CHAPTER

1 • Facultative Parasite B. Intermediate Host

- May exist with(parasitic) or - Harbors larva stage (asexual)
I. General Considerations without a host(free living) C. Reservoir Host
Parasitology • Accidental/ Incidental Parasite - Additional infection to human
- Area of biology concerned with - Establish itself in a host where it D. Paratenic Host
the phenomenon of does not ordinarily live - No further development
dependence of one living • Permanent Parasite
organism on another - Remains in the host for its entire VECTORS
Medical Parasitology life Vectors
- Concerned with parasites that • Temporary Parasite - Responsible for transmitting the
affect humans and their medical - Lives I the host for a short parasite from one host to
significance and importance in period of time another
human communities • Spurious Parasite A. Biological Vector
Tropical Medicine - Parasite that is free living and - Parasite completes several
- Branch of medicine that deals passes through a host without development within the host
with tropical diseases and infecting it and later on transmitted to
medical problems in tropical another susceptible host
regions C. Mode of Transmission B. Mechanical / Phoretic Vector
• Contact transmitted - Transport the parasite only
BIOLOGICAL RELATIONSHIPS - Trichomonas vaginalis
Symbiosis - Enterobius vermicularis EXPOSURE AND INFECTION
- Living together of unlike • Snail Transmitted Carrier
organism. Protection and - Snail is part of their life cycle - Harbors pathogen without
advantages to one another - Class trematoda ‘fluke’ manifesting signs and symptoms
3 Forms of Symbiosis • Air borne Exposure
1. Commensalism - Eggs of Enterobius - Process of inoculating an
- One benefits without harming • Food Borne infective agent
or benefiting the other - Majority of cestode, trematode Infection
- Entamoeba coli in the intestinal and intestinal protozoan - Establishment of the infective
lumen - Diplyllobothrium latum agent in the host
2. Mutualism - Pork – Taenia solium Incubation period / Clinical Incubation
- Two organism mutually benefit - Beef – Taenia saginata period
- Termites and the flagellates in - Fish – Capillaria phillipinensis - Period between infection and
their digestive system - Ipon/Dugong – Anisakis specie symptoms
3. Parasitism (nematode) Pre-patent period / Biologic Incubation
- One parasite lives in or on - Raw or improperly cooked period
another for its survival and - Period between infection and
freshwater fish
usually at the expense of the evidence or demonstration of
(Clonorchis,Opistorchis and
host infection
Haplorchis)
- Entamoeba histolytica derives Autoinfection
• Water Borne
nutrition from host and cause - Infected individual become his
- Protozoan
amebic desentery own source of infection
- Entameba histolytica and
- Enterobiasis (hand to mouth
Giardia lamblia
PARASITES transmission)
• Skin penetration
CLASSIFICATIONS Accdg. To - Capillaria philippinensis
- Soil to skin (hookworm and
A. Habitat (multiply internally)
strongyloides)
• Endoparasite Superinfection / Hyperinfection
- Water to skin (Schistosoma)
- Parasite living inside the body of - Infected individual is further
• Bites
the host infected by the same specie
- Malaria, filariasis, leishmaniasis,
• Ectoparasite leading to massive infection
trypanosomiasis an babesiosis
- Parasite living outside the body Rhabditiform to Filariform Larvae of
• Sexually transmitted
of the host Strongyloides
- Trichomonas vaginalis - Alteration in its life cycle which
Infection
• Transmammary results in a large increase in
- Presence of endoparasite
- Through breastfeeding worm burden
Infestation
- Hookworm - Leads to severe debilitation or
- Presence of ectoparasite
- Ancylostoma and Strongyloides death
Erratic
D. Pathogenicity
- Parasite is found in an organ the
• Pathogenic SOURCE OF INFECTION
is not its usual habitat
• Non-pathogenic • Contaminated Soil and Water

- Cyst of ameba and flagellates
B. Host Requirement
HOST - Cercariae of Schistosoma
• Obligate Parasite
A. Definitive/ Final Host • Lack of sanitary toilet
- Parasite that is fully dependent
- Harbors adult stage (sexual)
and can never survive without a

host
 • Use of night soil or human Prevalence parasite population that was
excreta as fertilizer - Number of individuals infected previously sensitive to the
- Ascaris Lumbrecoides, Trichuris in a given period of time appropriate therapeutic dose
trichiura, Strongyloides Cumulative prevalence
stercoralis and hookworm - Percentage of individuals PREVENTION AND CONTROL
• Food infected with at least one Morbidity control
