CLINICAL PARASITOLOGY MODULE 1 Entamoeba histolytica in the human

gut)

B. CLASSIFICATION OF
DEFINITION OF TERMS PARASITES

According to habitat:
• Parasitology  Ectoparasite – a parasite living
- area of biology concerned with outside the body
the phenomenon of Infestation – presence of an
dependence of one living ectoparasite on a host
organism on another
• Medical Parasitology  Endoparasite – a parasite living
- concerned primarily with the inside the body
animal parasites of humans and Infection – presence of an
their medical significance, as endoparasite in a host
well as their importance in ▪ Hematozoic – lives inside
human communities RBCs
• Tropical Medicine ▪ Cytozoic – living inside
- branch of medicine which deals cells or tissues
with tropical diseases and other ▪ Coelozoic – lives inside
special medical problems of body cavities
tropical regions ▪ Enterozoic – lives in the
• Tropical Diseases intestines
- an illness which is indigenous to
or endemic in a tropical area but  Erratic Parasite – parasite found
may also occur in sporadic or outside its usual habitat
epidemic proportions in non- Ex. adult Ascaris worms may
tropical areas migrate from their usual habitat
(small intestine) into other sites (e.g.
lungs)
A. BIOLOGICAL RELATIONSHIPS

Symbiosis – the living together of unlike

organisms and may also involve protection According to mode of development:
or other advantages to one or both partners 1. Obligate Parasite
1. Commensalism – a symbiotic - needs a host at some stage of
relationship in which two species its life cycle to complete its
live together and one specie development and to propagate
benefits from the relationship its species (e.g. Tapeworms)
without harming or benefiting the 2. Facultative Parasite
other (ex. Entamoeba coli in the - may exist in a free-living state or
human gut) may become parasitic as the
2. Mutualism – two organisms need arises (e.g. Strongyloides)
mutually benefit from each other 3. Accidental/Incidental Parasites
(ex. Flagellates in the digestive - establishes itself in a host
system of termites) where it does not ordinarily live
3. Parasitism – one organism, the 4. Permanent Parasite
parasite, lives in or on another - remains on or in the body of the
organism (host), depending on the host for its entire life
latter for its survival and usually at 5. Temporary Parasite
the expense of the host (ex.
 - lives on the host only for a short  Exposure
period of time - process of inoculating an
infectious agent
6. Spurious Parasite  Infection
- a free-living organism that - establishment of the ineffective
passes through the digestive agent in the host
tract without infecting the host  (Clinical) Incubation Period
- period between infection and
C. CLASSIFICATION OF HOSTS evidence of symptoms
 Biologic Incubation Period/Pre-
1. Definitive/Final Host patent Period
- one in which the parasite attains - period between infection or
sexual maturity acquisition of parasite and
2. Intermediate Host evidence or demonstration of
- harbors the asexual or larval infection
stage
3. Paratenic Host F. EXPOSURE AND INFECTION
- one in which the parasite does
not develop further to later  Autoinfection
stages, however, the parasite - occurs when infected individual
remains alive and is able to becomes his/her own direct
infect another susceptible host source of infection
4. Reservoir Host - Ex. Enterobiasis through hand-
- host other than definitive, to-mouth transmission when
intermediate, or paratenic host infective eggs may end up in the
which allows the parasite’s life hands by scratching the
cycle to continue and become perianal areas
additional sources of human  Superinfection/Hyperinfection
infection - when individual is further
infected by the same species
D. CLASSIFICATION OF VECTORS resulting to massive/severe
Vectors – responsible for transmitting the infection
parasite from one host to another - Ex. Alteration in the normal life
cycle of Strongyloides when
1. Biological Vector there’s an increase in
- transmits the parasite only after proportion of rhabiditiform
the latter has completed its larvae that transforms into
