Introduction to

Medical Parasitology
CBTS
09 June 2020
Outline
• Definition of Parasitology
• Biological relationships
• Disciplines
• Types of Parasites
• Classification of Parasites
• Types of Hosts
• Man as Hosts
• Pathology
• Treatment
Parasitology
• The science that deals with organisms that live temporarily or
permanently on or within other living organisms for the
purpose of procuring food. (auxiliary purpose: for shelter)
• Tropical Medicine – 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 or epidemic
proportions in areas that are not tropical
Biological relationships
• Symbiosis – permanent association of 2 organisms that cannot
exist independently (ex. Termites as shelter for protozoans
while protozoans helps cellulose digestion of termites)
• Mutualism – both organisms benefited
• Parasitism – one organism (host) is injured to some extent by
the other organism (parasite); a negative relation
• Commensalism – one partner is benefited, the other is
unaffected
Disciplines
• Zoology – morphology, physiology, life cycle
• Medicine – symptomatology, pathology, immunity, diagnosis and
treatment
• Public Health – prevention and control of disease based on the
morphology and life cycle of the parasites
• Biochemistry – metabolism; very important in treatment (like
which metabolic pathway of the parasite to target)
• Immunology and Molecular Biology – immune evasion,
vaccines, antigens
Types of Parasites
• According to host requirement:
• Obligate
• most parasites belong to this category;
• completely dependent on a host at some stage of its development for the
completion of its life cycle (perpetuation of the species)
• Facultative
• capable of having a free-living or parasitic existence for the completion of its
life cycle. (e.g. Naegleria sp.)
Types of Parasites
• According to duration of living inside host
• Temporary
• free-living during part of its existence
• Permanent
• lives in or on host from early life to maturity
• Incidental
• establishes itself in a host where it does not normally live; “being in the wrong
place at the wrong
• Spurious
• Free-living organism that passes through the digestive tract without infecting
the host.
Types of Parasites
• According to habitat
• Ectoparasite – surface of the host
• Fleas, lice, mites
• Infestation
• Endoparasite – inside the host
• Helminths and protozoans
• Infection
Types of Parasites
• According to number of hosts needed in one life cycle
• Monoxenous
• lives within a single host during its entire life cycle; has no intermediate host
• Heteroxenous
• lives within more than one host during entire life cycle; alternation of hosts;
vectors may be involved
Types of Parasites
• According to sex determination
• Monoecious
• hermaphroditic; complete functional set of sex organs in one individual. e.g.
flukes (i.e. Fasciola, Fascioloides, etc.), cestodes
• Dioecious
• sexes are separate. e.g. nematodes (i.e. Ascaris, Trichuris, etc.)
Classification of Parasites
• Protozoans (microparasites)
• Phylum Sarcomastigophora
• Phylum Ciliophora
• Phylum Apicomplexa
• Metazoans (macroparasites)
• Nematodes
• Flukes
• Cestodes
• Arthropods
Types of Hosts
• Definitive
• harbors adult or sexually mature parasite
• e.g. human with Schistosoma
• Intermediate
• harbors the asexual or larval forms
• e.g. snail with Schistosoma
• Some parasites may live in up to 3 intermediate hosts
Types of Hosts
• Reservoir – harbors the same adult stage as the human host;
source of transmission
• Parasites live and multiply without damaging this host but is
pathogenic for other species
• e.g. other mammals such as carabaos, dogs, mice
• Implication: Treatment/Intervention should not be limited to humans
(i.e. schistosomes – both human and snail should be treated)
• Paratenic – harbors the parasite in an arrested stage of
development (usually arrested in larval stage)
• e.g. wild boar with Paragonimus (lung fluke)
• human eats wild boar → human gets infected
Man as Hosts
• Intermediate Host
• Host in which development of parasite occurs but does not reach
maturity; contains LARVAL /ASEXUAL /JUVENILE stage of parasite
• e.g. Taenia solium larvae (can settle in brain and cause
neurocysticercosis), Plasmodium (malarial parasite; mosquito as int.
host)
• Definitive Host
• Host in which a parasite reaches sexual maturity and reproduction;
contains ADULT form of parasite
• e.g. Flukes, Cestodes
Man as Hosts
• Intermediate/Definitive Host
• Host in which a parasite may or may not reach sexual maturity
• e.g. Hymenolepis nana (dwarf tapeworm; more common in rodents)
• Incidental Host
• Host in which a parasite grows but dies eventually due to not being in
its usual environment; usually leads to very serious diseases
• e.g. Trichinella spiralis
Pathology
• Infection – Presence of parasite in the host; the host may or
may not manifest any symptoms
• Disease – Manifestation of symptoms (ex. Malnourishment)
• Pathogenicity – Capability of the parasite to produce disease
• Virulence – Degree of pathogenicity of a parasite; how much
damage the parasite can cause
Pathology
• Carrier – harbors a particular pathogen without manifesting
any signs and symptoms
• Exposure – process of inoculating an infective agent
• Infection – connotes the establishment of infective agent in
the host
• Autoinfection – infected individual becomes his own direct
source of infection
• Superinfection / hyperinfection – the already infected
individual is further infected with the same species leading to
massive infection with the parasite.
