MEDICAL PARASITOLOGY

Lecture I: Intro
 Introduction to Medical Parasitology

• Definition of Medical Parasitology

• The Scope of Medical Parasitology
• Classification of parasites
• Terms used in Parasitology
• Parasites’ Harms to Man (= pathogenic effects of parasites
on Man)

• Human Immunity against Parasites

• Characteristics of parasitic diseases
 MEDICAL PARASITOLOGY

WHAT IS PARASITOLOGY?
▪ Study of the biology of parasites

Medical Parasitology is the study of organisms

(parasites) that parasitize/infect humans.
 Why study Parasitology?
• Many of these parasites are causative agents of major public
health problems of the world.
• Recent estimates of prevalence of parasites in the world
are:
Ascaris 1.5 billion
Hookworms 1.3 billion
Whipworms 1 billion
Filarial worms 657 million
Plasmodium sp 500 million
Schistosomes 270 million
Entamoeba 50 million
Tapeworms 50 million
Clonorchis 20 million
Chagas’ Disease 15 million
• These parasites cause untold suffering and death in the
world today.
 The Scope of Human Parasitology
Parasitology deals with:

1) Protozoa (single celled animals) >>>> Protozoology

2) Helminths (worms) >>>>> Helminthology

3) Arthropods (Insects) >>>>>> Entomology

4) Ticks and mites are the concern of Acarology.

The insects that are of most interest in Human Parasitology

are those that are vectors of several parasitic infections.
 Types of Animal Associations

1. Intra-specific Association: association

organisms within the same species
2. Inter-specific Association: association
between organisms of different species
▪ All inter-specific associations are grouped
under Symbiosis ( = living together)
sym = together, bios = life
 Examples of Inter-specific associations
Commensalism:
Co = together, mensa = table
▪ One organism benefits from the association & the
other is neither harmed nor benefited
▪ No physiological dependence involved
▪ Both partners can survive independently
Commensal:
▪ Organism living on or within another, but not
causing injury to the host
 Examples of Commensalism
a) Cleaning commensalism
b) Comouflage/protection commensalism
c) Housing commensalism
d) Transport/phoretic commensalism
1. Cleaning commensalism: e.g
• Pilot fish and Sharks
2.Protection and camouflage commensal:
e.g pea crab in the mantle cavity of the mussel

Fig A female pea crab in

the mantle cavity of its
mussel host. The crab does
not damage the mussel and
uses its shell purely for
protection
3. House – burrows of larger animals become homes for
smaller animals
4. Transport/Phoretic commensalism
❖ Symbiont = Phoront
 Mutualism
❖ Symbiosis in the restricted sense
- more intimate and essential association
than commensalism
- Both partners benefit
- mutualists cannot survive independently
- association is physiologically dependent
E.g Legume nodules and nitrogen fixing
bacteria (Rhizobium)
 Mutualism-contd

▪ An association which is beneficial to

both
living things

Fig 2. A selection of ciliates from the rumen. The

rumen contains enormous numbers of ciliates that
break down cellulose into food.
 Parasitism:
Para = besides, sitos(Gk) = food
- One organism (parasite) is dependent on
another organism (host)
- Parasite benefits from the association at the
expense of the host
▪ A parasite is an organism that lives in or on
another organism, the host, for purposes of
deriving food and/or shelter while offering no
benefit to the association
Parasitism:
▪ is inter- specific

Is Intra- uterine development of the foetus

a form of parasitism?
▪ It is NOT; because the association is
intra-specific
 Types of Parasites
1. Ectoparasite: [Greek “Ektos”= outside; situated on the outside]
▪ Parasite that lives on the external surface of another living
organism” – e.g. lice, ticks
▪ Externally attached to the skin or superficial tissues
▪ Cause infestation
2. Endoparasite: (Greek “Endon”= within; an inward situation)
▪ a parasite that lives within another living organism” – e.g.
Plasmodium falciparum, Giardia lamblia, etc.
▪ Cause internal infection
3. Facultative parasites:
▪ can exist in the free living state, alternating of generations e.g
Strogyloides stecoralis
4. Obligate parasites:
▪ cannot exist in the free living state i.e cannot complete their lifecycle
outside the host – but ova and cysts can survive
Intermittent parasites:
▪ Visit and leave the host at intervals;
e.g micro-predators, leeches, ticks, mosquitoes,
fleas.

