PARASITOLOGY

LECTURE 1
BY: JAHRE MARK TOLEDO, RMT, MAED BIO
O Parasitology is the area of biology concerned with the
phenomenon INTRODUCTION
of dependence of one livingTO organism on
another. PARASITOLOGY
O Medical Parasitology is concerned primarily with
parasites of humans and their medical significance, as
well as their importance in human communities.
O Tropical Medicine is a branch of medicine that deals
with tropical diseases and other special medical
problems of tropical regions.
O tropical disease is an illness, which is indigenous to or
endemic in a tropical area but may also occur in sporadic
or epidemic proportions in areas that are not. tropical.
O Symbiosis is the living together of unlike organisms.
O Commensalism is a symbiotic relationship in which two
species live together and one species benefits from the
relationship without harming or benefiting the other.
O Entamoeba coli in the intestinal lumen are supplied with
nourishment and are protected from harm, while it does
not cause any damage to the tissues of its host.
O Mutualism is a symbiosis in which two organisms
mutually benefit from each other
O like termites and the flagellates in their digestive system,
which cellulase to aid in the breakdown of ingested wood.
O Parasitism is a symbiotic relationship where one organism, the
parasite, lives in or on another, depending on the latter for its
survival and usually at the expense of the host.
O One example of a parasite is Entamoeba histolytica, which
derives nutrition from the human host and causes amebic
dysentery.
O Endoparasite- living inside the host
O Ectoparasite- living outside the host
O Infection- presence of endoparasite
O Infestation- presence of ectoparasite
O Obligate parasites- they need host to complete their life cycle
(ex. Tapeworms)
O Facultative parasite- may exist in a free living state. (ex.
Acanthameoba)
O Accidental/incidental parasites- parasites that
establish itself but it is not originally living in that
organism.
O Permanent parasites- parasites that remains on the
body of the host for its entire life cycle(ex.
Dientameoba fragilis)
O Temporary parasites- parasites that temporary
lives in the host
O Spurious parasites- parasites that passes the
digestive tract without infecting the host
O definitive or final host is one in which the parasite
attains sexual maturity. In taeniasis, for example,
humans are considered the definitive host.
O intermediate host harbors the asexual or larval stage
of the parasite. Pigs or cattle serve as intermediate
hosts of Taenia spp.,while snails are hosts of
Schistosoma spp.
O paratenic host is one in which the parasite does not
develop further to later stages.
O Reservoir host animals that harbor the parasite other
than definitive, intermediate, and paratenic hosts.
O Vectors are responsible for transmitting the parasite
from one host to another.
O Biologic vector transmits the parasite only after the
latter has completed its development within the host.
O mechanical or phoretic vector, on the other hand, only
transports the parasite.
O A carrier harbors a particular pathogen without
manifesting any signs and symptoms.
O Exposure is the process of inoculating an infective
agent, while infection connotes the establishment of
the infective agent in the host.
O The incubation period is the period between infection
and evidence of symptoms. Also known as clinical
incubation period.
O The pre-patent period, also known as the biologic
incubation period, is the period between infection or
acquisition of the parasite and evidence or
demonstration of infection.
O Autoinfection results when an infected individual
becomes his own direct source of infection.
O Superinfection or hyperinfection happens when the
already infected individual is further infected with the
same species leading to massive infection of the
parasite.
O SOURCES OF INFECTION

O Contaminated soil and water- Ascaris, Trichiuris,

Schistosoma, Giardia, Cyclospora, Cryptosporidium
O Arthropods- Plasmodium, Wuchereria, Trypanosoma,
Leishmania, Babesia
O Other animals- Trichinella, Toxoplasma, Hymenolepis
O Beddings, clothings- Ectoparasites
O Self- Capillaria philippinensis, Enterobius
vermicularis, Strongyloides stercoralis, Hymenolepis
nana
O Since the most common source of parasitic infection is
contaminated food and water, the most likely portal of
entry is the mouth.
O Ingestion- it is known as fecal-oral route
O Skin penetration is another route of transmission.
O Arthropods also serve as vectors and transmit
parasites through their bites.
O Another way of acquiring infection is through
congenital transmission.
O Other ways of acquiring the infection include
inhalation of airborne eggs.
O Direct inoculation- via parenteral route/venereal
O Most parasitic organisms attain sexual maturity in
their definitive hosts. Some spend their entire lives
within the host with one generation after another,
while others are exposed to the external environment
before being taken up by an appropriate host.

