WHAT IS A PARASITE?

A parasite is a creature that depends on another living

thing, or host, for survival. Although a parasite depends on its’
host for food, often this guest is not invited. In facts, parasites
can harm their hosts. After all, the parasite gets strength from
its’ host, often making the host weaker in the process. Some
parasites make people sick. For example, the disease malaria is
caused by a parasite that is spread by mosquitos. Some types
of parasites, such as protozoa, are so tiny they can only be
seen with a microscope. Others such as helminths, can be seen
with the human eye when they become adults.

OVERVIEW OF THE FUNGAL CELL STRUCTURE

Fungi are eukaryotic organisms and are not related to
bacteria. As eukaryotes, they carry membrane-bound
organelles and possess cell membranes surrounded by a rigid
cell wall. Fungi occur in two (2) basic forms or stages: Yeast are
unicellular whereas filamentous and mold forms are a
vegetative form growth of filaments. Fungal filaments are also
known as hyphy which may be septate or non-septate.

The cell membrane of fungi is similar to that of other

eukaryotic cells and is composed of a lipid bilayer with proteins
embedded within it. A major component of the eukaryotic cell
membrane is the presence of sterols which are virtually absent
from all prokaryotes such as bacteria. Ergosterol is an essential
sterol in the fungal cell membrane. The fungal cell wall is made
up of 80 to 90 percent polysaccharides. In yeast, the cell wall
contains several different polysaccharides including glucans,
polymers of glucose, manon, a polymer of mannose, and chitin,
a polymer of n-acetyl glucosamine. Glucan is the major
component of the fungal cell wall, accounting for 30 to 60
percent of the cell wall of yeast such as Candida species. The
cell wall of filamentous fungi differs somewhat from that of
yeast and contains a higher concentration of chitin. The glucan
synthase complex located in the fungal cell membrane is
responsible for the synthesis of beta 1-3 glucan. Glucan
synthesis occurs in the cytoplasmis side of the fungal
membrane. As glucan chains are synthesized, they extrude
toward the periplasmic space where they are then incorporated
into the cell wall. In most fungi, ergosterol replaces the
cholesterol component found in higher eukaryotic cell
membranes.

Ergosterol provides stability and flexibility to the fungal

cell membrane. Although many enzymes are involved in the
formation of ergosterol, the 14 alpha demethylase enzyme is
responsible fro the C-14 alpha demethylation of lanosterol. 14
alpha demethylase is a cytochrome P450 dependent enzyme
which is essential for ergosterol formation. Once formed,
ergosterol is incorporated into the fungal cell membrane.

FUNGUS
Fungal infections are more common today than ever
before. One reason for this is that people are living longer, and
older adults are more likely than younger ones to have
compromised immune systems, a major risk factor for fungal
infections. In addition, the widespread use of antibacterial and
antiviral agents has contributed to the ever-increasing fungal
infection rates because of the destruction of beneficial
microorganisms (normal flora) that normally maintain a healthy
body environment.

Fungi are slow-growing oragnisms that may cause

systemic infections or may affect parts of the body with a poor
blood supply, such as the out layers of skin, hair or nails.
Because of this poor blood supply, fungal infections often are
more difficult to treat than bacterial infections.
 Antifungal drug action is further hindered by the
granulomatous tissue response, which may result in formation
of a tissue capsule around areas of the body affected by fungal
organisms, making penetration of the antifungal drug into the
infected area more difficult.

PARASITES
Parasites infections are caused by the feeding of one
organism on the living body of another. Parasitic infections
were once thought to be a problem only in tropical and
subtropical regions of the world. It has now became apparent
that parasitic infections can occur in almost any climate and
can affect the old and yougn and affluetn as well as poor
people. Parasites may be contracted in a variety of ways:
❖ Person to person contact
❖ Ingestion of contaminated water or food
❖ Transmission by an insect (mosquito or tick)
❖ Direct contact with the parasite (eg. walking barefoot in an
area in which the soil harbors parasites)

Human parasitic infections may be classified as systemic,

gastrointestinal or dermatological.

PROTOZOA
Protozoa are single-celled or unicellular and complex
eukaryotic organisms that carry out all of their life functions
within these single cells. They range in size from
submicroscopic to macroscopic and can divide only in a host
organism.
Protozoa are found worldwide, having the ability to survive
and thrive in most ecological conditions. Most Protoza are
free-living and can produce their own good, others are
heterotrophic or Protozoa that require a host for food.
Infections range from asymptomatic to life threatening,
depending on the species and strain of the parasite and the
resistance of the host.
The Protozoa that are infectious to humans can be
classified into four groups based on their mode of movement:
1. Sarcodina are amoeba (eg. Entamoeba)
2. Mastigophora are flagellates (eg. Gardia and
Leishmania)
3. Ciliophora are ciliates (eg. Balantidium)
4. Sporozoa are organisms whose adult stage is not
motile as other Protozoa are and include plasmodium
and cryptosporidium.

