HOST PARASITE INTERACTION

Sitti Wahyuni, MD, PhD

Department of Parasitology
Medical Faculty, Hasanuddin University

 Pathogenesis: the dynamics of any

disease process
Host-parasite interaction may produce:
No damage (opportunistic)
Produce damage (pathogen)

Damage location may:

localized
extend to distant parts of the host's body
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 The damage may produce:

1. trauma or physical damage
2. lytic necrosis
3. stimulation of host-tissue reactions
4. anemia
5. neoplastic growth
6. toxic
7. allergic phenomena
8. Anaphylactic shock
9. open the pathway for entry of other pathogens

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1. Traumatic Damage
Superficial: when the parasite invades the skin
scabic mite (S.scabiei)
fly maggots

Internal:
rupture of the pulmonary capillaries: migration of
larval stages of several
extensive trauma & hemorrhage: when the eggs of
Schistosoma spp. escape from mesenteric or vesical
venules
traumatic destruction of the villi when the
hookworms attach into the intestinal wall
acute intestinal obstruction: by Ascaris or T.saginata

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Traumatic damage by S. scabies

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2. Lytic Necrosis
Due to enzyme produce by parasite
Function of enzyme:
make parasite possible to digest availale food
transform the nutriment into their protoplasm
store it for the production of energy

Example :
E.histolytica: lyses tissues for nutritional needs &
to penetrate into tissues of the colon and extraintestinal viscera
intracellular parasites: cause necrosis of the host
cells during the growthment & multiplication
extensive necrosis in the liver by F. hepatica
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3. Stimulation of Host Tissue Reaction

Host tissue reaction:
cellular proliferation & infiltration at the site of
infection
involve systemic increase in certain types of
cells, especially those circulating in the blood

Function:
destroy the parasite
wall it off by fibrous encapsulation

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W.bancrofti in the lymphatic vessels

retrograde to lymph nodes :
hyperplasia of the endothelial
vessels
cellular infiltration into their lumens
perilymphatic fibrosis &
lymphadenitis
temporer or permanent
sequestration of the worms

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 Blood flukes in the

intrahepatic portal
veins :
acute hepatitis
in mesenteric or
vesical venules
after the females
ovipositing a
pseudotubercle is
formed around
each egg
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4. Anemia
a certain degree of erythropoiesis may
stimulated in infections which cause
mechanical loss or destruction of the
erythrocytes:
deep extensive amebic invasion of the colon
attachment of hookworms to the intestinalwall
in malaria

commonly associated with chronic

parasitoses
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5. Neoplasma growth
Result of the irritation of parasites to host
tissues
Found in:
Ca colon with amebic granulomas
The flukes in the bile ducts provoke progressive
hepatic cirrhosis in heavy infections
Blood fluke infections associate with colonic,
rectal & hepatic carcinoma
S.haematobium eggs trapped in the bladder wall
& vesical carcinorma in Egypt
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6. Toxic & Allergic Phenomena

Spiders & ticks: introduce venom when
they insert their mouth parts into the skin
caterpillars elaborate toxins in glands at
the base of delicate hollow hairs
jelly fishes: roultiple stinging cells, each
containing a nematocyst
Blister beetles: have a painful vesicating
fluid
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Anaphylactic shock
occurs when there is a sudden release of
the foreign protein in the host's body
gravid female D.medinensis begins to migrate
from the viscera to the skin
hydatid fluid is released from the rupture of an
Echinococcus cyst in a body cavity

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8. Intolerance
A greater degree of intolerance may result
from entry of a non adapted parasite
schistosome dermatitis caused by percutaneous
entry of the cercarial larvas of non-human blood
flukes
visceral larva migrans due to migration through
the tissues of the larvas of the dog ascarid, T.
canis.

