Chapter 1: INTRODUCTION TO 4.
Accidental / Incidental – a parasite that establishes
MEDICAL PARASITOLOGY
GENERAL CONSIDERATIONS
Parasitology
 The area of biology concerned with the phenomenon
of dependence of one living organism to another.
Medical Parasitology
 Concerned with parasites that affect humans and their
importance in human communities
Tropical Medicine
 A branch of medicine that deals with tropical diseases
and other special medical problems of tropical regions.
Tropical Disease
 An illness, that is indigenous to or endemic in a tropical
area, but may also occur in sporadic and epidemic
proportions in areas that are not tropical.
ener
BIOLOGICAL RELATIONSHIPS
Sporadic
1. Symbiosis – the living together of unlike organisms
that may also involve protection or other advantage to
one or both organism
2. Commensalism – it is a symbiotic relationship in which
two species live together, and one specie benefits
without harming or benefiting the other.
Ex. Entamoeba coli in the intestinal lumen gahatag
are supplied
with the nourishment and protection without causing
damage to the tissue of its host.
3. Mutualism – is a symbiosis in which two organisms
mutually benefit from each other. ful
Ex. Termites and flagellates secretes cellulose in the
digestive system to help in the breakdown of ingested
wood.
4. Parasitism – is a symbiotic relationship where one
organism (parasite) lives in or on the other, depending
on the latter, for its survival at the expense of the host
Ex. Entamoeba histolytica, which derives nutrition from
the human host, causes amebic dysentery. ga cause/disadvantage
PARASITES
Endoparasite – parasite that live inside the body of the host. Endo
-
Ectoparasite – parasite that lives outside the body of the host. Ecto
Infestation – presence of an ectoparasite on a host.
Infection – presence of an endoparasite in a host.
*A parasite is considered erratic when it is found in an organ that
is not its usual habitat.
Types: erratic
1. Obligate – they need a host at some stage of their life
cycle to complete their development and to propagate
species. dependent
2. Aberrant – a parasite that does not further develop in
a host’s body
3. Facultative – may exist in free-living state or may
become parasitic when the need arises.
itself in a host where it does not ordinarily live.
5. Permanent – remains in the body of the host for its
entire life.
6. Temporary – lives on the host only for a short period
of time
7. Spurious – free-living organism that passes through
the digestive tract without infecting the host.
HOSTS
Types:
1. Definitive / Final – one in which the parasite attains
sexual maturity
Ex. In Taeniasis, humans are considered to be the
definitive host
2. Intermediate – harbors the asexual or larval stage of
the parasites
Ex. Taenia spp. – pigs or cattles
Schistosoma spp. – snails
*If there is more than one intermediate host, these can
3.
be classified as first and second intermediate hosts.
Paratenic – one in which the parasite does not develop
further to later stages, but is alive and can still infect
other susceptible hosts.
Ex. Paragonimus metacercaria in raw wild boar meat
can pass through the intestinal walls of humans and
complete its development.
4. Reservoir – allows the parasite’s life cycle to continue
and become additional sources of human infection.
Ex. Balantidium coli – pigs
Paragonimus westermani – field rats
Brugia malayi – cats
5. Incidental
VECTORS
 Responsible for transmitting the parasite from one host
to another.
Types:
1. Biologic Vector – transmits parasite only after the
latter has completed its development within the host.
Ex. Aedes mosquito sucks blood from a patient with filariasis,
the person undergoes several stages of development from 1st
stage larva to 3rd stage larva before the latter (infective stage) is
transmitted to another susceptible host.
2. Mechanical / Phoretic – only transports parasite.
Ex. Flies and cockroaches that feed on fecal matter
may carry enteric organisms and transfer these to food,
which would be ingested by human.
EXPOSURE AND INFECTION
 Parasites are pathogens which are harmful and which
frequently cause mechanical injury to their host.
Carriers – harbors a particular pathogen without manifesting
any signs and symptoms.
Exposure – process of inoculating an infective agent.
Infection – the establishment of the infecting agent in the host.
 Incubation Period – period between infection and evidence of MODES OF TRANSMISSION
symptoms. Also known as clinical incubation period.
Mode Parasite
Pre-patent Incubation Period – period between infection or Foodborne: (infective larval stage)
acquisition of parasite and evidence or demonstration of  Taenia solium – pork
infection.  Taenia saginata – beef
 Diphyllobothrium latum – fish
Autoinfection – results when an infected individual becomes  Paragonimus westermani – crabs
his own direct source of infection.
Ex. Drinking Water: (cysts)
 In enterobiasis, infection may occur through hand-to- Mouth  Entamoeba histolytica
mouth transmission. Scratching of perianal area in the  Giardia lamblia
presence of infective eggs where the gravid females
lay them. Raw / Improperly Cooked Fresh
 Alternatively, parasites may multiply internally, such as Water Fish: (infective larvae)
Capillaria philippinensis.  Chlonorchis
 Opistorchis
Superinfection / Hyperinfection – happens when the already  Haplorchis
infected individual is further infected with the same species Exposure to soil:
leading to massive infection with the parasite.  Hookworms
Ex. Alteration in the normal life cycle of the Strongyloides results  Strongyloides stercoralis
in a large increase in worm burden, which may lead to severe Skin Penetration
deliberation or even death due to the increase in proportion of Via Water:
the rhabditiform larvae that transform into filariform larvae while  Schistosoma
in the gut.
Bites Arthropods (vectors)
SOURCES OF INFECTION Toxoplasma gondii trophozoites
Congenital
 Cross placenta barrier during
Transmission
Parasite Source pregnancy
Fecal-Oral Transmission: Mother’s milk:
 Ascaris lumbricoides Transmammary  Ancylostoma duodenale
 Trichuris trichiura  Strongyloides stercoralis
Use of night soil or human Inhalation of
Enterobius
excreta as fertilizer Airborne Eggs
Skin-Penetration: (allows eggs to come in contacts Sexual Intercourse Trichomonas vaginalis
 Strongyloides stercoralis with soil) Note: Ancylostoma duodenale and Necator americanus are
 Hookworm hookworms.