• Consumption of undercooked or parasite - Avoidance of illness caused by
raw freshwater fish Intensity of Infection infection
- Intestinal and liver fluke - Burden of infection related to IEC
- Raw crabs (paragonimiasis) number of worms per infected - Information – education –
- Raw Bullastra snail person communication
(Artyfechinostomum - Measured directly and indirectly - Health education strategy that
malayanum infection) Morbidity aims to encourage people to
• Arthropods - Clinical consequences of adapt and maintain healthy life
- Mosquito (malaria and filarial infection or disease that affect practices
parasites) an individual’s well-being Environmental Management
- Triatoma bugs (Tripanosoma - Planning, organization,
cruzi causing Chagas Disease) TREATMENT performance, and monitoring of
- Sand Flies (all types of Deworming activities for the modification
Leishmania) - Use anthelminthic drugs and or manipulation of
• Domestic animals - Public health program environmental factor
- Cats (Toxoplasma) Cure rate - Reduce contact
- Rats (Hymenolepis nana) - Number of previously (+) found Environmental Sanitation
• Person to be egg (-) on examination - Interventions to reduce
- Entamoeba histolytica after deworming environmental health risk
- Auto-infection (C. philippinensis, Egg reduction rate - Safe disposal, hygienic
E. vermicularis, H. nana, S. - Percentage fall in egg count management of excreta, refuse,
stercoralis) after deworming waste water
Selective treatment - Safe drinking water
NOMENCLATURE - Individual level deworming - Food safety
ICZN - Based on diagnosis of infection - Safe and healthy house and
- International Code of Zoological and intensity working condition
Nomenclature Targeted treatment Sanitation
Phylum – Class – Order – Family – Genus / - Group level deworming - Access to adequate facilities for
Genera – Species – - Defined by age, sex or others the safe disposal of human
Suborder/Superfamily/Subspecies irrespective of infection status excreta
Universal treatment - Safe drinking water
• Scientific name are latinized - Population level deworming
• Family names are formed by - Not defined of any characteristic ERADICATION VS ELIMINATION
adding idea to the genus or infection status Disease Eradication
• Generic name is a single word Preventive Chemotherapy - Permanent reduction to zero
- Regular, systematic, large scale incidence
initial capital letter
- Administration of one or more - Continued measures are no
• Specific name begins with small
drugs to selected population longer needed
letter
- Reduce morbidity and Disease Elimination
• Genera and specie are italicized
transmission of selected - Reduction to zero of incidence
or underlined when written
helminth infections - Continued surveillance measure

Coverage are still required
LIFE CYCLE
- Proportion of target population
• Ensure transmission from one
reached by an intervention
host to the next
Efficacy
• Adapt to protect itself from the
- Effect of drugs against infective
host’s defences and the external agent in ideal experimental
environment condition
• Overcome attrition in the specie Effectiveness
by producing numerous progeny - Measure of the effect of a drug
against infective agent in a
EPIDEMIOLOGIC MEASURES particular host and its
Epidemiology environment
- Study of patterns, distribution - Measured by means of
and occurrence of disease quantitative and qualitative
Incidence diagnostic test
- Number of new cases of Drugs resistance
infection in a given period of - Genetically transmitted loss of
time susceptibility to a drugs in a
 II. Host-Parasite D. ENTRY TO THE BODY / TISSUE b. Presence of Duffy blood factor
Relationship 1. Cysteine proteinases - Increase susceptibility to
Adaptation - In Entamoeba histolytica, allow Plasmodium vivax
- Changes in the molecular parasite to penetrate the
biology, biochemistry, mucosa and adhere to the • Nutritional Status
immunology and structure of underlying layer and a. Protein rich diet
the parasite that are essential surrounding tissue - Not suitable for the
for their survival 2. Penetration glands development of intestinal
- Locomotory and digestive - In cercariae of Schistosoma protozoan
system which produce enzyme that can b. Protein low diet
digest the skin - Favors appearance of symptoms
A. FOR SURVIVAL 3. Hooklets of amebiasis
1. No locomotory organelles - 6 hooklets are found in the c. High Carb diet
- Phylum apicomplexa embryo of cestodes which aid - Favor development of
2. Cilia them in tissue penetration tapeworms
- In the epidermis of free living
flatworms EFFECTS OF THE PARASITE ON THE HOST • Immune Response
