PARASITOLOGY

D.M.ONDARI
What is the parasite?
A parasite is a living organism that lives in (endoparasite) or on
(ectoparasite) another organism, termed its host. It obtains nourishment and
protection while offering no benefit in return. Consequently, the host
suffers from various diseases, infections, and discomforts. However, in
some cases, the host may show no signs at all of infection by the
parasite.parasites may be seen with the naked eye(macroscopically) or with
a microscope(microscopically)
.The parasites included in medical parasitology are:
Protozoa, Helminthes, and Arthropods.
. The host is an organism which supports the parasite. The hosts vary
depending on the developmental stages of the parasite they harbor.
• Parasitism: is a relationship in which one of the
participants, the parasite, either harms or lives at the
expense of the host. A parasite depends upon the host for
its nutrients, and obtain these nutrients at the expense of
the host. This category of parasite is normally the one
which causes pathogenic infections of humans. Parasites
may cause mechanical injury, such as boring a hole into
the host or digging into its skin or other tissues, stimulate
a damaging inflammatory or immune response.
 TYPES OF PARASITES
 An obligatory parasite that is completely dependent on its host during part or all of its life cycle
and can’t survive without it e.g. hookworms.
 A facultative parasite that can change its life style between free-living in the environment and
parasitic according to the surrounding conditions. e.g. Strongyloides stercoralis.
 An accidental parasite that affects an unusual host e.g. Toxocara canis (a dog parasite) in man.
 A temporary parasite that visits the host only for feeding and then leaves it. e.g. Bed bug visiting
man for a blood meal.
 A permanent parasite that lives in or on its host without leaving it e.g. Lice.
 An opportunistic parasite that is capable of producing disease in an immune-deficient host (like
AIDS and cancer patients). In the immuno-competent host, it is either found in a latent form or
causes a self-limiting disease e.g. Toxoplasma gondii.
• A zoonotic parasite that primarily infects animals and is transmittable to humans. e.g. Fasciola
species.
• Aberrant parasite – one which is never transmitted from man to man and which develops
abnormally in man (hydatid, Angiostrongilus, Toxocara)
• Erratic Parasite – one that wanders from its predilection sites into an organ where it is not usually
found, e.g. Entamoeba histolytica in lung or liver of the host
 TYPES OF HOSTS
•Hosts are classified according to their role in the life cycle of the parasite into:
 Definitive host (DH) harbors the adult or sexually mature stages of the parasite (or in whom sexual reproduction
occurs) e.g. man is DH for Schistosoma haematobium, while female Anopheles mosquito is DH for Plasmodium
species (malaria parasites).
 Intermediate host (IH) harbours larval or sexually immature stages of the parasite (or in whom asexual reproduction
occurs) e.g. man is IH of malaria parasites. Two intermediate hosts termed 1 st and 2nd IH may be needed for
completion of a parasite's life cycle, e.g. Pirenella conica snail is the 1st IH, while Tilapia (Bolty) fish is the 2nd IH for
Heterophyes heterophyes.
 Reservoir host (RH) harbours the same species and same stages of the parasite as man – a host that harbors the
parasite and makes the parasite available for transmission to another host and is usually not affected by the infection.
It maintains the life cycle of the parasite in nature and is therefore, a reservoir source of infection for man. E.g. sheep
are RH for Fasciola hepatica.
 Paratenic or transport host in whom the parasite does not undergo any development but remains alive and infective
to another host. Paratenic hosts bridge gap between the intermediate and definitive hosts. For example, dogs and
pigs may carry hookworm eggs from one place to another, but the eggs do not hatch or pass through any
development in these animals.
 Vector is an arthropod that transmits parasites from one host to another, e.g. female sand fly transmits Leishmania
parasites.
 COMMON RELATIONSHIPS
• Symbiont - Any organism that spends a portion or all of its life cycle intimately associated with
another organism of a different species and this relationship is called symbiosis. The following
are the three common symbiotic relationships between two organisms:
A. Mutualism - an association in which both partners are metabolically dependent upon each
other and one cannot live without the help of the other; however, none of the partners suffers
any harm from the association. One classic example is the relationship between certain species
of flagellated protozoa living in the gut of termites. The protozoa, which depend entirely on a
carbohydrate diet, acquire their nutrients from termites. In return they are capable of
synthesizing and secreting cellulases; the cellulose digesting enzymes, which are utilized by
termites in their digestion.
• B.Commensalism - an association in which the commensal takes the benefit without
causing injury to the host. E.g. Most of the normal floras of the humans’ body can
be considered as commensals.
• C.Parasitism - an association where one of the partners is harmed and the other lives
at the expense of the other. E.g. Worms like Ascaris lumbricoides reside in the
gastrointestinal tract of man, and feed on important items of intestinal food causing
various illnesses
EFFECT OF PARASITES ON THE HOST
The damage which pathogenic parasites produce in the tissues of the
host may be described in the following two ways;
(a) Direct effects of the parasite on the host
• Mechanical injury - may be inflicted by a parasite by means of
pressure as it grows larger, e.g. Hydatid cyst causes blockage of ducts
such as blood vessels producing infraction.
• Deleterious effect of toxic substances- in Plasmodium falciparum
production of toxic substances may cause rigors and other symptoms.
• Deprivation of nutrients, fluids and metabolites -parasite may
produce disease by competing with the host for nutrients.
• (b) Indirect effects of the parasite on the host:
Immunological reaction: Tissue damage may be caused
by immunological response of the host, e.g. nephritic
syndrome following Plasmodium infections. Excessive
proliferation of certain tissues due to invasion by some
parasites can also cause tissue damage in man, e.g.
fibrosis of liver after deposition of the ova of
Schistosoma.
 BASIC CONCEPTS IN MEDICAL PARASITOLOGY