 Schistosoma
 Amoeba and flagellates
Paragonimus westermani
Artyfechinostomum malayanum
Malaria and Filarial parasites
Trypanosoma cruzi
(Chagas disease)
Leishmania
Toxoplasma gondii
Hymenolepis nana
Entamoeba histolytica
Autoinfection:
 Capillaria philippinensis
 Enterobius vernicularis
(sitworm)
 Hymenolepis nana
 Strongyloides stercoralis
Contaminated water (with cysts
of amoeba and flagellates, and
cercariae of Schistosoma
Raw crabs
Raw Bullastra snails
Mosquitoes (vectors)
Triatoma bugs
Sand Flies (Phlebotomus spp.)
(vectors)
Cats
Rats
Asymptomatic carriers
Infected Individual
NOMENCLATURE
International Code of Zoological Nomenclature
 They classify Animal Parasites into different categories
Phylum  Class  Order (Suborder)  Family (Subfamily) 
Genus  Specie (Subspecie)
 Scientific names are latinized
 Addition of “idae” to the stem of the genus
 Generic name – Single word written in initial capital
letter
 Specie name – begins with small letter
Ex. “D. latum”
 Genera and species name are italicized (underlined
when written)

LIFE CYCLE
 Most parasitic organisms attain sexual maturity in the
definitive hosts.
 Some spend within the host with one generation after
another
 Others are exposed to the external environment before
being taken up by an appropriate host.
 The larval stage may pass through different stages in
an intermediate host before reaching the final host.
 When the life cycle becomes more complicated, the
lesser the chances of the individual parasite to survive.
EPIDEMIOLOGIC MEASURES Effectiveness – measure of the effect of a drug against an
infective agent in a particular host, living in a particular
Epidemiology – study of patterns, distribution, and occurrence environment with specific ecological, immunological, and
of disease. epidemiological determinants.