3. Microvilli • Interference with the Vital a. Absolute immunity
- Found in the tegument of Processes of the Host - Rare in protozoan
cestodes and trematodes to - The parasitic enzyme produced - Never in Helminth
obtain nutrients by excretion and secretion by b. Acquired immunity
4. Hooks and Suckers many parasites, enable the to - Modifying the severity of
- Highly specialized organ of metabolize the nutrients they disease in endemic areas
attachment of flatworms which get from the host and which
anchor them inside the body of give them energy (cysteine III. Immunology of Parasitic
the host proteinases in E. histolytica) Infection
5. Constant movement • Invasion and Destruction of Host Immune System
- Adaptation of adult Ascaris Tissue - Protect the body from invasion
women to maintain their a. Plasmodium by potential pathogen
position inside the intestinal - Invades red blood cell which - Dysfunction can lead to
wall eventually rupture releasing permissive environment for
6. Thickened Integument morozoites infection or unchecked
- Resist enzyme and juices b. Schistooma japonicum activation – can cause harm
- Protect against desiccation and - Deposite eggs in the liver - - Parasite have evolved strategies
physical injury granuloma formation and to survive and strive
7. Integument covered with spikes fibrosis – portal hypertension Parasitic Infection
- Used by intestinal flukes to and massive hemorrhagic - Parasite successfully establishes
prevent abrasion venules itself and the host’s defense
8. Special coverings c. Hookworms system does not eliminate it,
- Of ova, larvae and cysts which - Their cutting plates attaches to thus it continue its life cycle
protects them during their free- the intestinal mucosa and Outcomes of Host and Parasite Interaction
living stage. detroy the villi a. Parasite fails to establish
- Aids in resisting digestive juices d. Ascaris b. Parasite establish , Host
- Form tangled masses – intestinal eliminates infection
B. FOR REPRODUCTION obstruction c. Parasite establish , Host
1. Hermaphroditic - In appendix and bile duct – overcome but does not succeed
- All tapeworms and flukes except surgical emergency d. Parasite establish , host damage
Schistosoma spp. , to produce • Deprive Host of Essential itself while trying to eliminate it
thousands of ova Nutrients and Substances e. Parasite establish and Kill Host
2. Asexual Reproduction a. Heavy Hookworm Natural Selection
- Used by flukes to increase - Massive intestinal bleeding – - Process of evolution for parasite
number of progeny in chronic blood loss and iron to cause infection
intermediate host deficiency anemia Accidental Infection
b. Diphyllobothrium latum - Establishment of a new non-
C. BIOCHEMICAL - Compete for Vit. B12 – susceptible host that becomes
1. Streamlining megaloblastic anemia the dominant host
- Loss of certain metabolic - Trypanosoma sp.
pathways EFFECT OF THE HOST ON THE PARASITE - Plasmodium knowlesi
- Inability of the parasite to Factors that Determine the Outcome of an
synthesize certain cellular Infection HOST-PARASITE INTERACTIONS
components and the need for • Genetic Make-up • Skin
the parasite to obtain these a. Possession of Sickle cell trait a. Strongyloides
from the host - Confers protection in falciparum - Synthesize protein that aids in
- Exemplified by hemoflagellates malaria skin entry
and other helminth parasites
 b. Schistosoma spp. Cercariae b. Cell mediated immune Toxocara canis
- Have glands that secret lytic mechanism - Killed by cell-mediated activity
enzyme that aids in skin - NK cells or T-lymphocytes are Th2
penetration required to identify and destroy - Produce interleukin 4,5,6 that
• Mucous membrane Leishmania spp., Toxoplasma enhances the proliferation and
- Serve as barrier in respiratory, ghondii and Trypanosoma cruzi differentiation of B-lymphocyte
gastrointestinal and which are able to invade and into Plasma Cells
genitourinary tracts multiply inside macrophages Plasma cell
• Tight Junctions Toll-like receptors - Responsible for the production
- Prevent passage of large - Recognize foreign molecules to of Ig (IgE, IgG, IgM, IgA)
molecule the body and function for the a. Eosinophilia and elevated serum
• Low pH of vaginal secretion and early recognition of pathogens of IgE
gastric juices - LPS (TLR4), Diacylated - Immune response to helminthic
a. Trichomonas vaginalis lipoprotein (TLR 2 and 6), infection
- Trophozoite are unable to Triacylated lipoprotein (TLR 1 b. Lumen dwelling (A. lumbricoides
survive pH in vagina and 2), Flagellin (TLR5) and Trichuris trichiura) vs.