Leeches

Mosquito Tick Flea

 Some typical Characteristics of
Parasitism
1. High reproductive potential (i.e multiple fission
in Apicomplexa; hermaphroditism of
trematodes; parthenogenesis in Strongyloides
spp., strobilation of tapeworms for high ova
output; and overall high ova/larval output of
many worms
2. They have unique morphological or
physiological specializations, loss of structures,
etc
a) Loss of the digestive tract of tapeworms
b) Loss of wings of fleas and lice
c) Loss of many sensory structures of nematodes
d) Development of special holdfast organs, including
hooks, suckers teeth, clamps, cutting plates, spines
e) Production of anti-coagulants in leeches and
hookworms
3. They often exhibit site specificity
4. Generally, they are much smaller than the host
5. Generally more numerous than hosts
6. They are usually, but not always, non-lethal to
the host
7. They have evolved methods of evading the
host’s immune system e.g
a) Antigenic variation of trypanosomes
b) Tough tegument of acanthacephalans
c) Intracellular habitat of coccidia and Trichinella larvae
d) Antigen acquisition of schistosomes
e) Suppression of eosinophil or neutrophil migration to the site
of the parasite
f) Encystment
g) Ability to cleave antibodies or consume the complement
system
h) Ability to trigger certain arms of the immune response,
which may in turn damage host tissue enough to facilitate
parasite invasion
 Harmful Effects of Parasites on their Hosts
a) Compete with hosts for food including vitamins e.g Ascarid
round worms, tapeworms like Diphyllobothrium latum)
b) Decrease utilization and absorption of nutrients (e.g
Haemonchus contortus in sheep)
c) Reduction in feed intake by animals
d) Increase in the passage of food without proper digestion
through the digestive tract of animals
e) Changes or reduces the absorptive surface of the intestine e.g
Giardia lamblia
f) Alteration in the efflux and influx of water and ions into the
bowel
g) Removal of host’s body fluid including blood, e.g hookworms,
blood sucking insects, ticks
h) Cause mechanical obstruction of the gut lumen, air passages,
ducts, blood vessels e.g Ascarids, liver fluke, blood fluke
 Types of Hosts
Host: is a non parasitic member of the
association
1. Definitive /Final Host: host in which a
parasite reaches sexual maturity and
reproduces. Example: Cattle, buffaloes,
sheep and goats are definitive hosts for
Fasciola hepatica
2. Intermediate Host:
▪One in which early development of the parasite
occurs to produce usually infective stages of it
without reaching sexual maturity e.g snails in the
life cycle of S. haematobium
3. Vector
▪Usually a blood-sucking arthropod which
transmits the parasite from the infected
vertebrate animal to another susceptible
vertebrate animal
 Biological Vector

▪Transmits the parasite after some biological

development of the parasite to make it infective for a
susceptible host
▪Example: Mosquitoes involved in the transmission of
various filarial round worms and malarial parasites

Mechanical Vector

▪Transmits the parasite in a short time as such without

undergoing any developmental or biological change
▪Example: Tabanid flies transmit Trypanosoma evansi
4. Paratenic/Transport host:
▪ It is one that picks up the infective stage of a
parasite either from the intermediate host or
directly from the atmosphere without any
development of the parasite; but the parasite
continues to live and is ineffective to the next host
▪ Example: A mouse is the paratenic host for
Toxocara canis
5. Reservoir Host: reservoir of infection
▪ It is a vertebrate animal which may or may
not be the natural host of a parasite and
possess parasitic infection without any
clinical manifestation that serves as sources
of infection to other susceptible hosts

