Reading material for Basic Mechanisms of Diseases/S.

Wahyuni/Department of Parasitology/
Medical Faculty, Hasanuddin University/2009

GENERAL INTRODUCTION OF PARASITOLOGY

Parasitology is the science which deals with organisms that take up their abodes, temporarily or
permanently, on or within other living organisms for the purpose of procuring food. Broadly
speaking, parasitology embraces several fields of knowledge, including those dealing with
bacteria, viruses, rickettsias, spirochetes, fungi and animal parasites. In a more restricted sense,
parasitology is limited to the field of animal parasites belonging to the protozoa, helminths, and
arthropods.

PARASITE AND PARASITISM

Types of Parasites
Parasitism includes any reciprocal association in which a species depends upon another
for its existence. This association may be temporary or permanent. In symbiosis there is a
permanent association of two organisms that cannot exist independently; in mutualism both
organisms are benefited; and in commensalism one partner is benefited and the other is
unaffected. The term parasite, however, is ordinarily applied to a weaker organism that obtains
food and shelter from another organism and derives all the benefit from the association. The
harboring species, known as the host, may show no harmful effects or may suffer from various
functional and organic disorders.
Various descriptive names denote special types or functions of parasites. An ectoparasite
lives on the outside and an endoparasite within the body of the host. Parasites are termed
facultative when they are capable of leading both a free and parasitic existence, and obligate
when they take up a permanent residence in and are completely dependent upon the host. An
incidental parasite is one that establishes itself in a host in which it does not ordinarily live. A
temporary parasite is free-living during part of its existence and seeks its host intermittently to
obtain nourishment. A permanent parasite remains on or in the body of the host from early life
until maturity, sometimes for its entire life. A pathogenic parasite causes injury to the host by its
mechanical, traumatic, or toxic activities. A pseudoparasite is an artifact mistaken for a parasite.
A coprozoic or spurious parasite is a foreign species that has passed through the alimentary
trac.without infecting man.
Vital Requirements
The activities of living organisms are directed toward maintaining the individual and the race.
Parasites require a favorable environment to carry on unimpeded the functions of digestion,
excretion, respiration, and reproduction. The requirements of parasites do not differ essentially
from those of their free-living counterparts, except for such modifications as are necessary for

Reading material for Basic Mechanisms of Diseases/S. Wahyuni/Department of Parasitology/

Medical Faculty, Hasanuddin University/2009
existence within their hosts. Parasites often lack the necessary organs for assimilating raw food
materials and depend upon the host for predigested food. An adequate supply of moisture is
assured inside the host, but during the free-living existence of the parasite inadequate moisture
may either prove fatal or prevent larval development. Temperature is, likewise, important. Each
species has an optimal temperature range for its existence and development, and some are
susceptible to slight variations. Both high and low temperatures are detrimental and even lethal.
Scientific Nomenclature
Animal parasites are classified according to the International Code of Zoological Nomenclature.
Each parasite belongs to a phylum, class, order, family, genus, and species. At times the further
divisions of suborder, superfamily, subfamily, and subspecies are employed.
The law of priority obtains as to the oldest available name, even if only a portion of the
parasite or its larva has been described. To be valid a generic name must not have been given
previously to another genus of animals. The names of genera and species are printed in italics;
the generic name begins with a capital and the specific name with a small letter .
Classification
Animal parasites may be divided into the unicellular protozoa and the multicellular metazoa. The
metazoan cells are differentiated to perform special functions but are dependent upon one
another for their existence. The parasites of man are practically all confined to the PROTOZOA,
NEMATHELMINTHES, PLATHYHELMINTHES, and ARTHROPODA. The distribution of
parasites in the animal kingdom is present below:

Distribution of Parasites in the Animal Kingdom

Phylum

Subphylum

Parasitic species

Human parasite

Protozoa

Sarcodina

Many

Mastigophora

Many

Sporozoa

All

Few

Insecta

Many

Arachnida

Many

Crustacea

Many

Cestoda

All

Trematoda

All

Nematoda

All

Coelentrata
Arthropoda

Plathyhelminthes

Nemathelminthes

Reading material for Basic Mechanisms of Diseases/S. Wahyuni/Department of Parasitology/