Incidence – number of new cases of infection appearing in a Drug Resistance – genetically transmitted loss of susceptibility
population in a given period of time. to a drug in a parasite population that was previously sensitive
to the appropriate therapeutic dose
Prevalence – is the number (%) of individuals in a population
estimated to be infected with a particular parasite species at a PREVENTION AND CONTROL
given time.
Morbidity Control – avoidance of illness caused by infections.
Cumulative Prevalence – percentage of individuals in a
specific population infected with at least one parasite. Information-Education-Communication (IEC)
 A health education strategy that aims to encourage
Intensity of Infection – burden of infection that is related to the people to adapt and maintain healthy life practices.
number of worms per infected person.
Ex. For soil-transmitted helminths: Environmental Management – planning, organization,
a) Direct – counting of expelled worms performance, and monitoring, of activities for the modification
b) Indirect – counting helminth eggs excreted in feces and/or manipulation of environmental factors or their interactions
(number of eggs per gram or epg) with human beings with a view to preventing or minimizing
vector or intermediate host propagation and reducing contact
Morbidity – clinical consequences of infections or diseases that between humans and the infective agent.
affect and individual’s well-being.
Environmental Sanitation – involves interventions to reduce
TREATMENT environmental health risk. Includes safe disposal and hygienic
management of human and animal excreta, refuse, and waste
Deworming – use of anthelminthic drugs in an individuals or a water.
public health program
Sanitation – provision of access to adequate facilities for the
Cure Rate – number (%) of previously positive subjects found safe disposal of human excreta, usually combined with access
to be egg negative on examination of a stool or urine sample to safe drinking water.
using a standard procedure at a set time after deworming.
ERADICATION VERSUS ELIMINATION
Egg Reduction Rate (ERR) – percentage fall in egg counts
after deworming based on examination of a stool or urine Disease Eradication – permanent reduction to zero of the
sample using a standard procedure at a set time after treatment. worldwide incidence of infection caused by a specific agent, as
a result of deliberate efforts.
Types:
1. Selective – involves individual-level deworming with Disease Elimination – reduction to a zero of the incidence of a
selection for treatment based on a diagnosis of specified disease in a define geographic area as a result of
infection. An assessment of the intensity of the deliberate efforts.
infection, or based on presumptive grounds.
*Can be used in whole population or defined risk
groups.
2. Targeted – group-level deworming where the (risk)
group to be treated (without prior diagnosis) may be
defined by age, sex, or other social characteristic
irrespective of infection status.
3. Universal – population-level deworming in which
community is treated irrespective of sex, age, infection
status, or other social characteristics.
4. Preventive Chemotherapy – regular, systematic,
large-scale intervention involving the administration of
one or more drug to selected population groups with
the aim of reducing morbidity and transmission of
selected helminth infections.

Terms:
Coverage – refers to the proportion of the target population
reached by an intervention.
Ex. % of school-age children treated during a treatment day