6. Carrier Host:
▪ it is a vertebrate animal which had suffered
from an infection and in later stage carries
the infective organisms in its body without
showing any clinical signs
 Types of Parasitic infections
1. Auto-infection: self infection with a
pathogen
▪ The host animal is the own direct source of
exposure
▪ Autoinfection can be either external and
internal e.g infection with Strongyloides
stercoralis
2. Super-infection: re-infection with the same
parasite species, while harboring the same
species of the parasite
3. Hyper infection – high infection
 GENERAL CONSIDERATIONS
1. Biological incubation period = Prepatent
period
▪ Interval between exposure to a pathogen and
time when parasites or their products can be
demonstrated in body products, biopsy, or
other diagnostic procedures

2. Clinical incubation
▪ Interval between exposure to a pathogen and
the earliest evidence of signs and symptoms
produced as a result of the infection
 Types of Life Cycle
1. Direct Life Cycle

▪Does not involve any intermediate host

between the parasite and its host
▪Example: infection with Strongyloides
stercoralis
2. Indirect Life Cycle

Involves necessarily one or more intermediate

hosts or vector(s) to complete its life cycle
 3. Simple Life Cycle
▪One in which a parasite simply multiplies by
binary fission both in its vertebrate host and its
insect vector for its propagation
▪Example: Trypanosoma spp

4. Complex Life Cycle

▪One in which there is an alteration of both
asexual and sexual processes of reproduction in
the life cycle of a parasite
▪Example: All helminth parasites
 Examples of Important Intestinal
Protozoa
Transmitted by the faecal-oral route and cause
diarrhoea

• Giardia lamblia: world-wide distribution,

lives in the small intestine and results in
malabsorption
• Entamoeba histolytica: may invade the
colon and cause bloody diarrhoea – amoebic
dysentery. Also causes ameobic liver
abscess.
• Cryptosporidium parvum: more prevalent in Giardia lamblia
the immunocompromised (HIV patients).
• Balantidium coli: a large motile ciliated
parasite that lives in the colon of pigs,
humans and rodents and can lead to colonic
ulceration
• Enterocytozoon bienusi: a microsporidian
that parasitises the small intestine. Also
more common in the immunocompromised.
 Examples of important systemic protozoa
Detected in the blood
• Plasmodium: the cause of malaria.
There are 4 species that infect man:
P. falciparum, P. vivax, P. ovale and
P. malariae
• Toxoplasma gondi: transmitted by
the ingestion of oocysts from cat
faeces. Infection can lead to ocular
problems and is also a cause of Typical lesion of cutaneous leishmaniasis
neonatal toxoplasmosis
• Leishmania: transmitted by sand
flies, can lead to visceral, cutaneous
and mucocutaneous leishmaniasis
• Trypanosoma: haemoflagellates
which cause
In Africa - sleeping sickness (transmitted
by the Tsetse fly
Tsetse fly – the vector of African
In South America - Chagas disease trypanosomiasis It has a painful bite!
(transmitted by the Reduviid bug)
Taxonomic Classification of Helminths
Sub Phylum Class Genus –
kingdom examples
Metazoa Nematodes Ascaris (roundworm)
Round worms; appear round Trichuris (whipworm)
in cross section, they have Ancylostoma (hookworm)
body cavities, a straight Necator (hookworm)
alimentary canal and an Enterobius (pinworm or
anus threadworm)
Strongyloides

Platyhelminthes Cestodes Taenia (tapeworm)

Flat worms; dorsoventrally Adult tapeworms are found in
flattened, no body cavity the intestine of their host
and, if present, the They have a head (scolex) with
alimentary canal is blind sucking organs, a segmented
ending body but no alimentary canal
Each body segment is
hermaphrodite

Trematodes Fasciolopsis (liver fluke)