In medical parasitology, each of the medically important parasites are

discussed under the standard subheadings of morphology, geographical
distribution, means of infection, life cycle, host/parasite relationship,
pathology and clinical manifestations of infection, laboratory diagnosis,
treatment and preventive/control measures of parasites.
• 1. Morphology - includes size, shape, color and position of different
organelles in different parasites at various stages of their development.
This is especially important in laboratory diagnosis which helps to
identify the different stages of development and differentiate between
pathogenic and commensal organisms. For example, Entamoeba
histolytica and Entamoeba coli..
• 2.Geographical distribution –there are certain diseases that occur or are prevalent
than others in a certain region.Even though revolutionary advances in transportation has
made geographical isolation no longer a protection against many of the parasitic diseases,
many of them are still found in abundance in the tropics. Distribution of parasites depends
upon:
• a. The presence and food habits of a suitable host: • Host specificity, for example,
Ancylostoma duodenale requires man as a host where Ancylostoma caninum requires a
dog. • Food habits, e.g. consumption of raw or undercooked meat or vegetables
predisposes to Taeniasis
• b. Easy escape of the parasite from the host- the different developmental stages of a
parasite which are released from the body along with faeces and urine are widely
distributed in many parts of the world as compared to those parasites which require a
vector or direct body fluid contact for transmission. c. Environmental conditions favoring
survival outside the body of the host, i.e. temperature, the presence of water, humidity
etc.
• d. The presence of an appropriate vector or intermediate host – parasites that do not
require an intermediate host (vector) for transmission are more widely distributed than
those that do require vectors.
3.Life cycle
A parasite life cycle consists of two common phases;
1) The route a parasite follows inside the host body and
2) the route a parasite follows outside of the body.
• This provides crucial information pertinent to epidemiology, prevention and control.
Once the infecting organism is introduced into the body of the host, it reacts in different ways and
this could result in:
A) Carrier state – a perfect host parasite relationship where tissue destruction or damage by a
parasite is balanced with the host’s tissue/damage repair. At this point the parasite and the host
live harmoniously, i.e. they are at equilibrium, as in reservoir host.
B) Pathology and clinical manifestations of infection:
1) Disease state -this is due to an imperfect host parasite relationship where the parasite
dominates the upper hand. This can result either from lower resistance of the host or a higher
pathogenecity of the parasite.
2) Parasite destruction –occurs when the host takes the upper hand.
4.Laboratory diagnosis:
• Depending on the nature of the parasitic infections, the following specimens are
selected for laboratory diagnosis:
•Blood - in those parasitic infections where the parasite itself in any stage of its
development circulates in the blood stream, examination of blood film forms one of
the main procedures for specific diagnosis.
•Stools - examination of the stool forms an important part in the diagnosis of
intestinal parasitic infections.
• –trophozoites, cystic forms and parasite eggs may be detected. Some adult
worms and their larvae may also be found in the stools.
•Urine
• –when the parasite localizes in the urinary tract, examination of the urine will be of
help in establishing the parasitological diagnosis
•Sputum
• –examination of the sputum is useful in the following:
• •habitat of the parasite is in the respiratory tract, as in Paragonimiasis - the eggs of Paragonimus westermani are
found.
• •In amoebic abscess of lung or in the case of amoebic liver abscess bursting into the lungs, the trophozoites of E.
histolytica are detected in the sputum.
•Biopsy material
• –varies with different parasitic infections.
• –e.g. spleen punctures in cases of kala-azar,
• –muscle biopsy in cases of Cysticercosis, Trichinelliasis, and Chagas’ disease,
• –Skin snip for Onchocerciasis.
• Urethral or vaginal discharge
• –for Trichomonas vaginalis
• Indirect evidences
• •changes indicative of intestinal parasitic infections are:
• •Cytological changes in the blood
• –eosiniphilia often gives an indication of tissue invasion by helminthes,
• –a reduction in white blood cell count is an indication of kala-azar, and anemia is a feature of hookworm infestation
and malaria.
• •Serological tests
• –are carried out only in laboratories where special antigens are available.
5.Treatment and preventive measures of parasites