b. Giardia lamblia - Causes cascade of reactions that Lymphatic dwelling (Wuchereria
- Enveloped by intestinal produce cytokines (interferon bancrofti and Brugia malayi)
secretion will diminished its gamma and interleukin-1) that c. Parastrongylus contonensis and
motility activates NK cells and Toxocara canis
c. Ascaris, Trichuris and Taenia macrophages - Less likely to have immune
spp. - Trigger initial inflammatory evading mechanism
- Covered by thick egg shells to response IgE
survive Acquired immunity - In Mast cells, eosinophil, goblet
d. Entamoeba and Giardia - Result of complex series of cells mediate expulsion og
- Cystic wall are resistant of acidic immunoregulatory events gastrointestinal helminths
pH stimulated by the parasitic ADCC
• Chemicals in Bodily Fluids antigen - Anti-body dependent cell-
a. Lipase - Subsequent antigen exposure mediated cytotoxicity
- In breast milk is toxic to Giardia leads to more rapid and - IgE is found in the inflammatory
lamblia in vitro vigorous immune responses – cells of its cytotoxic action
b. Lysozome and IgA immunologic memory - EAF , interleukin-5, GM-CSF as
- Found in tears and saliva - Antibody dependent or cell- activating factors
destroy microorganisms mediated - Destruction of microfilariae in
• Physiologic functions • Immune response does not tropical pulmonary eosinophilia
a. Peristalsis always equate to protection - Schistosoma spp.
b. Motion of cilia • Immunity to one pathogen may IgG1 and IgE
c. Human reflexes confer immunity to another - Act on mast cell and basophil
d. Coughing closely related species that leads to degranulation and
- Expectorate Adult Ascaris release of pharmacologically
lumbricoides and eggs of ACQUIRED IMMUNE RESPONSE active substances
Paragonumus westermani Immune response - Unregulated activation of these
e. Flushing action of Urine - Influence the outcome of can lead to Anaphylactic Type 1
- Trichomonas vaginalis infection in terms of resistance, hypersensitivity reaction
susceptibility and pathology (rupture of Echinococcus
Pathogen-associated molecular pattern/ Major histocompatibility complex gene granulosus hydatid cyst) , (bite
pattern recognition responses and Human leukocyte antigen of mites and tikcs)
- Sensing and invading parasite - Regulate T-lymphocytes IgG and IgM
- Enable the body to mount activities - Prevent penetration of
immune response to eliminate CD4 T-helper Lymphocyte Plasmodium spp. And Babesia
or limit the infection - Where parasitic antigen are spp. In RBC
processed and presented - Ineffective against
HOST-IMMUNE RESPONSE - Produce different lymphokines gastrointestinal helminths
Innate Response Th1 - Mediate lysis of tripomstigotes
- Non-specific mechanism - Produce gamma interferon and of T. cruzi with complement
- Mechanical, chemical and interleukin-2 – activates - Rapid phagocytosis of parasite
cytokine mediated methods lymphocyte and macrophage – Secretpry IgA
- Little or no delay cell mediated immune response - In intestines protect against
a. Phagocytosis - Parasite-specific antigen – metacestode and
- Macrophages and Dendritic cells parasite-specific T-Lymphocyte gastrointestinal infection
through oxidative killing and use Parasite-specific T-lymphocyte - +IgM mediate ADCC in Giardia
of toxic peptides - Act directly by cytotoxicity lamblia infection
- Indirectly by acting on NK cells IgG and IgA
or B-Lymphocyte - Cell –mediated immunity self-
limits Cryptosporodium infection
PARASITE EVASION MECHANISM 8. Cystericercus cellulosae filtration and the action of
- Size, life cycle, location, Infection antibodies
antigenic complexity, natural - Produce immune complex that
selection and adaptation suppress inflammatory response ADVERSE EFFECTS OF THE IMMUNE
A. Resistance to Immune through inhibition of RESPONSE IN THE HOST
Response complement Dysfunction
- Protozoa and Helminth are 9. Plasmodium spp. And T. cruzi - Can result in damage to host
resistant to host innate immune Infection tissue and produce clinical
response - Immunosuppression through diseases
Protozoa production of immune Types of Reaction where the Normal
- Phagocytized but its cuticle and complexes Immune Response might contribute to
integument are resistant to 10. Schistosoma spp. Infection Tissue Damage
cytotoxic effects of neutrophil - Complement cannot participate • Type 1