Non-segmented, usually Schistosoma (not leaf
leaf-shaped, with two suckers shaped!)
but no distinct head
They have an alimentary canal
and are usually hermaphrodite
and leaf shaped
Schistosomes are the
exception. They are
 Examples of important metazoa – intestinal
• Trichuris (whipworm)
nematodes
– A soil transmitted helminth • Ascaris (roundworm)
– prevalent in warm, humid conditions – Found world-wide in conditions of
– Can cause diarrhoea, rectal prolapse poor hygiene, transmitted by the
and anaemia in heavily-infected
people faecal- oral route
– Adult worms lives in the small
• Ancylostoma and Necator (hookworms) intestine
– A major cause of anaemia in the – Causes eosinophilia
tropics

• Strongyloides
– inhabits the small bowel
– infection more severe in
immunosupressed people (e.g.
HIV/AIDS, malnutrition, intercurrent
disease)

• Enterobius (pinworm or threadworm)

– prevalent in cold and temperate Heavy intestinal infections may occur with Ascaris. Adult
climates but rare in the tropics worms can be several cms long.
– found mainly in children
 Examples of important metazoa
nematodes and cestodes
• Onchocerca volvulus – Intestinal - (“tapeworms”)
Transmitted by a black fly, this • Taenia saginata
microfilarial parasite can cause
visual impairment, blindness – acquired by ingestion of
and severe itching of the skin contaminated, uncooked beef
in those infected – a common infection but
• Wuchereria bancrofti – The causes minimal symptoms
major causative agent of • Taenia solium
lymphatic filariasis – acquired by ingestion of
• Brugia malayi – Another contaminated, uncooked pork
microfilarial parasite that that contains cystercerci
causes lymphatic filariasis – Less common, but causes
cystercicosis – a systemic
disease where cysticerci
encyst in muscles and in the
brain – may lead to epilepsy
 Examples of important metazoa –trematodes
(flukes)
• Fasciola hepatica (liver fluke)- • Clonorchis sinensis (liver fluke)-
Primarily, a parasite of sheep, humans Widespread in China, Japan, Korea
become infected. and Taiwan, this parasite is acquired
by ingestion of infective
metacercariae in raw or pickled fish

• Schistosoma haematobium, S.
mansoni and S. Japonicum.

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 • Class Lobosea (sarcodina)
Medical • Class Zoomastigophorea
Protozoology • Class Sporozoa
Human Parasitology

(Apicoplexa)
• Class Ciliophora
• Class Nematoda
Medical • Class Trematoda
Helminthology • Class Cestoda

• Class Insecta
Medical • Class Arachnida
Arthropology • Class Crustacea
• Class Chilopoda
 The Routes of Parasitic
Transmission
• Congenital transmission : From mother to
infant. Toxoplasmosis
• Contact transmission : Direct
contact---Trichomonas vaginalis; Indirect
contact---Ascaris lumbricodes
• Food transmission : The infectious stage of
parasites -->contaminated food / The meat
of the intermediate hosts containing
infectious stage of parasites.
 2. The Routes of Transmission II
• Water transmission : Drink or contact the
water contaminated with the infectious
stage of parasites.
• Soil transmission : Contamination of the soil
by feces containing the certain stage of
parasites and this stage can develop into an
infective stage.
• Arthropod transmission : Vectors of certain
parasitic diseases.
 3. The Susceptible Host
• In general, most people are susceptible
hosts.
• The parasite reaching a susceptible host
must gain entrance and set up a favorable
residence in order to complete its life cycle
and cause the transmission of parasitic
diseases.
 The Avenues of Invasion
• Digestive tract : Most common avenue of
entrance. (Food/ Water transmission)
• Skin : Infective larvae perforate skin and reach
to body and establish infection. (soil/ water
transmission)
• Blood : Bloodsucking insects containing
infective parasites bite the skin and inject
parasites into human blood. (Arthropod
transmission-malaria).
 PARASITOLOGY IN RELATION
TO OTHER SPECIALIZATIONS
Virology – viruses, purely parasitic
Bacteriology– Medical Bacteriology deals
with parasitic bacteria.
Plant Pathology – Study of parasites of
plants
Mycology – study of parasitic fungi
Time for Questions?