• Preventive measures include:

•Reduction of the source of infection–the parasite is attacked within the host,
thereby preventing the dissemination of the infecting agent.
• –Sanitary control of drinking water and food
• Proper waste disposal –through establishing safe sewage systems, use of
screened latrines, and treatment of night soil.
• •The use of insecticides and other chemicals used to control the vector
population.
• •Protective clothing that would prevent vectors from resting on the surface of the
body and inoculate pathogens during their blood meal.
• •Good personal hygiene.
• •Avoidance of unprotected sexual practices
 Nomenclature
•All animals and plants must have names by which they can be distinguished. Although common
names are frequently used for this purpose, these are not universally understood, partly because of
language barriers and partly because of a common name not necessarily applied to the same
organism in different countries. To overcome this difficulty, a binomial scientific name is used,
consisting of a generic and a specific designation based on the International Code of Zoological
nomenclature. The first name in the binomial is that of the genus to which the organism belongs,
and the second is that of the species. This combination in designating an animal or plant species is
termed binomial nomenclature. Taxonomic classification of medically important parasites of man
belong to the kingdom of Animalia and most parasites are members of three phyla:
•- Phylum Protozoa
•- Phylum Platyhelminths and
•- Phylum Nemathelminths.
• Describing animal parasites follows certain rules of zoological
classification as follows:

• Kingdom
• Phylum – sometimes with subphylum
• Class – occasionally with super-class and sub-class
• Order – sub-order
• Family – occasionally with super-family and sub-family
• Genus
• Species
CLASSIFICATION OF MEDICAL PARASITOLOGY
• Parasites of medical importance come under the kingdom called protista
and animalia. Protista includes the microscopic single-celled eukaroytes
known as protozoa. In contrast, helminthes are macroscopic,
multicellular worms possessing well differentiated tissues and complex
organs belonging to the kingdom animalia.
Medical Parasitology is generally classified into:
1• Medical Protozoology - Deals with the study of medically important
protozoa.
2• Medical Helminthology - Deals with the study of helminthes (worms)
that affect man.
3• Medical Entomology - Deals with the study of arthropods which cause
or transmit disease to man.
 Phylum protozoa
These are unicellular organisms in which the various activities of metabolism, locomotion, etc., are carried out by organelles of the cell. Protozoa of
medical importance are grouped in the following classes:
• Class - Sarcodina (Amoebae):
a) Genus, Entameba: e.g. Entameba histolytica
b) Genus Endolimax e.g. Endolimax nana
c) Genus Iodameba e.g. Iodameba butchlii
d) Genus Dientmeba e.g. Dientameba fragilis

• Class - Mastigophora (Flagellates):

Have one or more flagella
a) Genus Giardia e.g. Giardia lamblia
b) Genus Trichomonas e.g. Tricomonas vaginalis
c) Genus Trypanosoma e.g. Trypanosoma brucci
d) Genus Leishmania e.g. Leishmania donovani

• Class Sporozoa:
No organs of locomotion (except in gamete stages).
1) Genus Plasmodium e.g. Plasmodium falciparum
2) Genus Toxoplasma e.g. Toxoplasma Gondi
3) Genus Cryptosporidium e.g. CryptosporidiumParvum
4) Genus Isospora e.g. I. Beli

Class Ciliata (Ciliates)

Have cilia all over the clell body, e.g. Balantidium coli
Phylum platyhelminthes
• Dorso-ventrally flattened organisms which are usually hermaphroditic (except Schistosomes).
• Respiratory and blood vascular systems are absent.
• Two classes are important in medical parasitology:

• Class – Trematoda (Flukes):

• Leaf-shaped species that have an alimentary canal
• Genus Schistosoma e.g. S. mansoni
• Genus Fasciola e.g. F. hepatica
•
• Class – Cestoda (Tape worms):
• Species with segmented body and with no alimentary canal
• Mainly hermaphroditic

• (a) Diphylobotrium e.g. D. latum

• (b) Genus Taenia e.g. T. saginata and T. solium
• (c) Genus Echinococcus e.g. E. granulosus
• (d) Genus Hymenolepsis e.g. H. nana
Phylum nematyhelminthes
• Class Nematoda (Round worms):
• Cylindrical worms, both ends tapered.
• Have alimentary canal
• Are dioecious have- have male and female in different organisms
• Can be divided into:
• Intestinal Nematodes e.g. A. Lumbricoides
• Somatic Nematodes e.g. W. bancrofti
Phylum arthropoda
• Most arthropods are of medical importance in that they either cause pathological conditions or transmit
pathogenic organisms to man.
• Class - Arachnida e.g. ticks, spiders, mites, scorpions, etc. 4 pairs of limbs. Mostly 2 body parts –
cephalothorax and abdomen.
• Class - Insecta – includes all the insects, e.g. Mosquitoes, Tsetse flies, Sand flies, House flies, etc. Body
divided into 3 parts:
• Head, with one pair of antennae;
• Thorax, consisting of 3 segments bearing 3 pairs of legs and, typically, two pairs of wings (not all);
• Abdomen, consisting of a variable number of segments but commonly lacking appendages.
• Class - Crustacia e.g. lobsters, crabs, shrimps, etc. Most species are aquatic and breathe by means of gills.
Have 2 pairs of antennae on the head and several pairs of limbs on thorax and abdomen
• Class- diploda e.g. millipede
• Class - Chilopoda e.g. Centipedes
• Class - Pentastomida e.g. tongue worms
• The first three classes – Arachnida, Insecta and Crustacia are the most common classes of arthropods of
medical significance.
Phylum protozoa
• Reproduction – the methods of reproduction or multiplication among
the parasitic protozoa are of the following types:
• 1. Asexual multiplication: (a) Simple binary fission – in this process,
after division of all the structures, the individual parasite divides
either longitudinally or transversely into two more or less equal parts.
(b) Multiple fission or schizogony – in this process more than two
individuals are produced, e.g. asexual reproduction in Plasmodia.
Reproduction cont’d
• 2. Sexual reproduction:
• (a) Conjugation – in this process, a temporary union of two
individuals occurs during which time interchange of nuclear material
takes place. Later on, the two individuals separate.
• (b) Syngamy – in this process, sexually differentiated cells, called
gametes, unite permanently and a complete fusion of the nuclear
material takes place. The resulting product is then known as a zygote.
 1.Class Rhizopoda (Amoebae)
•Protozoan parasites belong to the class Rizopoda that characteristically move by pseudopodia.
Seven ameba, belonging to the order amoebida, are found in man. One of them is found in the
oral cavity and the remaining six species are found in the large intestine, these include:
Entamoeba histolytica, E.dispar, E. Coli, Endolimax nana, Iodamoeba butschlii and
Entamoeba polecki; of these only one, i.e. E. histolytica is pathogenic to man, E. nana and
other amoebae may coexist in the large gut as commensals. E. gingivalis is commonly found in
various teeth disease gum and tonsils.
•All human intestinal amoebae have:
1) a trophozoite from which is motile organism, feed, and reproduce,
2) Precystic form, intermediate between cyst and triphozoite stage.oval with blunt pseudopodia
3) a cystic form which is the non-feeding, non-motile, dormant stage of protozoa.
•Among amoeba, E. gingivalis has only a trophozoite form.
•Amoeba reproduce asexually by simply dividing into two (binnary fission).
Entamoeba histolytica