Pathology
• Factors that affect distribution of parasites
• Presence of suitable hosts
• Presence of Transmission
• Environmental Conditions/Climate
• Socio-economic Factors
• e.g. night soil (human excreta) as fertilizer
• Note: Parasitism may be an indicator of poverty
Pathology
• Vectors of Parasites - hosts that transmit parasites to man
• Biological Vectors
• those that are essential to the life cycle of the parasite; transmits parasite only
after it has completed its development in the host
• Phoretic / Mechanical Vectors
• those that are not essential to the life cycle of the parasite; only transports the
parasite; e.g. fly that has alighted from human feces
Pathology
• Portal of entry of parasites
• Mouth
• Skin/percutaneous
• Inhalation of air-borne eggs
• Transplacental Infection – infection of fetus when the mother is
infected
• Transmammary Infection – infection through mother’s milk
• Sexual intercourse
• Arthropod bites
Pathology
• Sources of Exposure to Infestation or Infection
• Contaminated soil or food
• Contaminated food containing the infective stage (e.g. trematodes)
• Blood-sucking insect (e.g. Anopheles mosquito – malaria)
• Domestic or wild animal harboring the parasite (zoonotic infection)
• Another person, his clothing or bedding, or the immediate
environment he has contaminated (vectors)
• One’s self (autoinfection)
• Zoonotic Infection – One that is normally transmitted only among
animals; involve reservoir hosts (ex. Avian flies)
Pathology
• Diagnosis of Parasitic Diseases
• Clinical Diagnosis
• diagnosis that is made based on signs and symptoms shown by a patient;
checking of patient’s history
• Laboratory Diagnosis
• diagnosis that is made based on examination of blood, urine, stool, sputum,
aspirate, biopsy, including how and when to extract specimens for laboratory
examinations;
• confirmatory method
Pathology
• Treatment of Parasitic Diseases
• Medical and surgical measures
• Attention to nutritional status
• Specific chemotheraphy
Pathology
• Factors to consider in Chemotheraphy
• Severity of disease
• Duration of infection
• Intensity of infection
• Probability of reinfection
• Efficacy of drugs
• Availability of drugs
• Toxicity
• Acceptability of treatment
Pathology
• Control and Prevention
• Health education - education in personal prophylaxis to prevent
dissemination of infection and to reduce opportunities for exposure
(e.g. safe water supply and thorough cooking of food)
• Environmental sanitation - sanitary control of water, food, living and
working conditions, and waste disposal (i.e. establishment of sewage
system, installation of screened latrine, prohibition of treated night
soil as garden fertilizer)
• Destruction or control of reservoir hosts or vectors (i.e. destruction of
breeding grounds, application of insecticides, protection of
susceptible hosts by screen or repellents)
Pathology
• Control and Prevention
• Erection of biologic barriers to the transmission of parasites
• Environmental management – planning, organization, performance,
and monitoring of activities for the modification and/or manipulation
of environmental factors or their interaction with human beings
• Sanitation – provision of access to adequate facilities for safe disposal
of human excreta, usually combined with access to safe water
Pathology
• Disease Eradication vs. Elimination
• Eradication – permanent reduction to zero of the worldwide incidence
of infection caused by a specific agent
• Elimination - reduction to zero of the incidence of infection of a
specific disease in a defined geographical area
Treatment
• Deworming – use of anthelmintic drugs in an individual or public health
program
• Selective treatment – individual-level deworming with selection for
treatment based on a diagnosis or intensity of infection
• Targeted treatment – group-level deworming where the (risk) group to be
treated may be defined by age, sex, other social characteristics
• Universal Treatment – population-level; community is treated irrespective
of characteristics
• Preventive chemotherapy – regular, systematic, large-scale intervention
involving the administration of one or more drugs to selected population
groups with the aim of reducing morbidity and transmission selected
helminth infections
Treatment
• Egg reduction rate – percentage fall in egg counts after
deworming
• Coverage – proportion of the population of the target
population reached by an intervention.
• Efficacy – effect of a drug against an infective agent in an
ideal experimental conditions and isolated from any context.
• Effectiveness – is a measure of the effect of a drug against an
infected agent in a particular host, living in a particular
environment with specific ecological, immunological, and
epidemiological determinants.
References
• Belizario, V. Y., & U., D. L. W. (2015). Medical parasitology in
the Philippines. Diliman, Quezon City: The University of the
Philip
• Leonardo, L. (2016). Introduction to parasitology and
laboratory diagnosis. Manila.