INTRODUCTION TO MEDICAL PARASITOLOGY 3.

​ Parasitism
-​ is a symbiotic relationship where one
I.​ GENERAL CONSIDERATIONS organism, the parasite, lives in or on
II.​ HOST-PARASITE RELATIONSHIPS another, depending on the latter for its
III.​ IMMUNOLOGY OF PARASITIC INFECTIONS survival and usually at the expense of the
IV.​ GROUPS OF PARASITES WITH MEDICAL AND host.
PUBLIC HEALTH IMPORTANCE -​ E.g. Entamoeba histolytica, which
derives nutrition from the human host and
I.​ GENERAL CONSIDERATIONS causes amebic dysentery and intestinal
ulcers.
Parasitology is the area of biology concerned with the
phenomenon of dependence of one living organism on
PARASITES
another.

Medical Parasitology is concerned primarily with parasites Endoparasite

of humans and their medical significance, as well as their -​ A parasite living inside the body of a host
importance in human communities. -​ E.g. lice, ticks, mites
Ectoparasite
Tropical Medicine is a branch of medicine that deals with -​ is a parasite living outside the body of a host
tropical diseases and other special medical problems of -​ E.g. Entamoeba histolytica, ascaris
tropical regions. lumbricoides

A tropical disease is an illness, which is indigenous to or Infection

endemic in a tropical area but may also occur in sporadic or -​ The presence of an endoparasite in a host
epidemic proportions in areas that are not tropical. Many Infestation
tropical diseases are parasitic diseases -​ the presence of an ectoparasite on a host

Anthroponosis Need of Host:

-​ Parasitic infection is found in humans alone Obligate Parasites
Zooanthroponosis -​ They need a host at some stage of their life cycle to
-​ Parasitic infections mainly affect humans; animal complete their development and to propagate their
become infected in life cycle of parasite like in species
taeniasis -​ E.g. Tapeworms, Plasmodium spp.
Anthropozoonosis Facultative Parasite
-​ Parasitic infection is mainly animal, may be -​ may exist in a free-living state or may become
acquired by human as in trichinosis, parasitic when the need arises.
echinococcosis -​ Exhibits both parasitic and non-parasitic modes
of living and does not absolutely depend on the
parasitic way of life, but it is capable of adapting to it
BIOLOGICAL RELATIONSHIPS if placed on host. (in short it can live inside and the
environment outside host)
Symbiosis -​ E.g. Strongyloides stercoralis
-​ is the living together of unlike organisms.
-​ It may also involve protection or other advantages
to one or both organisms. Accidental or incidental Parasite
-​ A parasite, which establishes itself in a host where it
Types of Symbiosis: does not ordinarily live.
-​ Parasite attacks an unnatural host and survives but
1.​ Commensalism may or may not complete life cycle.
-​ is a symbiotic relationship in which two -​ E.g. Echinococcus granulosus: accidental
species live together and one species parasite
benefits from the relationship without -​ Humans: accidental host
harming or benefiting the other. Erratic Parasites
-​ E.g. Entamoeba coli in the intestinal -​ also known as an aberrant or wandering parasite,
lumen are supplied with nourishment and is one that is found in an organ or tissue that is not
are protected from harm, while it does not its typical habitat.
cause any damage to the tissues of its -​ E.g. Ascaris Lumbricoides in Humans (lives in
host small intestine) but for some reason it can crawl to
2.​ Mutualism pancreatic duct causing pancreatitis
-​ is a symbiosis in which two organisms -​ E.g Entamoeba histolytica (colon) but reaches
mutually benefit from each other. (liver or lung) causing amebic liver/lung abscess
-​ E.g. termites and the flagellates in their
digestive system, which synthesize
cellulase to aid in the breakdown of
ingested wood.
Intermittent or Temporary Parasite Types of Life Cycle:
-​ lives on the host only for a short period of time or
only visits the host for feeding. Direct Life Cycle
-​ E..g mosquito -​ AKA Monoxenous life cycle
Permanent Parasite -​ Parasite does NOT REQUIRE an intermediate host
-​ remains on or in the body of the host for its entire to complete its life cycle
life
-​ E.g. Trypanosomes, Wuchereria Indirect Life Cycle
Spurious or Coprozoic Parasite -​ AKA Heteroxenous life cycle
-​ is a free-living organism that passes through the -​ Parasite does REQUIREs an intermediate host to
digestive tract without infecting the host complete its life cycle
Pseudoparasite
-​ NOT a true parasite but mistaken as parasite
VECTORS
-​ E.g. thread, seeds, pollen, air bubbles
Hyperparasite
-​ Parasite that parasitizes another parasite Agenst of Transmission:

Vehicle or Fomites
HOST -​ Non-living entity
Vector
Definitive Host -​ Living entity
-​ A host that harbors a parasite in the adult stage or -​ are responsible for transmitting the parasite from
where the parasite undergoes a sexual one host to another.
reproduction
-​ E.g. Taeniasis, humans are considered the 1.​ Biologic Vector
definitive host -​ transmits the parasite only after the latter
Intermediate Host has completed its development within the
-​ harbors the asexual or larval stage of the parasite host.
(no sexual reproduction, just developent) -​ E.g. malaria inside mosquito
-​ E.g. Pigs or cattle serve as intermediate hosts of 2.​ Mechanical or Phoretic Vector
Taenia spp., while snails are hosts of -​ only transports the parasite
Schistosoma spp -​ E.g. flies, cockroaches that feed on
-​ Larval development is completed in TWO different fecal material with parasites
intermediate host
-​ First Intermediate Host
EXPOSURE AND INFECTION
-​ Second Intermediate Host
Paratenic Host
-​ is one in which the parasite does not develop Carrier - harbors a particular pathogen without manifesting
further to later stages. However, the parasite any signs and symptoms.
remains alive and is able to infect another Exposure - is the process of inoculating an infective agent,
susceptible host. Infection- connotes the establishment of the infective agent
-​ Serves as a temporary refuge and vehicle for in the host.
reaching an obligatory host (definitive host)
-​ E.g. Paragonimus metacercaria in raw wild boar Incubation period
meat (the wild boar serves as a paratenic host -​ referred to as the clinical incubation period.
transferring the infective stage to humans) -​ is the period between infection and evidence of
Reservoir Host symptoms.
-​ They allow the parasite’s life cycle to continue and Pre-patent Period
become additional sources of human infection -​ also known as the biologic incubation period,
-​ A host that makes the parasite available for the -​ is the period between infection or acquisition of the
transmission to another host and is usually not parasite and evidence or demonstration of infection.
affected by the infection. Autoinfection
-​ E.g. Pigs are reservoirs of Balantidium coli, field -​ results when an infected individual becomes his
rats of Paragonimus westermani, and cats of own direct source of infection.
Brugia malayi. -​ E.g. Enterobiasis through hand-to-mouth
transmission. (Infective eggs may end up in the
Types of Host: hands by scratching the perianal areas where the
gravid females lay their eggs.)
Natural host Superinfection or Hyperinfection
-​ A host that is naturally infected with certain species -​ happens when the already infected individual is
of parasite further infected with the same species leading to
Accidental Host massive infection with the parasite.
-​ A host that is under normal circumstances not -​ E.g. Capillaria philippinensis. Strongyloides
infected with the parasite stercoralis
 SOURCES OF INFECTION EPIDEMIOLOGIC MEASURES