Medical Faculty, Hasanuddin University/2009
History
The large parasitic worms were among the first agents studied as causes of disease. The
famous Ebers papyrus, about 1600 B.C., contains some of the earliest records of the presence of
parasitic worms in man. Persian, Egyptian, Greek, Roman, and Arabic physicians were familiar
with various parasitic worms.
Modern parasitology dates from 1379 when Jehan de Brie discovered the liver fluke,
Fasciola hepatica, in sheep. During the eighteenth century many parasitic worms and arthropods
were described, but there was little progress until the compound microscope made possible the
study of the small protozoan parasites and of the larvae and detailed structures of the helminths.
Following the description of the larva of Trichinella spiralis by Owen in 1835, exact
knowledge concerning the helminthic parasites of man began to accumulate. Many new species
were discovered, prominent among which were the hookworm, Ancylostoma duodenale, in 1838
by Dubini and the blood fluke, Schistosoma haematobium, in 1851 by Bilharz. Between 1850 and
1900 investigators traced the life cycles of Taenia solium, Echinococcus granulosus, Fasciola
hepatica, and Ancylostoma duodenale, and between 1900 and 1920 those of Schistosoma
japonicum, Clonorchis sinesis, Diphyllobothrium latum, and Ascaris lumbricoides.
The first protozoan parasites to be recognized were: Trichomonas vaginalis in 1836 by
Donne, Endamoeba gingivalis in 1849 by Gros, Balantidium coli in 1856 by Malmsten, Giardia
lamblia in 1859 by Lambl, and Trichomonas hominis in 1860 by Davaine. In 1875 Losch
corroborated the earlier observations of Lambl upon Endamoeba histolytica in patients with
diarrhea. In 1880 Laveran observed the quartan malarial parasite of man. In 1900 Leishman
discovered Leishmania donovani, the cause of kala-azar, and in 1901 Forde found Trypanosoma
gambiense, the parasite producing African sleeping sickness.
Although certain arthropods had been recognized as parasites since early times, their
role as vectors of parasitic, bacterial, viral, and rickettsial diseases was not established until
Melnikov in 1869 found the larval stages of the dog tapeworm, Dipylidium caninum, in the dog
louse, and Manson in 1878 demonstrated that the mosquito, Culex quinquefasciatus,was an
intermediate host of the filarial worm, Wuchereria bancrofti. In 1893 Smith and Kilbourne
discovered that a tick was the transmitting agent of Texas fever in cattle. In 1898 Ross observed
the development of an avian malarial parasite in the mosquito. In 1900 Reed and his co-workers
proved that yellow fever was transmitted by Aedes aegypti, Subsequently other arthropods were
found to be vectors of disease: the tsetse fly in African sleeping sickness in 1903, the tick in
African relapsing fever in 1905, the reduviid bug in South American trypanosomiasis in 1907, and
the body louse in typhus fever in 1909.

Reading material for Basic Mechanisms of Diseases/S. Wahyuni/Department of Parasitology/

Medical Faculty, Hasanuddin University/2009
Geographic Distribution
The endemicity of a parasite depends upon the presence and habits of a suitable host, upon easy
escape from the host, and upon environmental conditions favoring survival outside the host.
Parasites with simple life cycles are more likely to have a cosmopolitan distribution than those
with complicated life cycles. The range of a parasite is confined to the habitat of its host.
Parasites restricted to a single species of host generally have a more limited range than those
that infect several species.
Economic and social conditions affect the distribution of the parasites of man. Customs
considered financially profitable may be hygienically unsound. Thus, irrigation projects and the
use of night soil in agriculture provide facilities for parasitic infection. Inadequate individual and
community sanitation, low standards of living, and ignorance favor the spread of parasitic
diseases. Religious rites such as immersion in heavily contaminated water may be responsible
for their transmission. Migrations of populations have tended to spread parasitic disease
throughout the world. The importation of the Negro to the Western Hemisphere was accompanied
by hookworm disease and schistosomiasis. Immigrants from the Baltic countries introduced the
fish tapeworm into North America.
Although many important species of parasites have a world-wide distribution, tropical
countries where optimal conditions of temperature and humidity are present are most favorable
for the survival, larval development, and transmission of parasites. The short summer season in
the temperate zones prevents the development of many species that require high temperatures
during their larval stages, thus establishing zones of distribution according to latitude. Each
parasite has an optimal range of temperature for its development. Warm temperatures, however,
do not always favor the existence of parasites. Intense dry heat or direct sunlight may destroy the
larval forms. On the other hand, low temperatures arrest the development of ova and larvae and
may even destroy them. Temperature indirectly affects the distribution of parasites by limiting the
range of animal hosts. Likewise moisture, which depends upon temperature, latitude, and
topography, governs the distribution of parasites. Not only is moisture essential for the
development of free-living larvae, but it is also necessary for the propagation of intermediate
hosts such as arthropods, snails, and fishes. Even in the tropics, dry plateaus, because of lack of
humidity, are practically free from parasites except resistant species or those that are transferred
directly from host to host.
Life Cycle
Parasites have developed more or less complicated life cycles through adaptation to their hosts
and external environment. Most parasites except certain arthropods attain sexual maturity in their
hosts. Some spend their entire lives within the host, one generation following another; others on
leaving the host are exposed to the vicissitudes of an external environment. During their