Efficacy – effect of a drug against an infective agent in ideal

experimental conditions and isolated from any context.
 HOST-PARASITE RELATIONSHIP
 Adaptation refers to the changes it caused in the
molecular biology, biochemistry, immunology, and
structure of the parasite.
The most noticeable adaptations are found in the Locomotory
and Digestive Organs:
 Protozoans of Phylum Apicomplexa does not have
locomotory organelles, and are mostly parasitic
 Free-living flatworms have cilia on their epidermis
while parasitic cestodes and trematodes don’t possess
such part. However, these two possess a tegument
which is provided by the microvilli to obtain nutrients.
 Hooks and Suckers – anchor flatworms inside the
host’s body and facilitate tissue migration
Size and Shape
 Adult Ascaris maintain their position inside the
intestinal wall by constant movement. The integument
is thickened to resist enzymes and juices in the
digestive tract, and to protech from dessication and
physical injury.
 For intestinal flukes, the tegument is covered with
spines to prevent abrasion
 Special coverings for the ova, larvae, and cysts protect
the parasite during its free-living stage. They also aid
in resisting digestive juices when it enters the host’s
body.
Reproductive System:
 Flatworms have highly elaborated and complicated
reproductive systems
 Tapeworms and flukes, except Schistosoma spp., are
hermaphrodites wherein they contain complete set of
male and female organs capable of producing
thousands of ova.
 Flukes undergo asexual reproduction in the
intermediate hosts to increase the number of progeny.
Result of Biochemical Adaptations:
 Streamlining
- the loss of certain metabolic pathways common to
free-living organisms.
- the inability of the parasite to synthesize certain
cellular components and the need to obtain it from
the host.
Ex. Hemoflagellates and other helminth parasites
Specialized Mechanisms: (to gain entry)
 Trophozoites of Entamoeba histolytica secretes
cysteine proteinases, that allows them to penetrate
the mucosa and adhere to the underlying layer and
surrounding tissue.
 No enzyme is found in the commensal Entamoeba coli.
 Cercariae of Schistosoma contain penetration glands,
which produce an enzyme capable of digesting the skin
allowing entry to the host’s body.
 All cestode embryos have 6 hooklets, which aid in
tissue penetration before developing into encysted
larvae
EFFECT OF PARASITE ON THE HOST
Mechanisms:
1. Interference with the vital processes of the host
through parasitic enzymes
 Secretory and excretory products elaborated by
many parasites allow them to metabolize
nutrients from the host and store them for energy
production.
Ex. The Trophozoites of Entamoeba histolytica
releases enzyme known as cysteine
proteinases, which do not only digest cellular
material but also degrade epithelial basement
membrane, facilitating tissue invasion.
2. Invasion and destruction of host tissue
 Plasmodium spp. Invades red blood cells. After
multiplication, the host’s RBC rupture releasing
merozoites.
 In Schistosoma japonicum infection, cumulative
deposition of eggs in the liver stimulates an
immune response mechanism resulting in
granuloma formation and then fibrosis, which lead
to portal hypertension and massive hemorrhage
in the venules.
 Hookworms have cutting plates, which attach to
intestinal mucosa and destroy the villi.
 Large number of worms such as Ascaris form
tangled masses that can lead to intestinal
obstruction. An Ascaris could invade other organs
such as appendix and bile ducts that may cause
surgical emergency.
3. Deprive the host of essential nutrients and
substances
 Heavy hookworm infection causes massive
intestinal bleeding, which results in chronic
blood loss and iron deficiency anemia.
 Diphyllobothrium latum competes its host for
the available supply of Vitamin B12 resulting
into megaloblastic anemia.
EFFECT OF HOST ON THE PARASITE
Factors:
1. Genetic Makeup of the Host
 In falciparum malaria, possession of sickle-
cell trait confers some protection, while
presence of Duffy blood factor increases the
susceptibility to Plasmodium vivax.
2. Nutritional Status of the Host
 Rich in protein diet is not favorable for
development of intestinal protozoan.
 Low protein diet favors appearance of
symptoms of amebiasis and complications of
the disease.
 High carbohydrate diet favors development of
tapeworms.
3. Immune Processes
 Absolute immunity to reinfection rarely occurs
following protozoan infections, and probably
never happens with helminth infections.
 Acquired immunity may be very important in
modifying the severity of disease in endemic
areas.
 GROUPS OF PARASITES WITH MEDICAL AND PUBLIC
HEALTH IMPORTANCE

 All parasites can be classified according to the Linnaean

hierarchical scheme in order of decreasing generality.
- Kingdom
- Subkingdom
- Phylum Linnaean
- ClassOrder Hierarchical
- Family Scheme
- Genus
- Species

 This scheme is based on the morphological characterization

found in the different stages of parasite development.
 However, there are tools that provide elucidation of the
taxonomic relationship at the subcellular level. These are
Molecular techniques such as:
- DNA extraction and sequencing
- Proteome analysis
- RNA interference
- Polymerase chain reaction
 These are useful in identifying cryptic protozoan parasites and
their sibling species.