and macrophage(loss of surface in the destruction because it has - Immediate type hypersensitivity
molecule that bind complement been consumed by the soluble • Type 2
or acquisition of daf) antigens of the parasite - Immune complex Formation
Trypanosoma brucei C. Antigenic Variation • Type 3
- Has evolve resistance through 1. Trypanosoma brucei Infection - Cytotoxic reaction of antibody
expression of serum resistance- - Initial response of host is very • Type 4
associated protein which effective but subsequent - Delayed-type hypersensitivity
enables it to survive immune response are no longer
apolipoprotein L-1 effective a. Trypanosoma cruzi
- Makeshift in APOL-1 make T. - Parasite change antigenic profile - In acute T. cruzi infection there
evansi infect human of their surface coat though is damage in the infected and its
- Recombinant APOL-1 restores variant surface glycoproteins surrounding cells including
trypanolytic activity - Giardia lamblia also nerve cells and myocytes
2. Plasmodium falciparum - Partially responsible for heart
B. Immune Suppression - Exhibit antigenic diversity failure and meningoencephalitis
1. Plasmodium spp. Infection - Through repeat variation of the - Antibodies to this parasite may
- Reduce immune function of encoded polypeptides, observed activate adrenergic and
macrophages – lower capacity in merozoite surface antigen muscarinic receptors because of
phagocytosis and defective and ring infected surface similarities with the parasite
processing of antigen antigen antigen – autonomic
2. Trypanosoma brucei Infection - Antibody fail to recognizee the dysfunction – arrhythmias
- Trypomastigote can produce antigen b. Wuchereria bancrofti
large amount of glycoproteins – - Over production of IgM due to
antigenic competition – impairs D. Host Mimicry dysfunctional T-suppressor cell
B and T-lymphocyte – 1. Larval stage of Echinococcus defect – formation of large
diminished production of granulosus amount if immune complexes in
lymphokines and Ig - In hydatid cyst carry P blood Tropical Pulmonary Eosinophilia
3. E. hystolytica group antigen c. Plasmodium spp. Infection
- Macrophage respiratory burst – 2. Schistosoma spp. - Immune complexes –
nitric oxide production – - Its tegument acquire antigenic hyperactive malarious
produce suppressor factor - molecules from the host splenomegaly
inhibit movement of monocyte • Antibodies produced against the - Duisturbancein the ability of T-
– inhibits complement assembly parasite them fail to recognize Lympgocyte to control the
4. Fasciola Infection non-self from self-antigens humoral response – Polyclonal
- Down regulation of Th1 IgM – Splenomegaly and Anemia
5. Filarial Infection E. Intracellular Sequestration d. Plasmodium malariae Infection
- Wuchereria bancrofti and Brugia 1. Trypanosoma cruzi and - Immune complexes may be
malayi and Plasmodium spp. Leishmania spp. deposited in basement of
- Polyclonal - Amastigotes proliferate in glomeruli - kidney failure and
hypergammglobulinemia – macrophages in various organs nephrotic syndrome
antibodies lack specificity 2. Toxoplasma ghondii - Also in Schistosomiasis
against these parasite - Multiply inside macrophageas e. Plasmodium falciparum
6. Blocking antibodies well as nucleated cells - Sequestration is the main cause
- Produce by Wuchereria 3. Plasmodium falciparum of manifestation of cerebral
bancrofti dampen immune - Its late stage are sequestered malaria
response from the circulation in depp f. Schistosoma spp. Infection
7. Necator americanus Infection vasculature beds - Clinical manifestations are
- Immune response against - Presence of knobs on infected related to the host’s immune
deeper layer of cuticle but rbc – attach to endothelial cells response to eggs that are
diverted to the integument of capillaries – exclude trapped in various organs
parasitized rbc from splenic
 - Hepatosplenomegaly, fibrosis,
portal hypertension and
esophageal varices
- High levels of this parasite’s
antigen in immune complexes –
serum sickness
- Stimulates T-cell mediated
delayed-type of hypersensitivity
lymphocyte to produce
attractants and activators to
other cells that form
granulomas around the
parasites egg
g. Leishmania Infection
- More macrophages(cutaneous,
mucocutaneous or visceral) are
damaged

PRACTICAL APPLICATIONS
• Immunodiagnosis
• Predicting results in pathology
• Immunoregulation
• Immunomodulation
• Vaccination
• Anti-parasitic drugs