MEDICAL PARASITOLOGY

IMD
DR. JOSEPHINE M. BANDALAN
INTRODUCTION TO MEDICAL
PARASITOLOGY
OBJECTIVES

• At the end of this session, students are able to

– Define parasitological terms
– Explain the impact of parasitic diseases
– Apply the knowledge to upcoming lessons
MEDICAL PARASITOLOGY
• Science that deals with organisms living in/on the
human body (the host) and the medical
significance of this host-parasite relationship
– Parasitology
• Study of the relationship between parasites and hosts
– Parasites
• Animals that live in or on the hosts for food and shelter
– Hosts
• Animals (usually bigger) which provide food and shelter for
parasite
• May get sick
KINDS OF PARASITES
Ectoparasite
• A parasitic organism that
lives on the outer surface
of its host, e.g. lice, ticks,
mites etc.
vInfestation
Endoparasite
• Parasites that live inside
the body of their host, e.g.
Entamoeba histolytica
vInfection
KINDS OF PARASITES

Obligate Parasite Facultative parasite

• Parasite is completely • An organism that exhibits
dependent on the host both parasitic and non-
during a segment or all of parasitic modes of living,
its life cycle, e.g. e.g. Naegleria fowleri
Plasmodium spp.
 KINDS OF PARASITES

Accidental Erratic parasite Spurious

parasite parasite
• When a parasite • One that wanders • A free-living
attacks an in to an organ in organism that
unnatural host and which it is not passes through the
survives; usually found; e.g. digestive tract
e.g. Hymenolepis Entamoeba without infecting
diminuta (rat histolytica in the the host; e.g.
tapeworm) liver or lung of Facsiola hepatica in
humans. the liver
KINDS OF HOSTS
Definitive host
• A host that harbors a
parasite in the adult stage
or where the parasite
undergoes a sexual
method of reproduction
Intermediate host
• Harbors the larval stages
of the parasite or an
asexual cycle of
development takes place
• In some cases, larval
development is completed in
two different intermediate
hosts, referred to as first and
second intermediate hosts
KINDS OF HOSTS

Paratenic host Reservoir host

• A host that serves as a • A host that allows the

temporary refuge parasite’s life cycle to
• Parasite does not develop continue and become
further to later stages and additional sources of human
serves as vehicle for
infection and is usually not
reaching the definitive
affected by the infection
host, i.e. it is not necessary
for the completion of the • Domestic and farm animals
parasites life cycle
• Fleas for certain
tapeworms
KINDS OF HOSTS

Natural host Accidental host

• A host that is naturally • A host that is under

infected with certain normal circumstances not
species of parasite infected with the parasite
• Toxocara (cats)
VECTORS

Biologic vector Mechanical or

Phoretic vector
• Transmits the parasite only • Only transports the
after it has completed its parasite
development within the
vector host

• Anopheles mosquito in • Houseflies, cockroaches

Plasmodium
RELATIONSHIPS BETWEEN ORGANISMS

• Symbiosis – living together of 2 unlike organisms

(symbionts)
– Mutualism-both organisms benefit from each other
– Commensalism- one organism benefits without
harming the host
– Parasitism-one organism benefits and harm the host
SOURCES OF EXPOSURE TO INFECTION
• Contaminated soil or water
• Food containing the infective stage of the parasite
• Blood-sucking insect
• Domestic or wild animal harboring the parasite
• Another person, his belongings or immediate
environment he has contaminated
• One’s self
PORTAL OF ENTRY

• Mouth
• Skin
• Inhalation
• Transplacental
• Sexual contact
EXPOSURE AND INFECTION
• Incubation period
– Clinical incubation period
– Pre-patent or biologic incubation period
• Autoinfection
– Finger to mouth transmission in enterobiasis
• Superinfection or hyperinfection
– Strongyloidiasis
EFFECT OF PARASITES ON THE HOST

• Direct effects of the parasite on the host

– Mechanical injury - may be inflicted by a parasite by
means of pressure as it grows larger, e.g. Hydatid cyst
causes blockage of ducts such as blood vessels producing
infarction; intestinal obstruction (adult Ascaris)
– Deleterious effect of toxic substances - in Plasmodium
falciparum production of toxic substances may cause rigors
and other symptoms
– Deprivation of nutrients, fluids and metabolites -
parasite may produce disease by competing with the host
for nutrients. Ex. Diphyllobothrium
EFFECT OF PARASITES ON THE HOST