Reading material for Basic Mechanisms of Diseases/S. Wahyuni/Department of Parasitology/

Medical Faculty, Hasanuddin University/2009
extracorporeal life they may remain quiescent in the form of resistant cysts, ova, or larvae, or they
may undergo active growth and metamorphosis. Furthermore, the larval parasite may pass
through developmental stages in an intermediate host before it reaches a final host.
The final or definitive host harbors the adult or sexually mature parasite. Every species of
carnivorous or omnivorous animal at some time has sheltered one or more types of parasites.
Man may be the only definitive host, the most important source of human disease; one of several
animal hosts; or merely an incidental host of a parasite prevalent in other animals. Animals that
harbor the same species of parasites as man are known as reservoir hosts. Such hosts insure the
continuity of the parasite's life cycle and act as additional sources of human infection. Part or all
of the larval stage may be passed in another animal, known as the intermediate host. Certain
species of trematodes and cestodes have two such hosts, known as primary and secondary
intermediate hosts. At times man may serve as an d intermediate host. As a rule parasites exhibit
host specificity, a parasite infecting naturally only one or at most a few species of animals. This
special adaptation depends upon the invasive power of the parasite, the susceptibility of the host,
and the opportunity for contact between parasite and host.
The perpetuation of the life of a parasite depends upon its transmission from host to host.
Various stage in the life cycles of the different parasites of man have been worked out, but many
details are still unknown. From a medical stand point, knowledge of the life cycle of a parasite is
important, since it often indicates the stages at which preventative measures can be most
effectively applied. Certain parasites have elaborate life cycles involving several hosts, while
others have simple life histories. The more complicated the life cycle, the slimmer are the
chances of survival, but over developed reproductive organs and parthenogenetic multiplication
tend to offset the increased hazards of a complex life history. The next figure gives a
diagrammatic representation of the various types of life cycles.

Life cycles of parasites.

a. transmission .with existence outside host
b.

transmission with development during free-living existence

c.

direct transmission from host to host.

Reading material for Basic Mechanisms of Diseases/S. Wahyuni/Department of Parasitology/

Medical Faculty, Hasanuddin University/2009
d. transmission through one intermediate host with or without .free-living existence
e. transmission through more than one intermediate host with or without free-living
existence
f.

final and intermediate host in same animal.

Transmission

The transmission of parasitic diseases involves 3 factors: ( 1) the source of the infection, (2) the
mode of transmission, and (3) the presence of a susceptible host. The combined effect of these
factors determines the dispersibility and prevalence of the parasite at any given time and place.
The next figure gives a diagrammatic representation of the factors involved in the transmission of
parasitic diseases :

The transmission of parasitic diseases. A, diagnosis and treatment; B, isolation; C, blocking

outllowing injection; D, detection of carriers and missed cases; E, immunization; F, cleanliness
and hygiene; G, isolation and screening; and H, quarantine.
On the left the 5 lines radiating from the source or focus of infection represent the 5 avenues
through which the infective agent may leave the body. The 4 concentric circles, A to D, represent
the methods of checking or controlling the outflowing infection. On the right a similar series of
concentric circles, E to H, surround the susceptible contact and represent the measures that
protect him against infection. Here the 3 radiating lines indicate the channels by which the

Reading material for Basic Mechanisms of Diseases/S. Wahyuni/Department of Parasitology/