The most common sources are contaminated soil and Epidemiology is the study of patterns, distribution, and
water. occurrence of disease.
Incidence is the number of new cases of infection appearing
Lack of sanitary toilets and the use of night soil or in a population in a given period of time.
human excreta as fertilizer allow the eggs to come in Prevalence is the number (usually expressed as
contact with the soil and favor the development of Ascaris percentage) of individuals in a population estimated to be
lumbricoides, Trichuris trichiura, Strongyloides infected with a particular parasite species at a given time.
stercoralis, and hookworm Cumulative prevalence is the percentage of individuals in a
population infected with at least one parasite.
Intensity of infection refers to the burden of infection which
MODES OF TRANSMISSION
is related to the number of worms per infected person. This
may be measured directly or indirectly and is also referred to
Peroral (Contaminated Food and Water) as the worm burden. In the case of soil-transmitted
-​ Majority of infections with cestodes, trematodes, helminths, it can be measured directly by counting expelled
and intestinal protozoans are foodborne: worms during treatment, or indirectly by counting helminth
-​ Taenia solium, Taenia saginata, and eggs excreted in feces. The latter is expressed as the
Diphyllobothrium latum from eating food number of eggs per gram (epg).
harboring the infective larval stages; Clinical consequences of infections or diseases that affect an
-​ Entamoeba histolytica and Giardia individual’s well-being refer to morbidity.
lamblia from drinking water contaminated
with cysts; and
-​ Clonorchis, Opistorchis, and TREATMENT
Haplorchis through ingesting raw or
improperly cooked freshwater fish Deworming is the use of anthelminthic drugs in an individual
containing infective larvae. or a public health program.
Percutaneous (Skin penetration) Cure rate refers to the number (usually expressed as a
-​ Hookworms and Strongyloides enter via percentage) of previously positive subjects found to be egg
exposure of skin to soil, while negative on examination of a stool or urine sample using a
-​ Schistosoma species enter skin via water. standard procedure at a set time after deworming.
Arthropod Vectors Egg reduction rate (ERR) is the percentage fall in egg
-​ transmit parasites through their bites. counts after deworming based on examination of a stool or
-​ E.g. agents of malaria, filariasis, leishmaniasis, urine sample using a standard procedure at a set time after
trypanosomiasis, and babesiosis. the treatment.
Congenital Transmission Selective treatment involves individual-level deworming
-​ Toxoplasma gondii trophozoites can cross the with selection for treatment based on a diagnosis of infection
placental barrier during pregnancy. (Transplacental or an assessment of the intensity of infection, or based on
infection) presumptive grounds. This strategy can be used in whole
-​ In (transmammary infection) with Ancylostoma populations, or in defined risk groups.
and Strongyloides, the parasites may be Targeted treatment is group-level deworming where the
transmitted through mother’s milk. (risk) group to be treated (without prior diagnosis) may be
Inhalation of Airborne Eggs defined by age, sex, or other social characteristics
-​ Enterobius irrespective of infection status.
Sexual intercourse Universal treatment is population-level deworming in
-​ Trichomonas vaginalis, gardia, entamoeba which the community is treated irrespective of age, sex,
Blood-borne Transmission infection status, or other social characteristics.
-​ Malaria Preventive Chemotherapy is the regular, systematic,
large-scale intervention involving the administration of one or
more drugs to selected population groups with the aim of
NOMENCLATURE
reducing morbidity and transmission of selected helminth
infections.
Animal parasites are classified according to the Coverage refers to the proportion of the target population
International Code of Zoological Nomenclature. reached by an intervention. It could be the percentage of
school-age children treated during a treatment day.
Scientific names are latinized; Efficacy is the effect of a drug against an infective agent
Family names are formed by adding -idae to the stem of the in ideal experimental conditions and isolated from any
genus type; context.
Generic names consist of a single word written in the initial Effectiveness is a measure of the effect of a drug against
capital letter; an infective agent in a particular host, living in a particular
Specific name always begins with a small letter. environment with specific ecological, immunological, and
The names of the genera and species are italicized or epidemiological determinants.
underlined when written.
Drug resistance is a genetically transmitted loss of ○​ Size & Shape: Adapted for maintaining
susceptibility to a drug in a parasite population that was position in the host (e.g., Ascaris worms
previously sensitive to the appropriate therapeutic dose. use constant movement).
○​ Integument: Thickened to resist digestive
enzymes and prevent desiccation/injury.
PREVENTION AND CONTROL
○​ Protective Coverings: Ova, larvae, and
cysts have coverings to withstand
Morbidity control is the avoidance of illness caused by digestion and free-living stages.
infections. It may be achieved by periodically deworming
individuals or groups, known to be at risk of morbidity.
Reproductive Adaptations
Information-education-communication (IEC) is a health
-​ Flatworms: Highly elaborate reproductive systems.
education strategy that aims to encourage people to adapt
-​ Tapeworms & Flukes: Mostly hermaphroditic
and maintain healthy life practices.
(except Schistosoma spp.), producing thousands of
Environmental management is the planning, organization,
ova.
performance, and monitoring of activities for the modification
-​ Flukes: Undergo asexual reproduction in
and/or manipulation of environmental factors or their
intermediate hosts to increase progeny.​