development within the host filariform larvae while in the gut
- Ex. Aedes mosquito
2. Mechanical/Phoretic Vector G. SOURCES OF INFECCTION
- only transports the parasites
- Ex. flies, cockroaches  Soil – favors the development of
Nematodes (e.g. Ascaris
E. EXPOSURE AND INFECTION lumbricoides, Trichuris trichiura,
Strongyloides stercoralis,
 Pathogen Hookworms)
- biological agent that causes  Water – may be contaminated by
disease or illness to its host cysts of amoeba and flagellates as
 Carrier well as cercaride of Schistosoma
- harbors a particular pathogen  Food – may contain the ineffective
without manifesting any signs stage of the parasite, as exemplified
and symptoms
 by a number of trematode and ❖ Transmammary Transmission
cestode infections - infection with Ancylostoma and
- Undercooked/Raw freshwater Strongyloides through mother’s
fish-intestinal and liver flukes milk
- Raw crabs- Paragonimiasis ❖ Sexual Intercourse
- Bullastra Snails – Echinostoma - Trichomonas vaginalis infection
malayanum
 Anthropods – serve as vectors I. NOMENCLATURE
- Mosquitoes: vectors of malaria • International Code of Zoological
and filarial parasites Nomenclature
- Triatoma bugs: carriers of - classifies animal parasites
Trypnosoma cruzi causing • Binomial Nomenclature
Chagas’ disease - formal system of naming
 Other Animals species of living things by giving
- Cats: direct sources of each a name (binomial
Toxoplasma infection name/scientific name)
- House rats: commonly infected composed of 2 parts
with Hymenolepsis nana - scientific names are latinized
 Other sources - family names are formed by
- Yourself (autoinfection) adding –idea to the stem of
- Another person, his/her genus type (e.g. Ascarididae)
beddings and clothing - generic names consist of a
- Asymptomatic carriers like food single word written in initial
handlers capital letter
- the specific name always begin
H. MODES OF TRANSMISSION with a smaller letter
- the names of the genera and
❖ Oral species are italicized or
- eating food harbouring the underlined when written (e.g.
ineffective larval stages: Taenia Ascaris lumbricoides or Ascaris
solium, Taenia saginata, and lumbricoides)
Diphyllobothrium latum
- drinking water contaminated
with cysts: Entamoeba
histolytica, and Giardia lambia
- Ingestion of raw or improper
cooked freshwater fish:
Clonorchis, Opistorchis, and
Haplorchis
❖ Skin Penetration
- Hookworms and Strongyloides
(exposure of skin to soil)
- Schistosoma (exposure of skin
to water)
❖ Arthropod Bites
- Malaria, Filariasis, J. LIFE CYCLE
Leishmaniasis and
Trypanosomiasis • Life cycle – a series of changes in
❖ Congenital Transmission form that an organism undergoes,
- Toxoplasma gondii trophozoite returning to the starting state.
can cross the placental barrier o Direct Life Cycle – a
during pregnancy parasite is transmitted
directly from one host to the
 next without an population infected with at least one
intermediate host or vector parasite
of another species. • Intensity of Infection – refers to
o Indirect Life Cycle – the number of worms per infected
require different types of person ; also referred to as worm
hosts or a vector burden
(intermediate host) for • Morbidity – clinical consequences
various stages of their life of infections of diseases that affect
cycle. an individual’s well-being
• Most parasitic organisms attain
sexual maturity in their definitive L. TREATMENT
hosts
• Some spend their entire lives within • Deworming – the use of
the host with one generation after antihelminthic drugs in an individual
another or a public health program
• Others are exposed to the external • Cure Rate – number (usually in
environment before being taken up percentage) of previously positive
by an appropriate host subjects found to be egg-negative
• The larval stage of the parasite may on examination of a stool or urine
pass through different stages in an after deworming
intermediate host before it reaches • Egg Reduction Rate – percentage
a final host fall in egg counts after deworming

Note: Cure rate and Egg reduction rate are

indicators to measure reduction in
prevalence and reduction in intensity of
infection respectively