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9. Secondary Invaders
Entry of parasite may open pathways in the
skin or the intestinal tract for invasion by
other pathogenic microorganisms
Ground itch in the skin: characteristically
complicated by pyogenic bacteria
Chronic amebic colitis & balantidiasis:
accompanied by secunder infection by bacteriae
viruses may introduce into the viscera by invading
& migrating of parasite
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Symptoms
The local or general symptoms are
manifestations of the deranged functions
of the affected organs
The response to parasite may results
- a typical clinical case
- no clinical evidence

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 Symptoms depend on:

species of the parasite
condition of the host
organs affected
number of parasites
sensitivity of the host

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Systemic Symptoms

Fever (chills)
Headache
Muscle & joint pains
Lymphangitis & lymphadenitis
Weakness: fatigue, languor,
prostration,neurasthenia, syncope
Debility: loss of weight, malnutrition,
cachexia
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Gastrointestinal Symptoms
Mild: irregular or loss of appetite, hunger or
gnawing sensations, vague abdominal
discomfort
Moderate: anorexia, nausea, vomiting,
abdominal discomfort, diarrhea or
constipation
Severe: diarrhea or dysentery, epigastric,
hypochondric or other abdominal pains &
cramps

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Nervous Symptoms
Psychic
Mild (confusion, irritability, insomnia)
Severe (instability/incoordination, altered personality,
hallucinations, mental deterioration)

Neurologic
Intracranial pressure: headache, vertigo, vomiting,
convulsions, optic neuritis & retinitis & other symptoms of
brain tumor
Parasthesia & amnesia
Encephalitis
Epilepsy
Paralyses
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Allergic Symptoms
Gastrointestinal: anorexia, nausea, vomiting,
diarrhea, abdominal pain & cramps
Cutaneous & subcutaneous: pruritus,
erythematous, macular, papular, purpuric &
eczematous rashes, urticaria, edema & calabar
swellings, lymphangitis
Pulmonary: coughing, sneezing, dyspnea, slight
hemoptysis, transient thoracic pain, asthma
Systemic: fever, headache, sweating, polyarthritis,
photophobia, languor, signs of collapse

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Diagnosis
Clinical manifestations are so general
Many infections give a few & indefinite
symptoms & clinically indistinguishable
Final diagnosis & proper methods of
treatment require the identification of the
parasite in the laboratory
Successful laboratory diagnosis requires a
knowledge of certain fundamental laboratory
procedures
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Laboratory direct diagnosis

Blood: plasmodium, trypanosoma, microfilaria
Liquor cerebrospinalis: trypanosome and toxoplasma.
Sputum: paragonimus westermanii.
Mouth: Amoeba gingivalis and mycoses.
Duodenal intubation: Giardia and trematode eggs
Stool: cyst and trophozoite protozoa, egg and adult
helminth
Urine: eggs of S- haematobium.
Secretion of vagina: trichomonas vaginalis
Skin biopsy: Leshmania.

Laboratory indirect diagnosis

Serologic test : Fleig precipitation for hydatid
cyst.
Skin test : Casoni test for hydatid cyst and
Montenegro test for leshmaniasis.
Immunofluorescence: antigen - antibody

Treatment
An intelligent treatment requires a knowledge
of the parasite:
pathogenic action
intensity of the infection
physical condition of the patient

Need also to consider:

sanitary environment
epidemiology of the disease
the best methods of controlling the spread of the
infection
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 No efficient antiparasitic drug is entirely

nontoxic to man
The best drug: minimal toxic effect to the host
& lethal action to the parasite
The successful of the drug depend on:

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Drug choice
patient condition & response
administration method
Dosage
auxiliary therapeutic preparation
aftercare procedures to prevent reinfection
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Prevention
Almost all parasite at some time in its life
cycle is susceptible to intervention
Such weak links in the life cycle may exist
at :
the departure of the parasite from its source
during its extracorporeal existence
at the time of its invasion of man

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Control
Strategy:
reduction of the sources of infection in man
education in personal prophylaxis to prevent
dissemination of infection
reduce opportunities for exposures
sanitary control of water, food, living & working
conditions & waste disposal
destruction or control of reservoir hosts,
intermediate host & vectors

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References :
CLINICAL PARASITOLOGY
By Faust & 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 H&BOOK OF TROPICAL MEDICINE
By Eddleston, M (1999)
Published by Oxford University Press,
Incorporated
(ISBN 0192627724)
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a clever person is good

but is better to be a good person

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