interaction with human beings.
Environmental sanitation involves interventions to reduce
Biochemical Adaptations
environmental health risks including the safe disposal and
-​ Streamlining: Loss of metabolic pathways, making
hygienic management of human and animal excreta, refuse,
parasites dependent on the host for nutrients.
and waste water.
-​ Examples: Hemoflagellates and helminths.
Sanitation is the provision of access to adequate facilities
-​ Potential Target: These biochemical changes may
for the safe disposal of human excreta, usually combined
be used in future chemotherapeutic treatments.​
with access to safe drinking water.
Specialized Mechanisms for Host Entry
ERADICATION VS. ELIMINATION -​ Entamoeba histolytica: Secretes cysteine
proteinases to penetrate mucosa and adhere to
Disease eradication is defined as a permanent reduction tissues.
to zero of the worldwide incidence of infection caused by -​ Schistosoma cercariae: Have penetration glands
a specific agent, as a result of deliberate efforts. Once this is that produce enzymes to digest skin for entry.
achieved, continued measures are no longer needed. -​ Cestode embryos: Possess six hooklets aiding
tissue penetration before encysting.
Disease elimination is a reduction to zero of the
incidence of a specified disease in a defined geographic EFFECTS OF THE PARASITE ON THE HOST
area as a result of deliberate efforts. Continued intervention
or surveillance measures are still required.
Effects of the Parasite on the Host
-​ Some parasites may live inside the host without
causing harm, but most inflict damage.​
II. HOST-PARASITE RELATIONSHIPS
Damage mechanisms include:
Evolution of the Parasite-Host Relationship 1.​ Interference with Host Vital Processes
-​ Has gradually evolved, affecting both the parasite -​ Parasites use enzymes to metabolize
and its host. nutrients and store energy.
-​ Adaptation leads to changes in molecular biology, -​ E.g Entamoeba histolytica secretes
biochemistry, immunology, and structure cysteine proteinases:
-​ Specialized parasites show the most significant -​ Digests cellular materials.
changes for survival. -​ Degrades the epithelial basement
membrane, facilitating tissue
Structural Adaptations invasion.
-​ Locomotory and digestive organ modifications: 2.​ Invasion and Destruction of Host Tissue
○​ Apicomplexa (Protozoans): No -​ Plasmodium invades red blood cells,
locomotory organelles, mostly parasitic. causing them to rupture and release
○​ Flatworms: Free-living species have cilia, merozoites.
but parasitic cestodes and trematodes lack -​ Schistosoma japonicum egg deposition
them. in the liver triggers an immune response,
○​ Cestodes & Trematodes: Absorb leading to granuloma formation, fibrosis,
nutrients through a tegument with portal hypertension, and hemorrhage.
microvilli. -​ Hookworms: Attach to intestinal mucosa
○​ Attachment organs: Hooks and suckers using cutting plates and destroy villi.
in flatworms help anchor and migrate in -​ Ascaris: Forms tangled masses, causing
host tissues.​ intestinal obstruction. May migrate to
organs like the appendix or bile ducts,
leading to surgical emergencies.
 3.​ Deprivation of Essential Nutrients Parasitic Infections: Host Outcomes
-​ Hookworm infections → Massive 1.​ Parasite fails to become established in the host.
intestinal bleeding → Chronic blood loss → 2.​ Parasite becomes established and the host
Iron deficiency anemia. eliminates the infection.
-​ Diphyllobothrium latum competes for 3.​ Parasite becomes established, and the host begins
Vitamin B12 → Causes megaloblastic to overcome the infection but is not totally
anemia. successful.
4.​ Parasite becomes established and the host, in
EFFECTS OF THE HOST ON THE PARASITE
trying to eliminate the organism, becomes damaged
itself.
1.​ Genetic Factors 5.​ Parasite becomes established and kills the host
-​ The host's genetic makeup influences Evolution of Host-Parasite Relationship
susceptibility to infection. -​ Parasite infection ability evolves through natural
-​ Examples: selection.
-​ Sickle-cell trait/disease provides -​ Hosts also evolve mechanisms to defend against
protection against Plasmodium parasites.
falciparum malaria. -​ Some parasites have complex life cycles, adapting
-​ Duffy blood factor increases to multiple hosts (definitive, intermediate, reservoir).
susceptibility to Plasmodium Host-Parasite Dynamics
vivax infection. -​ Relationships remain dynamic, with host specificity
2.​ Nutritional Status changing over time.
-​ The host’s diet affects parasite -​ Accidental infections in new hosts may lead to new
development. reservoirs or definitive hosts.
-​ Examples: -​ Example: Trypanosoma sp. and Plasmodium
-​ High-protein diet is unfavorable knowlesi (a newly discovered human malaria
for intestinal protozoans. parasite).
-​ Low-protein diet promotes
HOST-PARASITE INTERACTIONS
symptoms and complications of
amebiasis.
-​ High-carbohydrate diet supports 1.​ Natural Physical Barriers (First Line of Defense)
the growth of some tapeworms. -​ The skin acts as a protective surface
3.​ Immune Response against parasitic invasion.
-​ Absolute immunity to reinfection is rare -​ Some helminths have adaptive
in protozoan infections and does not occur mechanisms to bypass this defense.
in helminth infections. -​ Examples:
-​ Acquired immunity can reduce disease -​ Hookworm and Strongyloides
severity in endemic areas. larvae produce proteins that
assist in skin penetration.
Infective Stage -​ Schistosoma spp. cercariae
-​ The stage in the life cycle at which the parasite is secrete lytic enzymes from
able to initiate an infection to its host anterior glands for skin entry.
Diagnostic Stage -​ Mucous membranes in the respiratory,
-​ Is the life cycle stage that exits the definitive host gastrointestinal, and genitourinary tracts
serve as barriers.
III. IMMUNOLOGY OF PARASITIC INFECTIONS -​ Tight junctions between
epithelial cells prevent passage of
Function of the Immune System most molecules.
-​ Protects the body from invasion by potential -​ Low pH environments deter
