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introduction to parasitology
introduction to parasitology
HOST
Host is defined as an organism, which harbors the parasite and provides
nourishment and shelter.
Hosts may be of the following types:
Definitive host: The host in which the adult parasites replicate sexually
(e.g., anopheles species), is called as definitive host. The definitive hosts
may be human or nonhuman living things
Intermediate host: The host in which the parasite under goes asexual
multiplication is called as intermediate host. (e.g., in malaria parasite life
cycle, humans are the intermediate hosts). Intermediate hosts are essential
for the completion of the life cycle for some parasites. Some parasites
require two intermediate hosts to complete their different larval stages.
These are known as the first and second intermediate hosts respectively
(e.g., Amphibian snails are the first intermediate host and aquatic plants are
the second inter mediate host for Fasciola hepatica
Hosts can also be:
Reservoir host: It is a host, which harbours the parasites and serves as an
important source of infection to other susceptible hosts. (e.g., dog is the
reservoir host for cystic echinococcosis,)
Paratenic or transport host in whom the parasite does not undergo any
development but remains alive and infective to another host. Paratenic hosts
bridge gap between the intermediate and definitive hosts. For example, dogs
and pigs may carry hookworm eggs from one place to another, but the eggs
do not hatch or pass through any development in these animals.
Vector is an arthropod that transmits parasites from one host to another, e.g.
female sand fly transmits Leishmania parasites
HOST-PARASITE RELATIONSHIP
The relationship between the parasite and the host, may be divided into the
following types:
1. Symbiosis: It is the close association between the host and the parasite.
Both are interdependent upon each other that one cannot live without the
help of the other. None of them suffer any harm from each other
2. Commensalism: It is an association in which the parasite only derives the
benefit without causing any injury to the host. A commensal is capable of
living an independent life
3. Parasitism: It is an association in which the parasite derives benefit from
the host and always causes some injury to the host. The host gets no benefit
in return.
The life cycle of the parasite may be direct (simple) or indirect (complex).
Direct/simple life cycle: When a parasite requires only one host to
complete its development, it is referred as direct/simple life cycle
Indirect/complex life cycle: When a parasite requires two hosts
(one definitive host and another intermediate host) to complete its
development, it is referred as indirect/complex life cycle. Some of
the helminths require three hosts (one
definitive host and two intermediate hosts)
4.laboratory diagnosis
Depending on the nature of the parasitic infections, the following specimens are
selected for laboratory diagnosis:
•Blood - in those parasitic infections where the parasite itself in any stage of its
development circulates in the blood stream, examination of blood film forms one
of the main procedures for specific diagnosis.
•Stools - examination of the stool forms an important part in the diagnosis of
intestinal parasitic infections.
trophozoites, cystic forms and parasite eggs may be detected. Some adult
worms and their larvae may also be found in the stools.
•Urine –when the parasite localizes in the urinary tract, examination of the urine
will be of help in establishing the parasitological diagnosis
.Sputum –examination of the sputum is useful in the following:
•habitat of the parasite is in the respiratory tract, as in Paragonimiasis - the
eggs of Paragonimus westermani are found.
•In amoebic abscess of lung or in the case of amoebic liver abscess bursting
into the lungs, the trophozoites of E. histolytica are detected in the sputum.
•Biopsy material –varies with different parasitic infections.
–e.g. spleen punctures in cases of kala-azar,
–muscle biopsy in cases of Cysticercosis, Trichinelliasis, and Chagas’
disease,
–Skin snip for Onchocerciasis.
Urethral or vaginal discharge
–for Trichomonas vaginalis
Indirect evidences •changes indicative of intestinal parasitic infections are:
-Cytological changes in the blood
–eosiniphilia often gives an indication of tissue invasion by helminthes,
–a reduction in white blood cell count is an indication of kala-azar, and anemia is a
feature of hookworm infestation and malaria.
Serological tests –are carried out only in laboratories where special antigens are
available.