PROTOZOA

 Parasitic infections are either unicellular or multicellular

metazoan.
 Generally, protozoans are provided with a nucleus or nuclei,
cytoplasm, an outer limiting membrane, and cellular
elaborations called organelles (includes locomotory apparatus
such as cilia, flagella, and pseudopodia).
 There is increasing knowledge of the presence of apical
complex which aid the organism in the penetration of target
cells.
 They require wet environment for feeding, locomotion, 3. Phylum Apicomplexa
osmoregulation, and reproduction. - have an apical complex at the anterior end which
consists of:
Cyst – infective stage; relatively resistant to environmental a) polar rings
changes compared to the trophozoites. b) subpellicular tubules
c) conoid processes
Trophozoite – vegetative stage d) rhoptries
e) micronemes
All protozoa fall under Kingdom Protista, which is a diverse - these structure are involved in penetration and
group of eukaryotic microorganisms. invasion of target cells.
- all members are PARASITIC.
Phyla Sarcomastigophora, Ciliophora, Apicomplexa, and - have been reported practically in all organ systems
Microspora are the major phyla that causes disease. of both human and animals.
- Specifically, in the GI tract, genitourinary tract,
Phyla: central nervous system, reticuloendothelial
1. Phylum Sarcomastigophora system, respiratory tract, blood and blood cells,
 Subphylum Mastigophora eyes, skin and even in the oral cavity.
- organelles of locomotion are whip-like structures
arising in the ectoplasm called flagella 4. Phylum Microspora
 Subphylum Sarcodina - includes both Enterocytozoon and
- organelles of locomotion are hyaline foot-like Encephalitozoon.
extrusions from the ectoplasm called - consists of spore-forming parasite of both
pseudopodia vertebrates and invertebrates.
2. Phylum Ciliophora - though it contains more than 100 genera, the
- have organelles of locomotion that are hair-like members are similar in that they possess a unique
projections from the ectoplasm called cilia which extrusion apparatus which enables them to insert
includes only one parasite of medical and public infective material to the host cell.
health interest, Balantidium coli. - the apparatus includes a highly coiled polar
filament which extrudes, due to varying stimuli
 from the GI tract, forming a polar tube that a) Phasmid Nematodes (Secernentia)
penetrates the host cell in turn. b) Aphasmid Nematodes – without phasmids
- these parasites received more attention recently Three aphasmid worms (Adenophorea):
due to the increasing number of opportunistic - Trichuris
infections in the immunocompromised states, - Thrichinella
particularly AIDS. - Capillaria
Orders of some phasmid worms:
Metazoan Parasites are either helminths or arthropods that fall - Ascaris – Ascaridida
under Kingodm Animalia. Helminths causing infections in man - Parastrongylus and hookworms – Stongylida
belong to three groups: - Strongyloides – Rhabditida
a) Annelids – only leeches are of medical importance - Enterobius – Oxyurida
b) Nematodes
c) Flatworm Location Parasites
Small Intestines:
 Ascaris
 Capillaria
 Strongyloides
Intestinal
 Hookworm
Colon:
 Trichuris
 Enterobius
Lymph nodes and lymph vessels:
 Wuchereria
 Brugia
Extraintestinal Eyes and Meninges:
 Parastrongylus
Muscles
 Larvae of Trichinella
- Filarial worms – Spirurida

Mode of Infection Parasites

 Ascaris
Ingestion of
 Trichuris
Embryonted Eggs
 Enterobius
Penetration of  Hookworms
Filarial Larvae  Strongyloides
 Wuchereria
Mosquito Vectors
 Brugia
 Capillaria from fish
Ingestion of Infective  Trichinella from pork
Larvae  Parastrongylus from
snails
 Capillaria
Autoinfection  Strongyloides
 Enterobius
Inhalation of
Embryonaed eggs