pathogens. infections.
-​ Requires balance: -​ Trichomonas vaginalis
-​ Dysfunction can lead to infection due to cannot survive vaginal
weak immunity. acidity.
-​ Overactivation can harm the organism. -​ Giardia lamblia loses
Immunity to Parasites motility when exposed to
-​ especially eukaryotes such as helminths and intestinal secretions.
protozoans, more complex compared to bacterial -​ Parasite adaptations to evade these
pathogens due to similarities in makeup and defenses:
physiology. -​ Protective egg shells (e.g.,
-​ Parasites have evolved strategies to evade immune Ascaris, Trichuris, Taenia spp.)
detection. resist gastric acidity.
-​ Some thrive in the bloodstream despite constant -​ Cystic walls (e.g., Entamoeba,
exposure to immune defenses (e.g., Schistosoma Giardia) allow survival in acidic
sp.). conditions.​
-​
2.​ Chemical Defenses -​ flagellin (TLR5)],
-​ Body fluids contain antimicrobial -​ viral RNA (TLR3)
components: -​ Activation of TLRs leads to
-​ Breast milk lipase is toxic to cytokine production (e.g.,
Giardia lamblia. interferon-gamma, interleukin-1),
-​ Lysozyme in tears and saliva which enhances NK cell and
destroys microorganisms. macrophage activity.
-​ Secretory IgA antibodies in 3.​ Acquired (Adaptive) Immune Response (Second
fluids enhance defense. Line of Defense)
3.​ Physiologic Functions Preventing Infection -​ Develops after exposure to parasitic
-​ Peristalsis, cilia movement, and reflex antigens and involves immunologic
actions help expel parasites. memory.
-​ Coughing removes Ascaris -​ A complex process involving:
lumbricoides and Paragonimus -​ Antigen recognition
westermani eggs. -​ Immune cell activation
-​ Urine flow decreases Trichomonas -​ Effector responses (antibody
vaginalis colonization. production or direct
4.​ Second Line of Defense: Immune Response cell-mediated attack)
-​ If parasites bypass physical barriers, the -​ Sources of Parasitic Antigens:
body detects pathogen-associated -​ Surface proteins, secretions,
molecular patterns (PAMPs). excretions, and somatic tissues of
-​ Pattern recognition responses trigger an the parasite.
immune reaction aimed at eliminating or -​ Can be stage-specific (present
controlling the infection. only in certain life cycle phases)
or genus-wide (shared among
related species).
HOST-IMMUNE RESPONSE
-​ Types of Acquired Immunity:
-​ Antibody-dependent immunity
1.​ Types of Host Immune Defenses (humoral response).
-​ The immune system utilizes innate -​ Cell-mediated immunity (T-cell
(non-specific) and acquired (specific) response).
defenses to combat parasitic infections. 4.​ Cross-Reactivity and Immune Limitations
Both rely on humoral (antibody-based) -​ Cross-reactivity: Immunity to one parasite
and cell-mediated mechanisms. may provide protection against another
2.​ Innate Immune Response (First Line of Immune related species.
Defense) -​ Challenges in parasitic immunity:
-​ Rapid, non-specific mechanisms that -​ Some parasites evade immune
eliminate pathogens through mechanical, responses by antigenic variation
chemical, and cytokine-mediated or intracellular survival.
responses. -​ Immunity does not always
-​ Methods: guarantee protection—a strong
-​ Phagocytosis by macrophages immune response may not
and dendritic cells leads to always eliminate the parasite.
oxidative killing and use of toxic
peptides.
ACQUIRED IMMUNE RESPONSE
-​ Some intracellular parasites
evade destruction and multiply
inside macrophages (e.g., Acquired Immune Response
Leishmania spp., Toxoplasma
gondii, Trypanosoma cruzi). The immune response to parasitic infections is controlled by
-​ Natural killer (NK) cells and genetics and influences infection outcomes such as
T-lymphocytes play key roles in resistance, susceptibility, and pathology. The major
eliminating infected cells. histocompatibility complex (MHC) genes regulate
-​ Toll-like Receptors (TLRs) T-lymphocyte activities, and human leukocyte antigen
-​ Recognize non-native (HLA) also plays a role.
molecules from pathogens,
triggering inflammatory T-helper Lymphocytes and Their Role
responses.
-​ Examples of TLR activation: When the body detects a parasite, its antigens are
-​ LPS (TLR4), processed and presented to CD4 T-helper lymphocytes,
-​ diacylated lipoprotein which belong to either the Th1 or Th2 subset. These cells
(TLR 2 and 6) produce different immune signals (lymphokines) that help
-​ triacylated lipoprotein fight infections:
(TLR 1 and 2),
 -​ Th1 lymphocytes produce gamma interferon and -​ IgG and complement help destroy Trypanosoma
interleukin-2, which activate cytotoxic lymphocytes cruzi.
(CD8 cells) and macrophages. This triggers a
cell-mediated immune response. Comprehensive Immune Defense
-​ Th2 lymphocytes produce interleukins 4, 5, and
6, which help B-lymphocytes turn into plasma cells. -​ The immune system uses a combination of
Plasma cells produce antibodies (IgE, IgG, IgM, non-specific, specific, humoral, and
and IgA) that bind to parasites and help destroy cell-mediated defenses against infections.
them. -​ This integrated response is crucial in fighting both
microbial and parasitic infections.
Cell-Mediated Immunity
PARASITE EVASION MECHANISMS
-​ Found in many parasitic infections.
-​ T-lymphocytes specific to the parasite multiply and
attack it directly or by activating natural killer (NK)
cells and antibody-producing B-lymphocytes. I. Characteristics of Parasites That Make Detection
-​ Example: Migrating larvae of Toxocara canis are Difficult
killed through this process.
-​ Parasite size
-​ Complicated life cycles
Antibody-Mediated Immunity (Th2 Response)
-​ Protected body sites
-​ Antigenic complexity
-​ IgE antibodies help fight helminth infections
(worms).
II. Major Mechanisms of Evasion
-​ Eosinophils and mast cells help expel
gastrointestinal parasites.
-​ Immune suppression
-​ IgE is involved in antibody-dependent
-​ Antigenic variation
cell-mediated cytotoxicity (ADCC), which
-​ Host mimicry
destroys some parasites like Schistosoma spp.
-​ Sequestration