O The perpetuation of a species of parasite depends upon

its ability to ensure transmission from one host to the
next.
O Epidemiology is the study of patterns, distribution, and
occurrence of disease.
O Incidence is the number of new cases of infection
appearing In a population in a given period of time.
O Prevalence is the number (usually expressed as
percentage) of individuals in a population estimated to be
infected with a particular parasite species at a given time.
O Cumulative prevalence is the percentage of individuals in
a population infected with at least one parasite.
O Intensity of infection refers to burden of infection which
is related to the number of worms per infected person.
O Clinical consequences of infections or diseases that affect
an individual’s well-being refer to morbidity.
O Deworming is the use of anthelminthic drugs in an
individual or a public health program.
O Cure rate refers to the number (usually expressed as a
percentage) of previously positive subjects found to be egg
negative on examination of a stool or urine sample using a
standard procedure at a set time after deworming.
O Egg reduction rate (ERR) is the percentage fall in egg
counts after deworming based on examination of a stool or
urine sample using a standard procedure at a set time after
the treatment.
O Selective treatment involves individual-level deworming
with selection for treatment based on a diagnosis of
infection or an assessment of the intensity of infection, or
based on presumptive grounds.
O Targeted treatment is group-level deworming where
the (risk) group to be treated (without prior diagnosis)
may be defined by age, sex, or other social
characteristics irrespective of infection status.
O Universal treatment is population-level deworming in
which the community is treated irrespective of age,
sex, infection status, or other social characteristics.
O Coverage refers to the proportion of the target
population reached by an intervention.
O Efficacy is the effect of a drug against an infective
agent in ideal experimental conditions and isolated
from any context.
O Effectiveness is a measure of the effect of a drug
against an infective agent in a particular host, living in
a particular environment with specific ecological,
immunological, and epidemiological determinants.
O Drug resistance is a genetically transmitted loss of
susceptibility to a drug in a parasite population that
was previously sensitive to the appropriate therapeutic
dose.
O Morbidity control is the avoidance of illness caused by
infections.
O Information-education-communication (IEC) is a
health education strategy that aims to encourage people
to adapt and maintain healthy life practices.
O Environmental management is the planning,
organization, performance, and monitoring of activities
for the modification and/or manipulation of
environmental factors or their interaction with human
beings with a view to preventing or minimizing vector
or intermediate host propagation and reducing contact
between humans and the infective agent.
O Environmental sanitation involves interventions to
reduce environmental health risks including the safe
disposal and hygienic management of human and animal
excreta, refuse, and waste water.
O Sanitation is the provision of access to adequate
facilities for the safe disposal of human excreta,
usually combined with access to safe drinking water.
O Disease eradication is defined as a permanent
reduction to zero of the worldwide incidence of
infection caused by a specific agent, as a result of
deliberate efforts.
O disease elimination is a reduction to zero of the
incidence of a specified disease in a defined
geographic area as a result of deliberate efforts.
 ENTAMEOBA HISTOLYTICA
O Entamoeba histolytica is a pseudopod forming non-
flagellated protozoan parasite.
O It is the most invasive of the Entamoeba parasites
(which includes E. dispar, E. moshkovskii, E.
hartmanni, E. polecki, E. coli, and E. gingivalis),
O the only member of the family to cause colitis and liver
abscess.
O The life cycle of E. histolytica consists of two stages:

O infective cyst
O invasive trophozoite form.

O No host other than humans is implicated in the life cycle

although natural infection of primates has been reported.

O The quadrinucleate cyst is resistant to gastric acidity and

desiccation, and can survive in a moist environment for several
weeks.