5.Modes of Transmission
The infective stages of various parasites may be transmitted from one host to
another in the following ways:
Oral or feco-oral route: It is the most common mode of transmission of the
parasites. Infection is transmitted orally by ingestion of food, water or
vegetables contaminated with feces containing the infective stages of the
parasite. (e.g., cysts of E. histolytica, and ova of Ascaris lumbricoides)
Penetration of the skin and mucous membranes: Infection is transmitted by
the penetration of the larval forms of the parasite through unbroken skin
(e.g., filariform larva of Strongyloides stercoralis and hookworm can
penetrate through the skin of an individual walking barefooted over fecally
contaminated soil), or by introduction of the parasites through bloodsucking
insect vectors. (e.g., Plasmodium species, Leishmania species and
Wuchereria bancrofti)
Sexual contact: Trichomonas vaginalis is the most frequent parasite to be
transmitted by sexual contact. However, Entamoeba, Giardia and
Enterobius are also transmitted rarely by sexual contact among
homosexuals
Bite of vectors: Many parasitic diseases are transmitted by insect bite such
as: malaria (female anopheles mosquito), filariasis (Culex), leishmaniasis
(sandfly), Chagas’ disease (reduviid bug) and African sleeping sickness
(tsetse fly)
Vertical transmission: Mother to fetus transmission is important for few
parasitic infections like Toxoplasma gondii, Plasmodium spp. and
Trypanosoma cruzi.
Blood transfusion: Certain parasites like Plasmodium species, Babesia
species, Toxoplasma species, Leishmania species and Trypanosoma species
can be transmitted through transfusion of blood or blood products
Autoinfection: Few intestinal parasites may be transmitted to the same
person by contaminated hand (external autoinfection) or by reverse
peristalsis.
6.preventive measures
They include:
Reduction of the source of infection–the parasite is attacked within the
host, thereby preventing the dissemination of the infecting agent.
–Sanitary control of drinking water and food
Proper waste disposal –through establishing safe sewage systems, use of
screened latrines, and treatment of night soil.
The use of insecticides and other chemicals used to control the vector
population.
Protective clothing that would prevent vectors from resting on the surface
of the body and inoculate pathogens during their blood meal.
Good personal hygiene.
7.Treatment of parasitic diseases
Treatment of parasitic disease is primarily based on chemotherapy and in
some cases by surgery.
Antiparasitic Drugs Various chemotherapeutic agents are used for the
treatment and prophylaxis of parasitic infections
Surgical Management; For management of parasitic diseases like
cystic echinococcosis and neurocysticercosis surgery is indicated.
TAXONOMY OF PARASITES
According to the binomial nomenclature as suggested by Linnaeus, each parasite
has two names: a genus and a species name. These names are either derived from:
names of their discoverers, Greek or Latin words of the geographical area where
they are found, habitat of the parasite, or hosts in which parasites are found and its
size and shape. All parasites are classified under the following taxonomic units—
the kingdom, subkingdom, phylum, subphylum, super class, class, subclass, order,
suborder, super family, family, genus and species.
The generic name of the parasite always begins with an initial capital letter and
species name with an initial small letter, e.g., Entamoeba histolytica
CLASSIFICATION OF MEDICAL PARASITOLOGY
Parasites of medical importance come under the kingdom called protista and
animalia. Protista includes the microscopic single-celled eukaroytes known as
protozoa. In contrast, helminthes are macroscopic, multicellular worms possessing
well differentiated tissues and complex organs belonging to the kingdom animalia.
Medical Parasitology is generally classified into:
1• Medical Protozoology - Deals with the study of medically important protozoa.
2• Medical Helminthology - Deals with the study of helminthes (worms) that
affect man.
3• Medical Entomology - Deals with the study of arthropods which cause or
transmit disease to man.