ANTIFUNGAL AGENT

FUNGI
❖ FUNGAL infections in human range from conditions such
as the “athlete’s foot” to potentially fatal systemic
infections.
❖ An infection caused by a fungus is called a ‘mycosis’.
❖ Fungi differ from bacteria in that the fungus has a rigid
cell wall that is made up of chitin and various
polysaccharides & a cell membrane that contains
ergosterol.
❖ The composition of the protective layers of the fungal ell
makes the organism resistant to antibiotics.

TWO MAIN GROUPS OF FUNGI

1. Molds (filamentous fungi)
○ They grow as long filaments that intertwine to form a
mycelium.
○ Example of molds are the dermatophytes and
aspergillus fumigatus.
○ It causes infections of the skin, nails, and hair.
 2. True yeasts either unicellular round or oval fungus.
○ Examples of yeast: Cryptococcus neoformans which
may cause meningitis or pulmonary infections usually
in immunocompromised.

SYSTEMIC ANTIFUNGALS
❖ It is used to treat systemic fungal infections and can be
toxic to the host. They are not to be used indiscriminately.
❖ It is important to get a culture of the fungus causing the
infection to ensure that the right drug is being used.

TOPICAL ANTIFUNGAL
❖ Some antifungal drugs are available only in topical forms
for treating a variety of mycoses of the skin and mucous
membrane.
❖ Fungi that cause these infections are called
‘dermatophytes’.
❖ These diseases include a variety of tinea infections which
are often referred to as ringworms, although the causal
organism is a fungus, not a worm.

❖TYPES OF TINEA
❖ Tinea pedis → Athlete’s foot
❖ Tinea cruris → Affects scrotal, anal or genitals called ‘jock
itch’
❖ Tinea corporis → Affects the body called ‘ringworm’

EXAMPLES OF TOPICAL
❖ Amphotericin B
❖ Miconazole (Monistat)
❖ Clotrimazole
 ANTIPROTOZOAL AGENTS
❖ Protoza thrive in tropical climates, but they may also
endemic
survive and reproduce in any area where people live in
(can be
found
very crowded and unsanitary conditions.
specific to a ❖ Malaria is a parasitic disease spread via the bite of an
community)
Anopheles mosquito which harbors the protozoal parasite
and carries it to humans.
❖ This is the only known method of disease transmission.
Four (4) protozoal parasites, all in the genus Plasmodium
as causes of malaria. 1. Plasmodium falciparum
2. Plasmodium vivax
3. Plasmodium ovale
AMOEBIASIS 4. Plasmodium malariae

❖ An intestinal infection caused by Entamoeba histolytica, is

often known as amoebic dysentery. dysentery causes inflammation of intestines
resulting in severe bloody diarrhea

THE ORGANISM EXISTS IN TWO (2) STAGES:

❖ Cystic, dormant stage, in which the protozoan can live for
long periods outside the body or in the human intestine.
❖ Tropozoite stage in the ideal environment - the human
large intestine

TRICHOMONIASIS
❖ Caused by another flagellated protozoan, Trichomonas
vaginalis, is a common cause of vaginitis.
❖ This infection is usually spread during sexual intercourse
by men who have no signs and symptoms of infection. asymptomatic

PNEUMOCYSTIS CARINII PNEUMONIA respiratory in nature

❖ Pneumocystic carinii is an endemic protozoan that does

not usually cause illness in humans.
❖ When an individual’s immune system becomes suppressed,
because of acquired immune deficiency syndrom (AIDS) or
AIDS-related complex (ARC).
ACTION
❖ Inhibit DNA synthesis in susceptible protozoa, leading to
the inability to reproduce and subsequent cell death.

CONTRAINDICATIONS
❖ Hypersensitivity
❖ During pregnancy and lactation
❖ CNS disease
❖ Hepatic disease

ANTIHELMINTIC AGENTS
❖ The helminths that mostly infect humans are two kinds:
➢ Nematodes → roundworms
➢ Platyhelminths → flatworms
❖ Many of the worms that infect human lives only in the
intestinal tract
❖ Proper diagnosis requires stool examination for ova (eggs)
and parasites:
➢ Treatment of a helminth infection entail the use of an
antihelmintic drug
➢ Another important part of the therapy involves the
prevention of reinfection or spread of an existing
infection.