• Selective Treatment – involves

individual-level deworming ;
selection for treatment based on a
diagnosis of infection or an
assessment of the intensity of
infection
• Targeted Treatment – group-level
deworming ; the group to be treated
K. EPIDEMIOLOGIC MEASURES may be defined by age, sex or other
social characteristics irrespective of
• Epidemiology – the study of infection status
patterns, distribution and • Universal Treatment – population-
occurrence of disease level deworming ; community is
treated irrespective of age, sex,
• Incidence – number of new cases
infection status or the social
of infection appearing in a
characteristics
population in a given period of time
• Preventive Chemotherapy –
• Prevalence – is the number
regular, systemic, large-scale
(usually in percentage) of
intervention involving the
individuals in a population infected
with a particular parasite species at administration of one or more drugs
to selected population groups with
a given time
the aim of reducing morbidity and
• Cumulative Prevalence –
transmission of infection
percentage of individuals in a
• Coverage – refers to the proportion • Environmental Sanitation –
of the target population reached by involves interventions to reduce
intervention environmental health risks
• Drug Resistance – genetically • Eradication vs. Elimination
transmitted loss of susceptibility to a - Eradication: permanent
drug in a worm population that was reduction to zero of the
previously sensitive to the worldwide incidence of
appropriate therapeutic loss incidence of infection;
• Efficacy – effect of the drug against continued measures are no
an ineffective agent in ideal longer needed
experimental conditions - Elimination: reduction to zero
• Effectiveness – measure of the of the incidence of a specified
effect of the drug against the disease in a defined geographic
ineffective agent in a particular host, area; continued intervention or
living in a particular environment surveillance are still required
with specific ecological,
immunological and epidemiological
determinants II. HOST-PARASITE RELATIONSHIPS
- effectiveness is usually
measured by means of Adaptation – causes changes in the
qualitative and quantitative parasite (parasites which are more
diagnostic tests specialized show the greatest changes,
most of which are essential to survival)
M. PREVENTION AND CONTROL
o Phylum Apicomplexa have no
locomotory organelles and are
• Morbidity Control – avoidance of
mostly parasitic
illness caused by infections ;
o Free-living flatworms (cestodes
achieved by periodically deworming and trematodes) have cilia while
individuals or groups, known to be
parasitic cestodes and trematodes
at risk of morbidity
do not have any
• Information-Education- o Cestodes have hooks and suckers
Communication (IEC) – health for anchoring and tissue migration
education strategy that aims to o All cestode embryos have 6
encourage people to adapt and hooklets (hexacanth) which are
maintain healthy life practices useful for tissue penetration
• Environmental Management – o Cestodes and Trematodes obtain
planning, organization, nutrients through their tegument
performance and monitoring of provided with microvilli
activities for the modification and/or o Ascaris worms maintain their
manipulation of environmental position inside the intestinal wall by
factors or their interaction with constant movement
human beings in order to prevent or o Intestinal flukes have spine on their
minimize vector or intermediate tegument to prevent abrasion
host propagation and reducing o Parasite ova, larvae, and cysts have
contact between humans and the special coverings
ineffective state o All tapeworms and flukes except
• Sanitation – provision of access to schistosomes are hermaphroditic
adequate facilities for the safe o Streamlining is the inability of a
disposal of human excreta, usually parasite to synthesize certain
combined with access to safe cellular components
drinking water o E. histolytica trophozoites secrete
cysteine proteinases which allow
 the parasite to penetrate the happens in helminth infections
mucosa in humans
o The cercariae of Schistosoma
contain penetration glands capable
of digesting the skin III. IMMUNOLOGY OF PARASITIC
Effects of the Parasite on the Host INFECTIONS

Inflict damage to the body: Natural Selection

1. Interference with the vital o Allows a parasite to successfully

processes of the host through invade a host
enzyme systems o The ability of the host to exhibit
- Ex. E. histolytica trophozoites defences against parasitic invasion
secrete cysteine proteinases is also selected for
2. Invasion and destruction of the o Host parasite relationship is
host dynamic one; the parasites become
- Ex. Plasmodium spp which specific to some hosts because of
invade RBCs (Plasmodium can natural selection
destroy different stages of Ex. dog or cat hookworms to thrive
RBCs) in humans
3. Deprivation of host essential
nutrients and substances A. HOST-PARASITE INFECTION
- Ex. Diphyllobothrium latum The host is provided with both Natural
completes with host for Vit. B12 (Non-specific) and Acquired (Specific)
- Hookworms cause chronic immune defences
blood loss
A. Non-specific/Natural Immunity
Effects of Host on the Parasite