•E.histolytica is an enteric protozoan parasite with worldwide

distribution. It is responsible for amoebic dysentery (bloody diarrhea)
and invasive extraintestinal amebiasis (such as liver abscess, peritonitis,
pleuropulmonary abscess).
•Mode of transmission: Feco-oral route, via the ingestion of
contaminated food or water containing mature quadrinucleate
cyst of Entamoeba histolytica. Trophozoites if ingested would not
survive exposure to the gastric environment.
•As this protozoan parasite lyse the cells of intestinal tract; there will be
bleeding; so the stool contains blood and mucus (Amoebic dysentry).

•Quadrinucleated cyst of E.histolytica

•Infective form: Mature quadrinucleate cyst; it is spherical in shape with
refractile wall.
•Geographical distribution: Worldwide, more common in the tropics and
sub tropics, especially in areas with poor sanitation (developing and under-
developed countries).
•Habitat: Trophozoites of E. histolytica live in the mucosal and
submucosal layers of the large intestine of man.
•.
 Life cycle of Entamoeba histolytica has two stages: motile trophozoite and non-motile
cyst. Trophozoites are found in intestinal lesions, extra-intestinal lesions and diarrheal
stools whereas cyst predominate in non-diarrheal stools
 When they cyst of E. histolytica reaches caecum or lower part of ileum excystation
occurs and an amoeba with four nuclei emerges and that divides by binary fission to
form eight trophozoites.
 Trophozoites migrate to the large intestine and lodge in to the submucosal tissue.
 Trophozoites grow and multiply by binary fission in large intestine (Trophozoite phase
of life cycle is responsible for producing characteristics lesion of amoebiasis).
 Certain number of trophozoites are discharged in to the lumen of the bowel and are
transformed into cystic forms.
 The cysts thus formed are unable to develop in the same host and therefore necessitate
a transference to another susceptible host. The cysts are passed in the feces.
•Note: Because of the protection conferred by their walls, the cysts can
survive days to weeks in the external environment. Cysts are not highly
resistant and are readily killed by boiling. But they are resistant to
chlorination or can be removed by filtration. Trophozoites can also be
passed in diarrheal stools, but are rapidly destroyed once outside the body.
•Trophozoite is responsible for disease conditions;
 The trophozoites invade the colonic epithelium and secrete enzymes
that cause localized necrosis. Little inflammation occurs at the site.
 As the lesion reaches the muscularis layer, a typical “flask shaped”
ulcer forms, that can undermine and destroy large areas of intestinal
epithelium.
 Progression into submucosa leads to invasion of the portal circulation
by the trophozoites.
•Diseases
1. Non-invasive infection: In many cases, the trophozoites remain
confined to the intestinal lumen of individuals who are thus
asymptomatic carriers and cysts passers.
2. Intestinal disease: In some patients the trophozoites invade the
intestinal mucosa,
• Extra-intestinal disease: through the bloodstream, trophozoites invade
extraintestinal sites such as the liver, brain, and lungs, with resultant
pathologic manifestations
•Amoebic liver abscess
 About 2-10% of individuals infected with E. histolytica suffer from hepatic complications.