PREVENTIVE MEASURES
❖ Thorough hand washing after use of the toilet
❖ Frequent laundering of bed linens and underwear in very
hot
❖ Chlorine treated water
❖ Disinfection of toilets and bathroom areas after each use
❖ Good personal hygiene to wash away ova
 blood sucking worms (roundworms)

NEMATODES stays in the anal opening

1. Pinworms
○ Stay in the intestine, causes a little discomfort except
for perianal itching or occasionally vaginal itching.
○ Most common helminthic infection among
school-aged children
○ Dx: Test tape
2. Whipworms
○ Attach themselves to the wall of the colon
○ When large numbers of them in the intestine, they
cause colic and bloody diarrhea.
○ In severe cases, may result to prolapse of the
intestinal wall and anemia related to blood loss.
○ Dx: S/E
3. Threadworms
○ More pervasive than most of the other helminths.
○ After burrowing into the wall of the small intestine,
female worms lay eggs, which hatch into larvae that
invade many body tissues including lungs, liver and
heart.
4. Ascaris
○ Most prevalent helminthic infection
○ It may occur whenever sanitation is poor
○ Initially, the individual ingest fertilized round worms
which hatch in the small intestine and goes to the
lungs where they cause cough, fever, and other signs
of pulmonary infiltration
5. Hookworms
○ Attach themselves to the small intestines of infected
individuals and suck blood from the walls of the
intestine
○ This damages the intestinal wall and cause sever
anemia with lethargy, weakness and fatigue
6. Platyhelminths
○ Also known as flatworms
 ○ The include cestodes (tapeworms) that live in the
human intestine and the flukes (schistosomes) that
invade other tissues as part of their life cycle.
○ Cestodes are segmented flatworms with a head, or
scolex and a variable number of segments that grow
from the head.

ANTISEPTICS AND DISINFECTANTS

Antiseptics and disinfectants are among the most
commonly used agents in client care. Their usage has been
responsible for preventing considerable pain, suffering, and
death caused by infection. The following are definition of
specific terms used to describe these agents:
❖ Antiseptic → an agent that kills or inhibits the growth of
microorganisms.
❖ Disinfectant → an agent that rapidly destroys pathogenic
microorganisms and thereby prevents infection.
❖ Germicide → a general term for agents capable of
destroying microorganisms

ANTISEPTIC AND DISINFECTANT AGENTS

GLOSSARY
❖ Aldehyde → any of a large category of organic compounds
derived from a corresponding alcohol by the removal of
two hydrogen atoms.
❖ Community–acquire infection → an infection acquired from
the environment, including infections acquired indirectly
through the use of medications.
ANTISEPTIC
❖ One type of topical antimicrobial agent; a chemical that
can be applied to the surface of both living tissue and
nonliving objects that inhibits the growth and
reproduction of microorganisms without necessarily killing
them.
❖ It is also called static agents.

DISINFECTANT
❖ A second type of topical antimicrobial agent;
❖ A chemical applied to nonliving objects to kill
microorganisms.
❖ Also called cidal agents.
❖ Phenol as disinfectant are effective against bacteria
(especially gram positive bacteria) and enveloped viruses.
They are not effective against non-enveloped viruses and
spores. These disinfectants maintain their activity in the
presence of organic materials.

NOSOCOMIAL INFECTION
❖ An infectiona acquired at least 72 hours after
hospitalization; often caused by Candida albicans, E.coli,
hepatitis viruses, herpes zoster virus
❖ Also called Hospital–acquired infection
TOPICAL ANTIMICROBIALS
❖ A substance applied to any surface that either kills
microorganisms or inhibits their growth of replication.
❖ 2 categories of these agents:
➢ Antiseptics static agents

➢ Disinfectants cidal agents

Antiseptics Disinfectants

WHERE USED Living tissue Nonliving objects

TOXIC No Yes

POTENCY Less More

ACTIVITY AGAINST Primarily inhibits Kills (Bactericidal)

ORGANISMS growth (Bacteriostatic)

MECHANISM OF ACTION
❖ Antimicrobial agents either inhibit the growth of
microorganisms or destroy them, but the extent to which
they do this depends on the number and type of
microorganisms present.
❖ The concentration of the agent, the patient’s body
temperature and the time of exposure to the agent.

