Burton's Microbiology For The Health Sciences: Chapter 21. Parasitic Infections

Burton's Microbiology
for the Health Sciences

Chapter 21. Parasitic Infections
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 21 Outline
• Introduction 
Helminths
• Definitions 
Helminth Infections
of Humans
• How Parasites Cause
Disease 
Appropriate
Therapy for
• Parasitic Protozoa Parasitic Diseases
• Protozoal Infections of 
Medically Important
Humans Arthropods

Definitions
• Parasitology is a branch of microbiology; it is the
scientific study of parasites.
• Parasitism is a symbiotic relationship that is of benefit
to one party or symbiont (the parasite) and usually
detrimental to the other party (the host).
• Parasites are organisms that live on or in other living
organisms (hosts), at whose expense they gain some
advantage.
– Parasites that live on the outside of the host’s body
are called ectoparasites.
– Parasites that live inside the host are called
endoparasites.

Definitions, cont.
• The life cycle of a parasite may involve one or more
hosts.
– If more than one host is involved, the definitive host
is the host that harbors the adult or sexual stage of
the parasite.
– The host that harbors the larval or asexual stage is
the intermediate host.
• An accidental host is one that can serve as a host, but is
not the usual host in the parasites’ life cycle.
• A dead-end host is one in which the parasite cannot
continue its life cycle.

Definitions, cont.
• A facultative parasite is an organism that can be

parasitic, but does not have to live as a parasite; it is
capable of an independent life.
– Example: the free-living amoeba, Naegleria fowleri,
that causes primary amebic meningoencephalitis
• An obligate parasite has no choice; it must inhabit a host
or hosts.
– Most parasites that infect humans are obligate
parasites

How Parasites Cause Disease
• The manner in which parasites cause damage to their
host varies from one species of parasite to another,
and often depends on the number of parasites that are
present.
• Some parasites produce toxins; some produce harmful
enzymes; some invasive and migratory parasites
cause physical damage to tissues and organs; some
cause the destruction of individual cells; and some
cause occlusion of blood vessels and other tubular
structures.
• Sometimes, the host immune response to the
parasites causes more injury than do the parasites
themselves.
Parasitic Protozoa
• Most protozoa are unicellular.

• They are classified taxonomically by their mode of
locomotion; amebae move by means of pseudopodia
(“false feet”); flagellates move by means of flagella;
ciliates move by means of cilia; sporozoans do not move.
• Not all protozoa are parasitic (e.g., Paramecium spp.).
• Protozoal infections are most often diagnosed by
microscopic examination of body fluids, tissue specimens,
or feces – specimens are examined for motile
trophozoites and dormant cyst stages.

PROTOZOAL
INFECTIONS
OF HUMANS

Protozoal Infections of the Skin
• Leishmaniasis
– Caused by various species of flagellated protozoa
in the genus Leishmania
– Usually transmitted via the bite of an infected
sand fly
– Three forms of the disease: cutaneous,
mucocutaneous, visceral
– Cutaneous and mucocutaneous leishmaniasis can
cause severe tissue damage and disfigurement
– Visceral leishmaniasis can lead to death

Patients With Cutaneous Leishmaniasis

Protozoal Infections of the Eyes
• Amebic conjunctivitis and ketatoconjunctivitis
– Caused by several species of amebas in the
genus Acanthamoeba (facultative parasites)
– Can lead to loss of vision or enucleation
• Toxoplasmosis
– Caused by Toxoplasma gondii, an intracellular
sporozoan
– Can involve the CNS, lungs, muscles, or heart,
as well as the eyes
– Acquired by ingesting cysts or oocysts
Protozoal Infections of the Gastrointestinal Tract
MODE OF
DISEASE ETIOLOGIC AGENT
TRANSMISSION
Humans; fecally
Amebiasis Entamoeba histolytica contaminated food or
water
Pigs; food or water
Balantidiasis Balantidium coli contaminated with
pig feces
Infected humans,
Cryptosporidium
Cryptosporidiosis cattle and other
parvum
domesticated animals
Cyclospora Fecally contaminated
Cyclosporiasis
cayetanensis water and produce
Humans and infected
Giardiasis Giardia lamblia
animals
Three Protozoal Infections of the GI Tract

Giardia lamblia
trophozoite, 10-20 µm long
by 5-15 µm wide
The trophozoite resembles

a face; the 2 nuclei look
like eyes; it has been
described as resembling
an owl face, a clown face,
and an old man with
glasses

Protozoal Infections of the
Genitourinary Tract
• Trichomoniasis
– Caused by Trichomonas vaginalis, a flagellate
– A sexually transmitted disease of men and
women
– Usually symptomatic in women and
asymptomatic in men
– T. vaginalis causes about 1/3 of the cases of
vaginitis in the U.S.
– T. vaginalis vaginitis is usually diagnosed by
observation of motile trophozoites in a saline wet
mount of vaginal discharge material
Trichomonas vaginalis
trophozoites, 7-23 µm
long by 5-15 µm wide
Live T. vaginalis
trophozoites are
constantly in motion, as
a result of the flagella
and an undulating
membrane

Protozoal Infections of the Circulatory System
MODE OF
DISEASE ETIOLOGIC AGENT
TRANSMISSION
2 different subspecies
African Bite of infected
of Trypanosoma
Trypanosomiasis tsetse fly
brucei
Reduvid bug (also
American
known as a triatome,
Trypanosomiasis Trypanosoma cruzi
kissing, or
(Chagas’ Disease)
cone-nosed bug)
Babesia microti and
Babesiosis Tick bite
other Babesia spp.
4 different species of Bite of infected female
Malaria
Plasmodium Anopheles mosquito
Trypomastigotes of Trypanosoma brucei
A stained peripheral blood smear from a patient with