 The trophozoites of E.histolytica are carried as emboli by the portal vein from the base of amoebic
ulcer in the large intestine.
 Capillary system of the liver acts as an efficient filter and holds the trophozoites.
 Trophozoites multiply inside liver cells and carry on cytolytic actions.
 This leads to obstruction to the circulation and produces thrombosis of the portal venules
(sinusoids) resulting in anaemic necrosis of the liver cells
 Progressive destruction of concentric layers of liver cells occurs.
 Large sized abscess is formed by coalescence of miliary abscess.
 Amebic abscess of the liver is characterized by right upper-quadrant pain, weight loss, fever, and a
tender enlarged liver.
 Right-lobe abscesses can penetrate the diaphragm and cause lung disease (pulmonary amoebiasis)
 Other lesions include:
o Cerebral amoebiasis
•Clinical Findings
 Acute intestinal amebiasis
o dysentery (i.e. bloody, mucus containing diarrhea)
o lower abdominal discomfort,
o flatulence
 Chronic amebiasis:
• Low grade symptoms such as occasional diarrhea, weight loss and fatigue
also occurs.
 Roughly 90% of infected individuals have asymptomatic infection.
 Ameboma, a granulomatous lesion may form in the cecal or rectosigmoid
areas of the colon in some patients. These lesions resemble an
adenocarcinoma of the colon and must be distinguished from them.
•Diagnosis
•It rests on finding either trophozoites in diarrheal stools or cysts in
formed stools. Diarrheal stools should be examined within one hour of
collection to see the ameboid motility of the trophozoite. The
trophozoite characteristically contain ingested red blood cells.
•Characteristics of Stool
 Macroscopic appearance of stool: Offensive dark brown semisolid
stool, and mixed with blood, mucus and much fecal matter.
 General microscopic examination:
o Presence of charcot-Leyden crystals.
o E. histolytica infection is distinguished from bacillary dysentery by the lack of
high fever and absence PMN leukocytosis
•Laboratory diagnosis methods:
•A. Microscopy:
•E. histolytica can be distinguished from other amoebas by two major criteria
•1.nature of the nucleus and the trophozoit.
The E. histolytica nucleus has a small central nucleolus and fine chromatin granules along the
border of the nuclear membrane. The nuclei of other amebas are quite different.
•Note: The trophozoites of Entamobea dispar, a nonpathogenic species of Entamoeba, are
morphologically indistinguishable from those of E. histolytica
2. Cyst size and number of its nuclei.
Mature cysts of E. histolytica are smaller than those of Entamoeba coli and contain four
nuclei, whereas E. coli cysts have eight nuclei.
•B. Antigen detection: detection of E. histolytica antigen in the stool
•C. Serologic testing is useful for the diagnosis of invasive amebiasis.
•C. Detection of nucleic acid of this protozoan parasite by PCR based assay.
•Prevention and Control
•1. Cooking of food and vegetables
•2. Hand washing after defecation and before eating
•3. Safe water supply (treatment, boiling, filtration, etc.)
•4. Control of mechanical vectors like flies
•5. Avoid use of night soil as a fertilizer proper sanitary disposal of faeces.
• 6. Treatment of infected individuals and health education
Treatment
• metronidazole