Medical Faculty, Hasanuddin University/2009
infective agent may or more types of parasites. Man may enter the body. The lines connecting the
source of infection and the susceptible contact show the various modes of transmission.
Source of infections
Man is the chief source of most human parasitic diseases, but in certain infections various
animals that act as reservoir or intermediate hosts may also be important sources. The patient
with clinical disease usually is the most potent source, particularly in rapidly spreading infections
or epidemics. Since parasitic diseases often tend to run a chronic course with few or no
symptoms, practically every infected individual eventually becomes a carrier who harbors the
parasite without showing clinical evidence of infection and thus serves as a potential source of
infection to others. In other words, the carrier represents the normal state of infection in which
there is an equilibrium between the host and the parasite. The percentage of human carriers and
the intensity of their infection is an index of the endemicity of a parasite.
Modes of transmission
The methods whereby parasites reach susceptible hosts from their primary sources are varied
and at times complex. Some parasites require only direct contact; others with more complicated
life histories must pass through various developmental stages either as free-living forms or in
intermediate hosts before becoming infective. Transmission is effected through direct and indirect
contact, food, water, soil, vertebrate and arthropod vectors, and rarely, from mother to offspring.
The chances of infection are increased by environmental conditions favoring the extracorporeal
existence of the parasite and by lack of sanitation and communal hygiene. Intermediate hosts
include mammals which, when eaten as food, may transmit 2 important cestodes and 1
nematode; fresh-waterfishes-which harbor the larvae of 5 trematodes, 1 cestode and 2
unimportant nematodes; gastropod mollusks which are the primary intermediate hosts of
trematodes; and arthropods which shelter stages of several animal parasites and likewise act as
vectors of other diseases.
Soil polluted with human excreta is commonly responsible for exposure to infectionn with
Ascaris lumbricoides, Trichocephalus trichiurus , human hookworms, and Strongyloides
stercoralis. Water may contain viable cysts of parasitic amebas, intestinal flagellates, Taenia
solium eggs and the infective cercarial stage of the human blood flukes. Freshwater fishes
constitute the source for fish tapeworm (Diphyllobothrium latum), as well as several types of
intestinal and liver flukes; crabs and crayfishes, for the Oriental lung fluke; hog flesh, for
Trichinella spiralis and Taenia solium; beef, for Taenia saginata,. buffalo nuts (Trapa spp.), for the
giant intestinal fluke (Fasciolopsis buski), and watercress (Nasturtium officinale), for the sheep
liver fluke (Fasciola hepatica). Blood-sucking arthropods transmit malaria parasites, leishmanias,

Reading material for Basic Mechanisms of Diseases/S. Wahyuni/Department of Parasitology/

Medical Faculty, Hasanuddin University/2009
trypanosomes, filaria worms, viruses, rickettsias, bacteria and spirochetes. Dogs are the direct
source for human infection with the hydatid cyst of Echinococcus granulosus, as well as
cutaneous larva migrans due to Toxocara canis, while herbivorous animals commonly constitute
the source for human infection with Trichostrongylus spp. Other human beings are directly
responsible for all or a considerable amount of infection with the pathogenic ameba (Entamoeba
histolytica), the pinworm (Enterobius vermicularis) and the dwarf tapeworm (Hymenolepis nana).
Autoinfection accounts for some of these parasitoses and for some reinfections with
Strongyloides stercoralis.

Susceptible host
Man, when infected by a parasite, may serve as: (1) its only host, (2) its principal host with other
animals also infected, and (3) its incidental host with one or several other animals as priricipal
hosts. In addition to the natural adaptability of the parasite in respect to its host, the ease of
transmission depends upon the habits and communal associations as well as the resistance of
the host. The chances of infection are increased by overcrowding, movements of population, and
insanitary habits and customs. Finally, the host may be protected by systemic resistance against
the invasion of the parasite.

The biologycal incubation period

Biological incubation is related to the development of the parasite. Clinical incubation refers to the
interval between exposure and the earliest evidence of symptoms produced as a result of the
infection (or infestation). Biological incubation involves 3 factors : (1) exposure to infection, (2)
development of the infection, (3) end of biological incubation.