Immune Responses to Different Parasites

A. Resistance to Immune Response
-​ Helminthic infections: Cause eosinophilia (high
-​ Protozoa and helminths survive and replicate in
eosinophil levels) and increased IgE.
blood/tissue by resisting the innate immune
-​ Ascaris lumbricoides and Trichuris trichiura:
response.
Weaker immune response since they live in the gut
-​ Resistance to complement:
and have less contact with immune cells.
-​ Protozoa can be phagocytosed by
-​ Wuchereria bancrofti and Brugia malayi
macrophages, but helminths resist
(lymphatic parasites): Stronger immune response
cytotoxic effects due to their cuticle and
because they interact more with immune cells.
integument.
-​ Visceral larval infections (Parastrongylus
-​ Loss of surface molecules that bind
cantonensis, Toxocara canis): Less immune
complement.
evasion since they are not adapted to human hosts.
-​ Acquisition of host regulatory proteins
(e.g., decay accelerating factor).
Antibody-Dependent Cell-Mediated Cytotoxicity (ADCC)
-​ Trypanolytic factors:
-​ Apolipoprotein L-1 (APOL1) destroys
-​ Eosinophils, neutrophils, and platelets help
non-human trypanosomes except
destroy parasites.
Trypanosoma brucei.
-​ IgE and eosinophils play a role in tropical
-​ T. brucei expresses serum
pulmonary eosinophilia.
resistance-associated protein to resist
-​ IgE activation of mast cells and basophils can
APOL1.
cause anaphylactic reactions (e.g., when
-​ Frameshift mutation in the APOL1 gene
Echinococcus granulosus cysts rupture or
allows T. evansi to infect humans.
during arthropod bites like mites and ticks).

B. Immune Suppression
Antibody Functions in Parasite Defense
-​ Reduced macrophage immune function → lower
-​ IgG and IgM prevent Plasmodium spp. and
phagocytosis and defective antigen processing
Babesia spp. from entering red blood cells.
(Plasmodium spp.).
-​ IgA in the intestines protects against gut infections
-​ Trypanosoma brucei infection:
(e.g., Giardia lamblia, Cryptosporidium spp.).
-​ Trypomastigotes produce large amounts
-​ IgM and secretory IgA help kill Giardia lamblia
of surface glycoproteins.​
through ADCC.
-​ Leads to antigenic competition.
 -​ Impairs B- and T-lymphocyte function → -​ Plasmodium falciparum (late intracellular
↓ lymphokine and immunoglobulin stages):
production. -​ Sequestered in deep vasculature →
-​ Entamoeba histolytica: avoids circulation.
-​ Suppresses macrophage respiratory -​ Knobs on infected erythrocytes attach
burst → ↓ nitric oxide production. to endothelial cells.
-​ Produces monocyte locomotion -​ Prevents splenic filtration and antibody
inhibitory factor → inhibits monocyte action.
migration.
-​ Inhibits complement assembly.
-​ Fasciola infection: IV. GROUPS OF PARASITES WITH MEDICAL AND
-​ Downregulation of Th1 lymphocytes. PUBLIC HEALTH IMPORTANCE
-​ Filarial infections (Wuchereria bancrofti, Brugia
malayi): Linnaean Hierarchical Scheme
-​ Polyclonal hypergammaglobulinemia → -​ classification of parasites
antibodies lack specificity. -​ Kingdom → Subkingdom → Phylum →
-​ Blocking antibodies: Class → Order → Family → Genus →
-​ Produced by Wuchereria bancrofti to Species (KSP COS GS)
dampen immune response.
-​ Necator americanus → immune response Modern Molecular Approaches
diverted to the changing surface of its -​ DNA extraction & sequencing – Identifies genetic
integument. variations.
-​ Immune complexes suppress immune -​ Proteome analysis – Studies protein structures in
response: parasites.
-​ Cysticercus cellulosae → inhibits -​ RNA interference (RNAi) – Helps understand gene
complement activity. function.
-​ Plasmodium spp. and Trypanosoma cruzi -​ Polymerase Chain Reaction (PCR) – Detects
→ immune suppression via immune genetic material for precise identification.
complexes.
-​ Schistosoma spp. → complement
PROTOZOA
consumed by soluble antigens, preventing
parasite destruction.
Cellular Structure
-​ UNICELLULAR eukaryotes with nucleus,
C. Antigenic Variation
cytoplasm, and outer membrane.
-​ Locomotion structures: Cilia, flagella,
-​ Trypanosoma brucei changes variant surface
pseudopodia, and in some cases, an apical
glycoproteins (VSG) → evades immune
complex for host cell penetration.
response.
-​ Giardia lamblia exhibits surface protein variation.
Life Cycle & Transmission
-​ Malarial parasites (Plasmodium falciparum):
-​ Many protozoa thrive in wet environments for
-​ Antigenic diversity through repeat
feeding and reproduction.
variation of encoded polypeptides.
-​ Exist in two primary stages:
-​ Merozoite surface antigen (MSA) and
-​ Trophozoites: Active, feeding stage.
ring-infected erythrocyte surface
-​ Cysts: Infective stage, more resistant to
antigen (RESA) contain antigenic
environmental changes.
epitopes.
-​ Some protozoa require a biological vector (e.g.,
-​ Variation prevents antibody
mosquitoes for Plasmodium spp.).
recognition.