O Infection with E. histolytica occurs when cysts are ingested

from fecally-contaminated material. Other modes of
transmission include venereal transmission through fecal-oral.
O Pathogenesis and Clinical Manifestations

O The proposed mechanisms for virulence are: production

of enzymes or other cytotoxic substances, contact-
dependent cell killing, and cytophagocytosis.
O E. histolytica trophozoites adhere to the colonic mucosa
through a galactoseinhibitable adherence lectin (Gal
lectin).
O The recent differentiation of E. dispar and E. histolytica
by PCR has confirmed the high prevalence of non-
pathogenic E. dispar compared to the pathogenic E.
histolytica. However, studies also revealed that most E.
histolytica infections in endemic communities are
asymptomatic.
O Amebic colitis clinically presents as gradual onset of
abdominal pain and diarrhea with or without blood
and mucus in the stools.
O Although some patients may only have intermittent
diarrhea alternating with constipation, children may
develop fulminant colitis with severe bloody diarrhea,
fever, and abdominal pain.
O Ameboma occurs in less than 1% of intestinal
infections. It clinically presents as a mass-like lesion
with abdominal pain and a history of dysentery.
O Amebic liver abscess (ALA) is the most common
extra-intestinal form of amebiasis.
O In ALA, the most serious complications are rupture
into the pericardium with a mortality rate of 70%,
rupture into the pleura with mortality of 15 to 30%,
and super infection.
O Secondary amebic meningoencephalitis occurs in 1 to
2%, and it should be considered in cases of amebiasis
with abnormal mental status.
O Acute amebic colitis should be differentiated from
bacillary dysentery of the following etiology: Shigella,
Salmonella, Campylobacter, Yersinia, and
enteroinvasive Escherichia coli.
DIAGNOSIS AND TREATMENT
O The standard method of parasitologic diagnosis
is microscopic detection of the trophozoites and
cysts in stool specimens.
O Ideally, a minimum of three stool specimens
collected on different days should be examined.

O Method: Direct fecal smear, FECT

O +- RBC inclusion
O TREATMENT: METRONIDAZOLE
 COMMENSAL AMEOBA
O Entamoeba dispar is morphologically similar to E.
histolytica, but their DNA and ribosomal RNA are
different. The former’s isoenzyme pattern is
different from that of E. histolytica.

O Entamoeba moshkovskii isolates, although first

detected in sewage, have been reported in some
areas, such as North America, Italy, South Africa,
Bangladesh, India, Iran, and Australia.
O The appearance of E. hartmanni is relatively similar to
that of E. histolytica apart from its smaller size.
Trophozoites of the former measure from 3 to 12 μm in
diameter.
O Mature cysts measure 4 to 10 μm, are quadrinucleated
like E. histolytica, and have rod-shaped chromatoid
material with rounded or squared ends.
O E. hartmanni does not ingest red blood cells
 ENTAMEOBA COLI
O Entamoeba coli is cosmopolitan in distribution, and is considerably
more common than other human amebae. Trophozoites of E. coli
measure 15 to 50 μm in diameter.
O It can be differentiated from E. histolytica trophozoite
O by the following features:
O 1) a more vacuolated or granular endoplasm with bacteria and debris,
but no red blood cells;
O 2) a narrower, less-differentiated ectoplasm;
O 3) broader and blunter pseudopodia used more for feeding than
locomotion;
O 4) more sluggish, undirected movements; and 3
O 5) thicker, irregular peripheral chromatin with a large, eccentric
karyosome in the nucleus.
O An E. coli cyst may be differentiated from E.
histolytica by:

O 1) its larger size (10 to 35 μm in diameter),

O 2) more nuclei (eight versus four in E. histolytica),
O 3) more granular cytoplasm, and
O 4) splinter-like chromatoidal bodies.
O Entamoeba polecki is a parasite found in the intestines
of pigs and monkeys.
O Motility of trophozoites of E. polecki is sluggish.
O A small karyosome is centrally located in the nucleus.
E. polecki can be distinguished from E. histolytica in
that the former’s cyst is consistently uninucleated, and
chromatoidal bars are frequently angular or pointed.
O Entamoeba chattoni, which is found in apes and
monkeys, is morphologically identical to E. polecki.
O More recently, it has been detected in eight human
infections. Identification of E. chattoni was done via
isoenzyme analysis.
O Entamoeba gingivalis can be found in the mouth. The
trophozoite measures 10 to 20 μm. It moves quickly,
and has numerous blunt pseudopodia.
O Endolimax nana occurs with the same frequency as
Entamoeba coli. Trophozoites are small, with a
diameter of 5 to 12 μm, and exhibit sluggish movement.
They have blunt, hyaline pseudopodia, and the nucleus
has a large, irregular karyosome.
 IODAMEOBA BUTSCHII
O The trophozoite averages 9 to 14 μm in diameter (ranging
from 4-20 μm). It is identified by its characteristic large,
vesicular nucleus with a large, central karyosome,
surrounded by achromatic granules.
O The cyst is about 9 to 10 μm in diameter (ranging from 6-
16 μm), is uninucleated, and has a large glycogen body
which stains dark brown with iodine
 ACANTHAMEOBA
O Acanthamoeba is a ubiquitous, free-living ameba that
is the etiologic agent of Acanthamoeba keratitis (AK)
and granulomatous amebic encephalitis (GAE).
O Acanthamoeba is characterized by an active
trophozoite stage with characteristic prominent
“thorn-like” appendages (acanthopodia) and a highly
resilient cyst stage into which it transforms when
environmental conditions are not favorable.
O Acanthamoeba has only two stages, cysts and
trophozoites, in its life cycle. No flagellated stage
exists as part of the life cycle. The trophozoites
replicate by mitosis (nuclear membrane does not
remain intact).
O Acanthamoeba trophozoites exhibit a characteristic
single large nucleus with a centrally-located, densely
staining nucleolus; a large endosome; finely
granulated cytoplasm; and a large contractile vacuole.
O Acanthamoeba spp. have been implicated as possible
reservoir hosts for medically important bacteria such
as Legionella spp., mycobacteria, and gram-negative
bacilli such as E. coli.
O Acanthamoeba keratitis is diagnosed by epithelial
biopsy or corneal scrapings for recoverable ameba
with characteristic staining patterns on histologic
analysis.
O While historically, only surgical excision of the
infected cornea with subsequent corneal
transplantation was curative, early recognition of
AK coupled with aggressive combination anti-
amebic agents can preclude the need for extensive
surgery.
 NAEGLERIA
O Naegleria spp. are free-living protozoans with two
vegetative forms: an ameba (trophozoite form), and a
flagellate (swimming form).
O There are two forms of trophozoites of Naegleria
fowleri: ameboid and ameboflagellate, only the
former of which is found in humans.
O Naegleria spp. are thermophilic organisms which
thrive best in hot springs and other warm aquatic
environments.
O Only Naegleria fowleri has been reported to
consistently cause disease in humans, although some
non-fowleri species may cause opportunistic
infections.
O N. fowleri trophozoites are found in cerebrospinal
fluid (CSF) and tissue, while flagellated forms are
occasionally found in CSF. Cysts are not seen in
brain tissue.
O N. fowleri is the causative agent of a rare but rapidly
destructive and fatal meningoencephalitis termed
primary amebic meningoencephalitis (PAM).
O N. fowleri is able to survive in elevated temperatures
and reproduces rapidly in temperatures above 30°C.
O Diagnosis of PAM is usually suspected in persons
with a compatible history of exposure and a rapidly
progressive meningoencephalitis.
O Aspirates from suspected infections, when introduced
into bacteria-seeded agar culture medium, will exhibit
active trophozoites within 24 hours.
O Naegleria trophozoites can be identified by the
presence of blunt, lobose pseudopodia and
directional motility.
O Amphotericin B in combination with clotrimazole is
synergistic, and has been successfully used to treat
PAM.
 BALAMUTHIA
O Balamuthia mandrillaris is a free-living ameba (a single-
celled living organism) naturally found in the
environment. Balamuthia can cause a rare and serious
infection of the brain called granulomatous amebic
encephalitis (GAE).
O Balamuthia is thought to enter the body when soil
containing Balamuthia comes in contact with skin
wounds and cuts, or when dust containing Balamuthia is
breathed into the lungs. Once inside the body, the amebas
can travel through the blood stream to the brain, where
they cause GAE.
O The indirect immunofluorescence assay (IFA) is a
test used to detect antibodies developed
against Balamuthia amebas in the serum of infected
patients. In contrast, immunohistochemistry (IHC)
and indirect immunofluorescence (IIF) staining use
specific antibodies against Balamuthia to detect the
amebas.
O Drugs used in treating granulomatous amebic
encephalitis (GAE) caused by Balamuthia have
included a combination of flucytosine, pentamidine,
fluconazole, sulfadiazine and either azithromycin or
clarithromycin