• Indirect effects
– Immunological reaction- tissue damage may be
caused by immunological response of the host, e.g.
nephritic syndrome following Plasmodium infections
– Excessive proliferation of certain tissues due to
invasion by some parasites can also cause tissue
damage in man, e.g. fibrosis of liver after deposition of
the ova of Schistosoma (pipe-stem fibrosis)
BASIC CONCEPTS IN MEDICAL
PARASITOLOGY
• Medically important parasites are discussed under
standard subheadings of
– Geographical distribution
– Morphology
– Life cycle (include mode of infection)
– Host/parasite relationship
– Pathology and clinical manifestations of infection,
– Laboratory diagnosis
– Treatment
– Preventive/control measures
• Geographical distribution depends on
– Host specificity, for example, Ancylostoma duodenale
requires man as a host whereas Ancylostoma caninum
requires a dog
– Food habits, e.g. consumption of raw or undercooked
meat or vegetables predisposes to Taeniasis
– Easy escape of the parasite from the host- feces and
urine
• Geographical distribution depends on
– Environmental conditions favoring survival outside the
body of the host, i.e. temperature, the presence of
water, humidity etc.
– The presence of an appropriate vector or
intermediate host – parasites that do not require an
intermediate host (vector) for transmission are more
widely distributed than those that do require vectors.
• Morphology
– Includes size, shape, color and position of different
organelles in different parasites at various stages of
their development
– This is especially important in laboratory diagnosis
• To identify the different stages of development
• Differentiate between pathogenic and commensal organisms.
Example: Entamoeba histolytica (pathogenic) and Entamoeba
coli (nonpathogenic)
• Life cycle – can either be simple or complex
– This information provides an understanding of the
symptomatology and pathology of the parasite
– The method of diagnosis and selection of appropriate
medication
– Provides crucial information pertinent to the
epidemiology, prevention, and control
Entamoeba histolytica
– life cycle completed
in one host
Plasmodium spp require 2 hosts to complete the life cycle:
human host and mosquito vector
• Epidemiologic Measures
– Epidemiology
– Incidence
– Prevalence
– Intensity of infection or worm burden
– Morbidity
– Mortality
• Host-Parasite relationship
– Carrier state – harbors the pathogen without
manifesting any signs and symptoms; a perfect host
parasite relationship where tissue destruction by a
parasite is balanced with the host’s tissue repair
– Disease state - can result either from lower resistance
of the host or a higher pathogenicity of the parasite.
– Parasite destruction – occurs when the host takes
the upper hand
• Laboratory Diagnosis
– Blood – in those parasitic infections where the parasite
itself in any stage of its development circulates in the
blood stream; e.g. malaria, filariasis
– Stool – intestinal parasitic infections
– Urine - Schistosoma haematobium infection
• Laboratory Diagnosis
– Sputum - Paragonimiasis
– Biopsy material – Cysticercosis, Chaga’s disease,
Leishmaniasis, Trichinella infection
– Urethral and vaginal discharges - Trichomoniasis
• Indirect evidences – changes indicative of
intestinal parasitic infections are:
– Cytological changes in the blood
• Eosinophilia often gives an indication of tissue invasion
by helminthes
• Reduction in white blood cell count is an indication of
kala-azar
• Anemia is a feature of hookworm infestation and
malaria
– Serological tests
• Are carried out only in laboratories where special antigens
are available
• Treatment – deworming
– Cure rate
– Egg reduction rate
– Drug resistance
– Efficacy and Effectiveness of the drug

* Refer to official textbook for definition of the above terms

• Prevention and control
– Prompt diagnosis and treatment of parasitic diseases
and therefore reduce of the source of infection
– Sanitary control of drinking water and food
– Proper waste disposal – through establishing safe
sewage systems, use of screened latrines, and treatment
of night soil
• Prevention and Control
– The use of insecticides and other chemicals used to
control the vector population
– Protective clothing that would prevent vectors from
resting in the surface of the body and inoculate
pathogens during their blood meal
– Good personal hygiene
– Avoidance of unprotected sexual practices
– Health education
CLASSIFICATION OF MEDICAL
PARASITOLOGY

• Medical Protozoology
– Deals with the study of medically important protozoa
• Medical Helminthology
– Deals with the study of helminthes (worms) that affect
man
• Medical Entomology
– Deals with the study of arthropods which cause or
transmit disease to man
 Super class Super family

Phylum Subphylum Class Order Family Genus

Species
Subclass Subfamily
 Protozoa Metazoa
Sarcodina (Amoeba)- Nematoda
Entamoeba, Endolimax,
Iodamoeba Ascaris, Trichuris,
Hookworm, Enterobius,
Capillaria, Filarial worms,
Mastigophora Trichinella
(Flagellates)- Giardia,
Chilomastix, Dientamoeba, Trematoda
Trichomonas, Trypanosoma,
Leishmania Schistosoma, Fasciola,
Opisthorchis, Paragonimus,
Heterophyes
Ciliophora - Balantidium

Cestoidea
Apicomplexa – Diphyllobothrium, Taenia,
Plasmodium, Babesia, Echinococcus, Hymenolepis,
Crytosporidium, Isospora, Dipylidium
Toxoplasma, Sarcocystis
READING ASSIGNMENT

• Immunology of Parasitic Infections

– Innate immunity
– Specific immune response
• Humoral
• Cellular
– Parasite evasion mechanism

*Medical Parasitology textbook by Dr.Vicente Belizario