African trypanosomiasis
Trypomastigotes of
Trypanosoma cruzi
(note the
characteristic “C”
shape)
A stained peripheral blood smear from a patient with

American trypanosomiasis (Chagas’ disease)
Life Cycle of Malarial Parasites

Peripheral blood
erythrocytes infected
with trophozoites of
Plasmodium
falciparum (arrows)
Young P. falciparum
trophozoites have a
“signet ring”
appearance

Protozoal Infections of the CNS
• Primary Amebic Meningoencephalitis

– Caused by Naegleria fowleri, an ameboflagellate
– Acanthamoeba and Balamuthia spp. can cause
similar conditions
– Persons often become infected by swimming
and/or diving in ameba-contaminated water
(e.g., “the old swimming hole”)
– After the amebas colonize nasal tissues, they
invade the brain and meninges by traveling
along the olfactory nerves; often fatal

Helminths
• The word helminth means parasitic worm

– Helminths are multicellular, eucaryotic organisms; 2
major divisions: (1) round worms or nematodes, and
(2) flatworms or Platyhelminthes. The flatworms are
further divided into tapeworms (cestodes) and flukes
(trematodes).
– The helminth life cycle has 3 stages: egg, larva, and
the adult worm.
– Helminth infections are primarily acquired by
ingesting the larval stage; in some helminth
diseases, larvae enter by penetration of the skin.
Helminth Infections of Humans
LOCATION HELMINTH DISEASE CAUSE
Skin Onchocerciasis Onchocerca volvulus
Muscle/Subcutaneous Trichinosis Trichinella spiralis

Tissue Dracunculiasis Dracunculus medinensis
Onchocerciasis O. volvulus
Eyes
Loiasis Loa loa
Respiratory System Paragonimiasis Paragonimus westermani
Wucheria bancrofti/
Filariasis
Circulatory System Brugia malayi
Schistosomiasis
Schistosoma spp.
Taenia solium (cysts)
Cysticercosis
Central Nervous System Echinococcus granulosis or
Hydatid cyst disease
Echinococcus multilocularis
Helminth Infections of the GI Tract
• Ascariasis – Ascaris lumbricoides • Dwarf tapeworm – Hymenolepis
(N) nana (C)
• Hookworm infection – • Fish tapeworm –
Ancylostoma duodenale or Diphyllobothrium latum (C)
Necator americanus (N)
• Pork tapeworm – Taenia solium
• Pinworm – Enterobius (C)
vermicularis (N)
• Rat tapeworm – Hymenolepis
• Whipworm – Trichuris trichiura diminuta (C)
(N)
• Fasciolopsiasis – Fasciolopsis
• Strongyloidiasis – Strongyloides buski (T)
stercoralis (N)
• Fascioliasis – Fasciola hepatica
• Beef tapeworm – Taenia (T)
saginata (C)
• Clonorchiasis – Clonorchis
• Dog tapeworm – Dipylidium sinensis (T)
caninum (C)
Medically Important Arthropods
• 3 classes of arthropods studied in Parasitology courses:
– Insects (e.g., lice, fleas, mosquitoes)
– Arachnids (e.g., mites and ticks)
– Crustaceans (e.g., crabs, crayfish, and certain
Cyclops species)
• Arthropods serve as mechanical or biologic vectors in the
transmission of certain infectious diseases.
– Mechanical vectors pick up a parasite at point A and
drop it off at point B.
– Biological vectors harbor the parasite in their body,
where the parasite matures and/or multiplies.

Ways in Which Arthropods May Be
Involved in Human Diseases
TYPE OF INVOLVEMENT EXAMPLE(S)
Scabies, a disease in which microscopic

The arthropod may actually be the cause
mites live in subcutaneous tunnels and
of the disease.
cause intense itching
The arthropod may serve as the Flea in the life cycle of the dog
intermediate host in the life cycle of tapeworm; beetle in the life cycle of the
a parasite. rat tapeworm
The arthropod may serve as the
Female Anopheles mosquito in the life
definitive host in the life cycles of a
cycle of malarial parasites
parasite
The arthropod may serve as a vector Oriental rat flea in the transmission of
in the transmission of an infectious plague; tick in the transmission of Rocky
disease. Mountain spotted fever and Lyme disease

Medically Important Arthropods, cont.
A. Dermacentor
andersoni, wood tick,
one of the tick vectors of
Rocky Mountain spotted
fever
B. Xenopsylla cheopis,
oriental rat flea, vector of
plague and endemic
typhus

Medically Important Arthropods, cont.
C. Pediculus humanus,
human body louse; a
vector of epidemic typhus
D. Phthirus pubis, the

pubic or crab louse

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Burton's Microbiology

for the Health Sciences

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

• A facultative parasite is an organism that can be

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Most protozoa are unicellular.

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Amebiasis Entamoeba histolytica contaminated food or

Balantidiasis Balantidium coli contaminated with

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

The trophozoite resembles

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

A stained peripheral blood smear from a patient with

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

A stained peripheral blood smear from a patient with

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Primary Amebic Meningoencephalitis

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

• The word helminth means parasitic worm

Skin Onchocerciasis Onchocerca volvulus

Muscle/Subcutaneous Trichinosis Trichinella spiralis

Respiratory System Paragonimiasis Paragonimus westermani

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Scabies, a disease in which microscopic

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

D. Phthirus pubis, the

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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