG-3, CD160, CTLA4, 2B4
– Plays a central role in T cell exhaustion
➢ The expression of multiple inhibitory receptors
– Leads to severe T cell exhaustion
➢ Exhausted T cells
– Exhibit increased apoptosis potential
– Leading to their complete deletion
➢ T cell exhaustion is highly dependent on:
– antigen load
– antigen burden
 TH2-type effector mechanisms in immunity to
helminths
➢ Mucosal immunity to helminths
– Th2-type responses are initiated and sustained by innate
populations (epithelial cell layer) through IL-25& IL-33
– IL-13(Th2-type cytokines)
• Increases cell turnover (resulting in ‘epithelial escalator’)
• Induces differentiation of goblet cells
– produce mucins and anti-nematode protein resistin-like molecule-β
(RELMβ)
• Fluid transfer into gut is raised by action of mast cell proteases
– degrade tight junctions in epithelial cell layer
– adding to the ‘weep and sweep’ process
– Antibodies from B cells
• Diminishing worm fitness and fecundity
 Effector Th2 type immunity in peripheral tissue

➢ Parasites are open to attack by full range of host innate effectors

– macrophages
– neutrophils
– Eosinophils
– Basophils
– platelets
➢ Ability of these effector cells is often dependent on
– one or more isotypes of specific antibody
• often IgE, but IgM in the bloodstream
– complement
➢ Armed granulocytes or macrophages can release damaging
metabolic ROI or RNI
– but in vivo killing methods are not yet fully understood
The role of TH2 responses in defense against helminths

Eosinophils are better at killing helminths than are other

leukocytes; the TH2 response and IgE provide a mechanism
for bringing eosinophils to helminths and activating the cells.
 Immune evasion by parasites
1- Sequestration of Parasite
Means: The location of the parasite that makes it
inaccessible to the immune response.
This can be achieved through:
➢ Intracellular habitat:
E.g. Plasmodium, Toxoplasma, Leishmania Plasmodium
Tissue cyst of Amastigotes of parasite
Toxoplasma Leishmania

➢ Presence of surrounding cyst wall

E.g. Trichinella larva.
Encysted larva of T.spiralis
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2- Parasite movement

o Adult Ancylostoma: move away from inflamed

tissue to fresh areas.
o larva migrans: Migrating larva escapes the
immune response elicited locally.
 3- Antigenic modification
➢ Antigen variation:
E.g. African trypanosomes, malaria parasites.
➢ Antigen disguise/masking:
Parasites cover themselves with host proteins to be considered as
self and will not be attacked by the immune factors
E.g. adult Schistosoma.
➢ Antigen mimicry:
Parasites produce antigens similar to host antigens so they are not
recognized by the host’s immune system
E.g. Schistosoma.
➢ Antigen shedding:
Parasites shed their antigens in abundance can neutralize antibody
response at a distance away from the parasite
E.g. Schistosoma mansoni and Plasmodium falciparum. 66
 4- Inhibition of Immune Factors
➢ Cleavage of antibodies: parasite produces a protease enzyme that
can cleave immunoglobulin molecule into Fab and Fc portions
E.g. Trypanosoma cruzi. enzyme
Fab Fc
➢ Inactivation of complement: through:
o Protease activity E.g. Schistosoma larva.
o Acceleration of decay of complement E.g. Trypanosoma cruzi.
o Ejection of membrane attack complex from their surface
E.g. Leishmania.
➢ Inhibition of macrophages by several inhibitory mechanisms so they
can survive in macrophages e.g. Leishmania, Toxoplasma,
Trypanosoma cruzi.
X 67
 5- Production of blocking antibodies

➢ Antibodies of little protective effect. Some helminths

produce blocking Abs that combine with helminths Ags
making them unavailable for antibodies of high
protective effect (antibodies involved in ADCC)
E.g. Schistosoma
6- Immunosuppression
➢ Mediated through Ts cells E.g. Leishmania
➢ Schistosoma spp. produce the so-called “Schistosomes
apoptosis factor“ that induces apoptosis of CD4+ T
lymphocytes.
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Diagnosis of Parasitic Infections
1. Clinical diagnosis
➢ Sign
➢ Symptom
2. Laboratory diagnosis
1. Parasitic (morphological) diagnosis
– Macroscopic
– Microscopic
2. Immunological diagnosis
– Antibody detection
– Antigen detection
3. Molecular diagnosis
4. Culture
5. Animal inoculation
6. Xenodiagnosis
Control of parasitic disease

A. Prevention
➢ Blocking transmission
✓ Control of vectors
✓ Reduction of contamination
✓ Control of animal reservoir
➢ Health education and improved sanitation
✓ Personal hygiene- hand washing
✓ Food handling - covering & Cooking
➢ Sewage treatment and waste disposal
➢ Water quality: boiling, treating and covering

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 Cont…

B. Treatment: Early identification and treatment of

infected individuals

1. Surgical

2. Chemotherapy

3. Adequate nutrition

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Parasites are our problems!!!

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