Two other groups of worms are cestodes or tapeworms and

NEMATODES (Roundworms) trematodes or flukes. The members of Phylum Platyheminthes
 Phylum Nematoda or the flatworms are dorso-ventrally flattened with bilateral
symmetry.
 Nematodes are also known as roundworms because
they are elongated and cylindrical in shape, with
CESTODES (Tapeworms0
bilateral symmetry.
 Phylum Cestoidea
 They have complete and fully functional digestive tract
Mode of Infection: Consumption of infected IH
and muscular pharynx that is characteristically
 They are segmented with a ribbon-like appearance,
triradiate.
and don’t have digestive tracts.
 They are separate in sexes, although some may be
 Adult tapeworms are hermaphroditic.
parthenogenetic.
 Amphids – semsory organs in the anterior end  The adult tapeworms are found in the intestines of the
Phasmids – sensory organs in the posterioir end definitive host, and the larval stage is encysted in
tissues of the intermediate host.
 Phasmids are very useful in grouping nematodes:
  Scolex – anterior structure which is the main organ of encysted larva (metacercaria) which develops into the
attachment of the worm to the definitive host. second intermediate hosts.
 After the scolex is in the neck, it is then followed by the Exception: The infective stage of the Schistosomes is
strobila. The neck is the region of growth because the cercaria. Their first intermediate host is always a
segmentation or strobilization originates from it. snail, while the second could be a fish, crustacean,
 Segments or proglottids that are nearest to the neck another snail, or a fresh water plant.
are the most immature, followed by increasing mature Parasites Habitat
segments, and the most distal are gravid segments. Adult Schistosomes
Mesentric veins
 Only two orders are of medical importance which are (blood flukes)
Order Pseudophyllidea and Order Cyclophillidea. Adult Paragonimus worms Lung parenchyma
 These two differ in morphology of the scolex, Fasciola
segments, and eggs. Also, the number of intermediate Clonorchis Liver and Bile ducts
host and the type of encysted larvae that develop in the Opistorchis
intermediate host. Fasciolopsis
Echinostoma Intestines
ORDERS OF CESTODES Heterophyids
Pseudophyllidea Cyclophyllidea
Both have genital pores, but Pseudophyllidean segments have uterine  Miracidium – embryo inside the mature eggs
pores which allows release of eggs from the gravid uterus.  Eggs passed out by an infected host may be mature in
the case of Schistosoma, Chlonorchis, Opistorchis,
Bothria – spatulate scolex with Scolex is globular with 4 muscular and heterophyids.
sucking grooves suckers  Immature eggs are associated with Paragonimus,
Apolysis – since their segments Fasciola, Fasciolopsis, and Echinostoma. The
don’t have uterine pores, the gravid miracidium of immature eggs develop in an aquatic
segments are detached from the environment.
main body of the worm and eggs are
eventually released. ARTHROPODS
 Phylum Arthropoda
For diagnosis purposes, in Cyclophyllidean infections, both eggs and  Composed of bilateral symmetrical organisms
segments are recovered from patients, but in Pseudophyllidean, with segmented and jointed appendages
segments are not found.  The body is covered with a chitinous
Coracidium – Eggs, which are cytoskeleton (chitin).
Non-operculated Cyclophyllidean
operculated and immature,  This includes insects, mites, ticks, spiders,
eggs are passed out readily,
require aquatic development of scorpions, centipedes, millipedes, and
containing the hexacanth embryo.
the embryo crustaceans.
Requires two intermediate host Only requires one intermediate host,  Pentastomids or pentastomes may be
in their life cycle: but produces different types of included in this group since they have
First IH - eggs are encysted as encysted eggs: attributes of both arthropods and annelids.
precercoid larvae Cysticercus – Taenia
Second IH – becomes Cysticercoid – Hymenolepis, How Arthropods affect human health:
plerocercoid larvae Dipylidium, Raillietina a) Envenomization through bites of spiders, ticks, flies,
Hydatid – Echinococcus spp.. bugs, and mites.
Ex. Diphyllobothrium utilizes b) Introduction of venom can also occur with stings of
humans as definitive hosts, while scoprions, wasp, ants, and bees.
Spirometra employs human as c) Exposure to arthropod allergens is considered a health
intermediate hosts. hazard
d) There are some who feed on human blood, like biting
Infection with adult tapeworms is generally acquired though the flies and mosquitos that enable them to become
consumption of infected intermediate hosts. There are cases, vectors to some disease agents like Plasmodium,
however, where humans are infected with larval stage of: Babesia, Leishmania, filarial, and trypanosomes.
a) Cysticercosis – Taenia solium e) Inhabitants of unsanitary environment, such as flies
b) Hyatid cyst – Echinococcus spp. and cockroaches, could be mechanical vectors of
microbes and parasites.
TREMATODES (Flukes)
 Also known as flukes and are hermaphroditic Some arthropods, such as fleas and lies, can cause
 Mode of infection: ingestion of intermediate host and dermatologic manifestations due to prolonged contact with
skin penetratio human hosts. Fly larvae can cause infestation and invasion of
 Adult trematodes are equipped with: human tissues, also known as myiasis.
a) Oral Sucker – which digestive tract opens
b) Acetabulum – ventral sucker for attachment
c) Genital Sucker / Gonotyl – third sucker; only
observed among heterophyids
 Require two intermediate hosts in their life cycle. They
have operculated eggs, and the infective stage is the