Antiseptics and Disinfectants: Mechanisms of Action

Agent Mechanism of Action Comments

Alcohol Denature or 60%-70%

essentially destroy the concentration, most
microorganism’s effective; > 90%
protein, some may concentration,
directly lyse the Bactericidal activity
microorganism

Aldehydes Act via alkylation, Bacteriostatis or

inhibiting the bactericidal
formation of the depending on
essential amino acid concentration
methionine
 Biguanides Disrupt bacterial Chlorhexidine
cytoplasmic
membranes and
inhibit cell wall
synthesis

Halogens Precipitate protein Iodine compounds:

and oxidize essential bactericidal; chlorine
enzymes by binding to compound:
and changing bactericidal
structure of proteins

Antiseptics
❖ Biguanides: Chlorhexidine
❖ Low toxicity
➢ Used on skin and mucous membranes

INDICATIONS
❖ Living tissue such as skin and mucous membranes cannot
be sterilized.
❖ However, the risk for infection can be minimized by
reducing the number of microorganisms on such tissue.
❖ Antiseptics are applied to these living tissues to inhibit the
growth of the microorganisms that typically reside on the
tissue surfaces (normal flora) and that can do harm if they
get into the body through an incision in the skin or by
means of an injection.
❖ Inanimate objectives such as tabletops and surgical
autoclaving equipment may be treated with disinfectants, as well as by
is like a
pressure autoclaving, radiation heat and so on.
cooker

CONTRAINDICATIONS
❖ The only usual contraindication to the use of a particular
antiseptic agent is known patient allergy to a specific
product.
ADVERSE EFFECTS
❖ Antiseptics and disinfectants are normally very safe
agents, with the most common adverse effects, if any at all,
being mild skin irritation.

Antiseptics and Disinfectants agents: Adverse Effects

Agent/Body System Adverse Effects

Alcohol Integumentary Excessive dryness of the skin

Aldehydes Integumentary Burns to skin or mucous

membranes

Chlorhexidine Gluconate Central Use as a preoperative scrub or as

nervous a wash for neonates and burn
patients

Iodine compounds Integumentary Iodine at concentration > 3% may

produce skin blistering

SAFE NURSING PRACTICE: CLIENTS RECEIVING

ANTIFUNGAL AGENTS
1. Never reconstitute amphotericin with saline or water
containing a bacteriostatic agent. Use only sterile water
for injection.
2. Intravenous solutions of amphotericin should be added to
infusions of dextrose and water only.
3. Never use a solution of amphotericin that contains a
precipitate.
4. Monitor the vital signs and intake and output of all clients
receiving amphotericin and miconazole infusions.
5. Observe the client for fever, nausea, chills, and headaches
and for hypokalemia if the client is receiving ampotericin.
6. Observe the intravenous injection site for indications of
phlebitis.
SAFE NURSING PRACTICE: CLIENTS RECEIVING
ANTIMALARIAL DRUGS
1. Observe the client carefully for toxicity. Including
headaches, drowsiness, visual disturbances, cardiac
collapse, convulsions, respiratory arrest, and bleeding.
2. Administer these medications immediately before or after
meals.

SAFE NURSING PRACTICE: CLIENTS RECEIVING

AMOEBIASIS AND THE TRICHOMONAL
INFECTIONS
1. Assess vital signs and record the number and character of
stools in. Clients in receiving drugs for the treatment of
amoebiasis.
2. Stress the importance of completing therapy in clients
being treated for Trichomonal infections.
3. For treatment of Trichomonal infections to be effective, all
sexual partners needs to be treated simultaneously.
4. Clients taking metronidazole are instructed to avoid the
use of alcohol during treatment. They should be informed
that their urine may darken or turn reddish brown while
taking metronidazole.

SAFE NURSING PRACTICE: CLIENTS RECEIVING

ANTHELMINTICS
1. Obtain an accurate weight before beginning the course of
therapy.
2. Stool cultures must be carefully obtained.
3. Observe the client for skin rashes and GI disturbances.
4. Continue to note the nature of the client’s stools thorough
the therapy.
5. Close contacts should be examined and treated. If
necessary, an instruction in hygienic measures should be
given.
 6. Monitor effectiveness of mebendazole, especially if the
client also is prescribed carbamazepine and/or phenytoin.

ANTIFUNGAL DRUGS
❖ Class #1: Polyenes
➢ Amphotericin”Amph(ibian)” “Tears”
❖ Class #2: Imidazoles
➢ Middle hole -azole “A Hole”
➢ Ketoconazole
➢ Miconazole
➢ Clotrimazole
❖ Triazoles
➢ Fluconazole
➢ Itraconazole
➢ Voriconazole
❖ Echinocandins
➢ Caspofungin
➢ Griseofulvine
➢ Terbinafine
➢ Flucytosine