Exposure to infection
Exposure to infection is the act or process of inoculation. Often the term "infection" is employed
carelessly when inoculation is intended. For example, a person may be exposed by ingesting
cysts of Entamoeba histolytica without colonization of the ameba, so that no infection is
produced.
Development of the Infection
Once the successful parasite has entered the body of the host, characteristically it is carried or
actively migrates to a location where it matures and produces progeny. This may be a relatively
simple procedure or it may be lengthy and complicated. For example, for Entamoeba histolytica it
consists of excystation of the protoplast in the lumen of the ileum and division into as many small
metacystic trophozoites as there were nuclei in the encysted stage, then passive carriage in the

Reading material for Basic Mechanisms of Diseases/S. Wahyuni/Department of Parasitology/

Medical Faculty, Hasanuddin University/2009
fecal stream through the ileocecal sphincter into the large intestine, lodgement in a glandular
crypt, growth to normal size and multiplication by asexual binary division. Similarly, for fully
embryonated eggs of Trichocephalus trichiurus and Enterobius vermicularis it consists of
hatching in the duodenum) migration of the larva down to the cecal level, attachment to the
mucosa and development to the adult stage, followed by the production of eggs of the new
generation.
In the case of Ascaris lumbricoides the ingested egg hatches in the duodenum. The emerging
larva enters the mucosa and migrates via bloodvessels to the lungs, then breaks out into the air
sacs and passes up the respiratory tree to the epiglottis, crawls over into the digestive tract and is
carried to the small intestine where it develops into the adult form. Hookworms and Strongyloides
stercoralis , which actively invade the skin, are carried in the bloodstream to the lungs, after which
their course of migration parallels that of Ascaris.
Organisms which are introduced in the encysted larval stage in food characteristically
become freed of their cyst wall or capsule in the duodenum. Intestinal helminths soon become
attached to the mucosa, usually in the upper or middle levels of the small intestine where they
mature; inhabitants of the bile ducts enter via the ampulla of Vater (e.g., Clonorchis sinensis), or
utilize a more indirect route (e.g., Fasciola hepatica), and the lung fluke Paragonimus westermani
takes a devious route through tissues and body cavities before arriving at its destination near a
bronchiole.
The blood flukes (Schistosoma spp.), after actively invading the skin, burrow to the
cutaneous blood vessels. Once they have entered the blood stream they are carried to the lungs,
squeeze through the pulmonary capillaries and on reaching the left heart are rapidly transported
through the arterial circulation into portal blood. Here they grow, then migrate actively to the
smaller mesenteric venules (S. japonicum or S. mansoni) or via the mesenteric and rectal
venules into the vesical venules (S.haematobium).
Malaria parasites, when introduced into the human skin by an anopheline mosquito, are
rapidly carried in the blood stream, which they leave in about 30 minutes. Those which secure
lodgement in the liver undergo asexual multiplication in parenchyma cells before they get into
visceral blood and initiate infection in the red blood cells.
Trypanosomes may rapidly multiply in circulating blood (Trypanosoma gambiense) or
may develop as. intracellular parasites in macrophages near the site of inoculation (Trypanosoma
cruzi). Species of Leishmania invariably colonize intracellularlyin the reticuloendothelial system.
The filaria worms, once introduced as filariaform larvas into the skin by the infected
insect, enter lymphatic vessels, in which the immature worms migrate for several months, finally
developing to maturity in various sites, depending on the species of filaria, for example, lymphatic
system (Wuchereria bancrofti, W. malayi), subcutaneous tissues (Loa loa, Acanthocheilonema
streptocerca, Onchocerca volvulus), or body cavities (A. perstans and Mansonella ozzardi).

Reading material for Basic Mechanisms of Diseases/S. Wahyuni/Department of Parasitology/

Medical Faculty, Hasanuddin University/2009

End of the Biological Incubation

Biological incubation is terminated as soon as the parasites or their products can be
demonstrated in the feces or other excreta, in the circulating blood (parasitemia), by aspiration,
biopsy or other diagnostic procedure. The biological incubation period varies from one or more
days to weeks or months, depending on the particular species of parasite and its ability to
develop in the particular host.

References :
CLINICAL PARASITOLOGY
By Faust and Russel ( 1st edition since 1937)
Published by Lea & Febiger (Library of Congress Card Number 57-7440)
BASIC CLINICAL PARASITOLOGY
By David L. Belding (1st edition since 1958)
Published by Appleton Century Croft, Inc ( Library of Congress Card Number 58-6554)
HUMAN PARASITOLOGY
By Bogitsh, B (Copyright 1998)
Published by Academic Press, Incorporated (ISBN 0121108708)
OXFORD HANDBOOK OF TROPICAL MEDICINE
By Eddleston, M (1999)
Published by Oxford University Press, Incorporated (ISBN 0192627724)

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