Classification under Kingdom Protista

D. Host Mimicry
-​ Phylum Sarcomastigophora
-​ Subphylum Mastigophora (Flagellates):
-​ Echinococcus granulosus (larval stage) carries
Locomotion via flagella. Examples:
P blood group antigen.
Giardia, Chilomastix, Trichomonas,
-​ Schistosoma spp. adult tegument acquires host
Dientamoeba, Trypanosoma,
antigenic molecules → immune system fails to
Leishmania.
recognize parasite as foreign.
-​ Subphylum Sarcodina (Amoebae):
Locomotion via pseudopodia. Examples:
E. Intracellular Sequestration Entamoeba, Endolimax, Iodamoeba,
Acanthamoeba, Naegleria.
-​ Trypanosoma cruzi and Leishmania spp. → -​ Phylum Ciliophora
proliferate inside macrophages.​ -​ Locomotion via cilia.
-​ Includes Balantidium coli, the only
-​ Toxoplasma gondii → multiplies in macrophages medically significant ciliate.
and nucleated cells.
 -​ Phylum Apicomplexa
NEMATODES
-​ Characterized by apical complex
structures for cell penetration.
-​ All are parasitic. Metazoan parasites belong to the Kingdom Animalia and
-​ Class Sporozoa includes: Plasmodium, are classified into helminths (worms) and arthropods
Babesia, Toxoplasma, Cystoisospora,
Cryptosporidium, Cyclospora.​ Helminths that cause infections in humans fall into three
major groups:
-​ Infects multiple organ systems (e.g., GIT, 1.​ Annelids: Only leeches are considered of medical
CNS, blood, skin, respiratory tract, eyes, importance.
genitourinary tract). 2.​ Nematodes (Roundworms):
-​ Phylum Microspora -​ Elongated, cylindrical, bilaterally
-​ Spore-forming parasites of vertebrates and symmetrical worms.
invertebrates. -​ Possess a complete digestive tract and a
-​ Includes: Enterocytozoon, muscular pharynx (triradiate in structure).
Encephalitozoon. -​ Exhibit separate sexes, though some may
-​ Uses a polar filament to inject infective be parthenogenetic (asexual reproduction
material into host cells. where offspring develop from unfertilized
-​ Opportunistic infections in eggs, resulting in genetically identical
immunocompromised individuals (e.g., individuals.)
AIDS patients). -​ Have sensory organs at both ends:
-​ Amphids (anterior) & Phasmids
(posterior) → Used for
CLASSIFICATION OF PROTOZOAN PARASITES classification.
-​ Aphasmid Nematodes (Adenophorea):
Lack phasmids. Includes Trichuris,
Sarcomastigophora Trichinella, Capillaria.
-​ Sarcodina Acanthamoeba castellani -​ Phasmid Nematodes (Secernentia):
Endolimax nana
Entamoeba coli Have phasmids. Includes:
Entamoeba dispar -​ Ascaris (Order Ascaridida)
Entamoeba gingivalis -​ Parastrongylus, Hookworms
Entamoeba histolytica (Order Strongylida)
Iodamoeba butschlii -​ Strongyloides (Order
Naegleria fowleri Rhabditida)
-​ Enterobius (Order Oxyurida)
Mastigophora
-​ Filarial worms (Wuchereria,
-​ Atrial flagellates Chilomastix mesnili
Dientamoeba fragilis Brugia) –( Order Spirurida)
Giardia lamblia 3.​ Flatworms
Trichomonas hominis -​ Cestodes and Trematodes
Trichomonas tenax
Trichomonas vaginalis CLASSIFICATION OF METAZOAN PARASITES
-​ Hemoflagellates Leishmania braziliensis
Leishmania donovani Nematoda
Leishmania tropica -​ Intestinal Ascaris lumbricoides
Trypanosoma brucei Capillaria philippinensis
complex Enterobius vermicularis
Trypanosoma cruzi Hookworm
Strongyloides stercoralis
Ciliophora Balantidium coli Trichuris trichiura

Apicomplexa Babesia spp. -​ Extraintestinal Lymphatic filarial

Cryptosporidium hominis Parastrongylus
Cyclospora cayetanensis cantonensis
Cystoisospora belli Trichinella spiralis
Plasmodium spp.
Toxoplasma gondii Cestoidea
-​ Cyclophyllidea Dipylidium caninum
Microspora Enterocytozoon bieneusi Echinococcus spp.
Encephalitozoon spp. Hymenolepis diminuta
Vittaforma cornea Hymenolepis nana
Trachipleistophora hominis Raillietina garrisoni
Pleistophora spp. Taenia saginata
Anncaliia vesicularum Taenia solium
Microsporidium spp.
-​ Pseudophyllidea Diphyllobothrium latum
Spirometra sp.
 Trematoda Artyfechinostomum - Eggs require aquatic development
malayanum (coracidium stage)
Clonorchis sinensis - Example: Diphyllobothrium (definitive
Echinostoma ilocanum host: humans), Spirometra (intermediate
Fasciola hepatica host: humans)
Fasciolopsis buski
Heterophyids Cyclophyllidea - Globular scolex with four muscular
Opisthorchis felineus suckers
Opisthorchis viverrini - No uterine pore → releases eggs
Paragonimus westermani through apolysis (gravid proglottids
Schistosoma haematobium detach)
Schistosoma japonicum - One intermediate host needed
Schistosoma mansoni - Various types of encysted larvae:
• Cysticercus (e.g., Taenia)
Arthropoda Mites • Cysticercoid (e.g., Hymenolepis,
-​ Arachnida Scorpions Dipylidium, Raillietina)
Spiders • Hydatid (e.g., Echinococcus)
Ticks

-​ Chilopoda Centipedes
-​ Crustacea Copepods, Crabs Pseudophyllidean eggs:
-​ Diplopoda Millipedes -​ Operculated and immature when passed in feces.
-​ Insecta Flies, Flea, Beetle, Bees, -​ Require aquatic development → coracidium stage.​
-​ Lice, Wasp, Bugs,
-​ Pentastomida Mosquitoes Tongue Worms Cyclophyllidean eggs:
-​ Non-operculated and contain a hexacanth
embryo.
CESTODES
-​ Do not require water for development.