Factors which determine the outcome of 1. Intact skin

infection: - provides surface protection
against parasite invasion
1. Genetic make-up of the host – - Hookworm and Strongyloides
can protect or make the host can penetrate skin
vulnerable to infection of certain 2. Acidic pH of the vaginal secretion
parasites and gastric juice
- Sickle cell trait confers - hostile to many microorganisms
protection versus P. malaria - Embryonated Ascaris,
- Duffy blood factor increases Trichiuris, and Taenia eggs are
susceptibility to P. vivax protected by their thicker shells
2. Nutritional status of the host - Cystic wall of Giardia and
- High protein diet is not suitable Entamoeba are resistant
for growth of intestinal 3. Mucus secretions
protozoans - Lipase content of breastmilk is
- Low protein diet favors toxic to Giardia lamblia
symptoms of amoebiasis and - Lysozyme in tears and saliva
its complications (amoebic destroy microorganisms
abscess or others) to appear 4. Human reflexes
- Carbohydrate-rich diet favors - Coughing can expel erratic
some tapeworms adult Ascaris
3. Immune Process - Flushing action of urine can
- absolute immunity to reinfection lower the number of
rarely occurs in protozoal Trichomonas vaginalis
infections and probably never 5. Cells in the Human Body
 - Eosinophils and Neutrophils - Trypanosoma gambiense –
increase parasitic invasion host immune response may be
- Macrophages serve as first line ineffective for subsequent
cellular defences against releases of trypomastigotes
invading pathogens through due to parasite’s change of Ag
phagocytosis profile of its surface coat – VSG
4. Host Mimicry
- Tegument of Schistosome adult
can acquire antigenic
molecules from the host
B. Specific/Acquired Immunity

The host, once infected is exposed to the

parasite antigen, which in turn stimulates the
5. Intracellular Sequestration
host to mount an acquired specific response
- Toxoplasma gondii multiply
• Humoral – production of Antibodies inside macrophages and other
o IgE – associated with nucleated cells thus, enabling it
allergic reactions and to escape the host immune
parasitic infections response
o IgG and IgM – can prevent
penetration of RBC by D. ADVERSE EFFECTS OF THE
Babesia; Generally IMMUNE RESPONSE IN THE
infective against GI HOST
helminthes Intense or abnormal immune response to
o IgA – protection against parasitic infection may result in pathological
metacestode and GI manifestations of the parasitic disease.
infections
• Cell-mediated – production Examples:
Cytokines
• T. cruzi – intense immune response
C. PARASITE EVASION in acute infection may result to
MECHANISMS massive damage to infected cells,
surrounding normal cells (nerve
Developed by parasites to avoid the cells, myofibers)
destructive effect of the host response. • Schistosoma spp. – immune
response to eggs trapped in
1. Resistance to Immune Response
different host organs →
- The cuticle and integument of
hepatosplenomegaly, fibrosis,
helminth parasites make them
esophageal varices, portal
resistant to the cytotoxic effect
hypertension
of both neutrophils and
• Schistosoma spp and Leishmania
macrophages
spp. – T-delayed type
2. Immune Suppression
hypersensitivity (T-DTH)
- Plasmodium spp. reduce the
immune function of
E. PRACTICAL APPLICATIONS
macrophages
- Trypanosoma brucei
• Immunodiagnosis – to diagnose
trypomastigotes large amounts
what source of parasite is
of surface glycoproteins that
invading/infecting the human body
impairs B and T-lymphocyte
using the immunologic response
activities
3. Antigenic Variation • Control of Immunopathology
- immunoregulation
 - immunomodulation o Subphylum
- novel drugs Mastigophora – has
- vaccine development flagella (Atrial flagellates,
Hemoflagellates)
IV. PARASITE GROUPS AND THEIR o Subphylum Sarcodina –
MEDICAL IMPORTANCE includes the amebae
 All parasites can be classified • Phylum Ciliophora – ciliated
according to the Linnean hierarchal (Balantidium coli)
scheme • Phylum Apicomplexa – has apical
- based on morphological complex (all members are parasitic)
characteristics • Phylum Microspora – spore-
 Currently, there are more powerful forming parasites
tools to classify parasites based on
molecular studies (e.g. DNA
sequencing, PCR, etc)
II. Metazoans – multicellular
organisms

• Phylum Nemathelminthes –
Roundworms (Nematodes)
• Phylum Platyhelminthes –
Flatworms (Cestodes, Trematodes)
• Phylum Anthropoda – Medically-
significant insects

I. Protozoa
• unicellular organisms
• has locomotory apparatus
o Cilia – hairlike
projections from
the ectoplasm
o Flagella – whiplike
structure arising
from the ectoplasm
o Pseudopodia –
hyaline, foot-like
extrusions from the
ectoplasm
• has 2 stages
o Cyst – non-feeding, non-
motile, ineffective stage
o Trophozoite –
feeding/vegetative, motile
stage
• Phylum Sarcomastigophora