PHYLUM PROTOZOA
These are unicellular organisms in which the various activities of metabolism,
locomotion, etc, are carried out by organelles of the cell. Protozoa of medical
importance are grouped in the following classes:
Class - Sarcodina (Amoebae):
a) Genus, Entameba: e.g. Entamoeba histolytica
b) Genus Endolimax e.g. Endolimax nana
c) Genus Iodameba e.g. Iodameba butchlii
d) Genus Dientmeba e.g. Dientameba fragilis
Class Sporozoa:
No organs of locomotion (except in gamete stages).
1) Genus Plasmodium e.g. Plasmodium falciparum
2) Genus Toxoplasma e.g. Toxoplasma Gondi
3) Genus Cryptosporidium e.g. Cryptosporidium Parvum
4) Genus Isospora e.g. I. Beli
PHYLUM PLATHYHELMINTHES
Dorso-ventrally flattened organisms which are usually hermaphroditic (except
Schistosomes).
Respiratory and blood vascular systems are absent.
Two classes are important in medical parasitology:
a.Class – Trematoda (Flukes):
Leaf-shaped species that have an alimentary canal
Genus Schistosoma e.g. S. mansoni
Genus Fasciola e.g. F. hepatica
b.Class – Cestoda (Tape worms):
Species with segmented body and with no alimentary canal
Mainly hermaphroditic
Precyst
It is the intermediate stage between trophozoite and cyst.
It is smaller to trophozoite but larger to cyst (10–20 µm)
It is oval with a blunt pseudopodia. Food vacuoles and RBCs
disappear. Nuclear
Cyst
It is the infective form as well as the diagnostic form of the parasite found in the
feces of carriers as well as patients with active disease structures are same as that
of trophozoite
It measures 10–20 µm (average 12–15 µm) in diameter
Nuclear structures are same as in trophozoites.
First, the cyst is uninucleated; later the nucleus divides to form binucleated
and finally becomes quadrinucleated cyst
Cytoplasm of uninucleated cyst contains 1–4 numbers refractile bars with
rounded ends called as chromatoid bodies (aggregation of ribosome) and a
large glycogen mass (stains brown with iodine)
Both chromatoid body and glycogen mass gradually disappear, and they are
not found in mature quadrinucleated cyst
Cysts are present only in the gut lumen; they never invade the intestinal
wall.
Note: Trophozoites and immature cysts can be passed in stool of amoebic
patients, but they can’t serve as infective form as they are disintegrated in
the environment or by gastric juice when ingested
Mode of transmission
Feco-oral route (most common)
By ingestion of contaminated food or water with mature quadrinucleated
cysts
Sexual contact: Rare, either by anogenital or orogenital contact. (especially
in developed countries among homosexual males)
Vector: Very rarely, flies and cockroaches may mechanically transmit the
cysts from feces, and contaminate food and water
LIFE CYCLE
Life cycle of E.histolytica has two stages: motile trophozoite and non-motile
cyst. Trophozoites are found in intestinal lesions, extra-intestinal lesions and
diarrheal stools whereas cyst predominate in non-diarrheal stools
When they cyst of E. histolytica reaches caecum or lower part of ileum
excystation occurs and an amoeba with four nuclei emerges and that divides
by binary fission to form eight trophozoites.
Trophozoites migrate to the large intestine and lodge in to the submucosal
tissue.
Trophozoites grow and multiply by binary fission in large
intestine (Trophozoite phase of life cycle is responsible for producing
characteristics lesion of amoebiasis).
Certain number of trophozoites are discharged in to the lumen of the bowel
and are transformed into cystic forms.
The cysts thus formed are unable to develop in the same host and therefore
necessitate a transference to another susceptible host. The cysts are passed in
the feces.
Note: Because of the protection conferred by their walls, the cysts can
survive days to weeks in the external environment. Cysts are not highly
resistant and are readily killed by boiling. But they are resistant to
chlorination or can be removed by filtration. Trophozoites can also be
passed in diarrheal stools, but are rapidly destroyed once outside the body.