Cestodes / Tapeworms
-​ belong to the Phylum Platyhelminthes Mode of Infection Parasites
(Flatworms) along with trematodes (flukes).
Ingestion of infected All adult tapeworm infections
-​ Flat, segmented, and ribbon-like in appearance.
intermediate host
-​ Lack a digestive tract (absorb nutrients through
their tegument). Larval infection (cysticercosis) Taenia solium (humans ingest
-​ No circulatory system (similar to trematodes). eggs)
-​ Hermaphroditic (each proglottid contains both
male and female reproductive organs). Larval infection (hydatid cyst) Echinococcus spp. (humans
-​ Adult tapeworms inhabit the intestines of ingest eggs)
definitive hosts, while their larval forms encyst in
tissues of intermediate hosts.

Structure of a Cestode
TREMATODES
-​ Scolex: Anterior attachment organ (varies by
species).
-​ Neck: Region of growth where new segments form. Trematodes, also known as flukes, belong to the Phylum
-​ Strobila: Main body composed of segments Platyhelminthes (Flatworms) along with cestodes
(proglottids), arranged as follows: (tapeworms).
-​ Immature proglottids: Nearest to the
neck. Trematodes/Flukes
-​ Mature proglottids: Contain functional -​ Flat, leaf-like, and unsegmented in structure.
reproductive organs. -​ Equipped with suckers:
-​ Gravid proglottids: Contain fully -​ Oral sucker for feeding.
developed eggs. -​ Ventral sucker (acetabulum) for
attachment.
Classification of Cestodes: -​ Genital sucker (gonotyl) present only in
Two orders of tapeworms with medical and public health heterophyids.
significance: -​ Hermaphroditic, except for Schistosoma.
-​ Require two intermediate hosts in their life cycle.
-​ All trematodes have operculated eggs, except
Order Characteristics
Schistosoma.
-​ Infective stage: Metacercaria (encysted larva in the
Pseudophyllidea - Spatulate scolex with bothria
tapeworms (sucking grooves) second intermediate host), except for Schistosoma,
- Uterine pore present (allows eggs to where the cercaria is the infective stage.
be released)
- Two intermediate hosts needed
LIFE CYCLE AND HOSTS EFFECTS OF ARTHROPODS ON HUMAN HEALTH

Stage Characteristics Effect Examples

Eggs Contain miracidium (embryo). Envenomization (Venom Bites from spiders, flies,
Mature eggs: Schistosoma, Injection) bugs, mites, and ticks.
Clonorchis, Opisthorchis, Stings from scorpions,
heterophyids ants, wasps, and bees.
Immature eggs: Paragonimus,
Fasciola, Fasciolopsis, Echinostoma Allergen Exposure Recognized as a health
(miracidium develops in water). hazard.

First Intermediate Always a snail. Blood Feeding & Disease Biting flies and
Host Transmission mosquitoes feed on
human blood and act as
Second Varies by species: biological vectors for:
Intermediate Host - Fish (e.g., Clonorchis) - Plasmodium (Malaria)
- Crustacean (e.g., Paragonimus) - Filaria (Filariasis)
- Another snail - Trypanosomes
- Freshwater plants (e.g., (Trypanosomiasis)
Fasciola). - Babesia (Babesiosis)
- Leishmania
Infective Stage Metacercaria (except Schistosoma, (Leishmaniasis)
where it is the cercaria).
Mechanical Vector Flies and cockroaches
Transmission carry microbes and
CLASSIFICATION BASED ON HABITAT parasites from unsanitary
environments.
Habitat Flukes
Dermatologic Fleas and lice cause skin
Manifestations conditions due to
Blood flukes (mesenteric Schistosoma prolonged contact.
veins)
Myiasis (Tissue Infestation Fly larvae invade and infest
Lung flukes (lung Paragonimus by Fly Larvae) human tissues.
parenchyma)

Liver & bile duct flukes Fasciola, Clonorchis,

Opisthorchis

Intestinal flukes Fasciolopsis, Echinostoma, RHONAZEL N. TAMPUS, RMT, MD, TBH, IDC, IG, ISTG,
heterophyids AMP, NVM, IKR, IRL, SLR, OFC, WDM, LOL, LOML, FR

ARTHROPODS

Phylum Arthropoda consists of bilaterally symmetrical

organisms with segmented bodies and jointed
appendages. They possess a chitinous exoskeleton for
protection.

Arthropods (Phylum Arthropoda)

This phylum includes:
-​ Insects (e.g., mosquitoes, flies, fleas, lice)
-​ Mites and ticks
-​ Spiders and scorpions
-​ Centipedes and millipedes
-​ Crustaceans
-​ Pentastomids (Pentastomes) – considered part of
this group due to shared characteristics with both
arthropods and annelids.