Parasitology

Dr Abdullahi Suleiman
MBBS, MPH, Candidate of MSc. TID
 Parasitology
Parasitology: is the study of Parasites
A parasite: is a living organism,
which takes its nourishment and other
needs from a Host.
Medical parasitology: study of
parasites which infect humans.
Host: the organism in, or on,
which the parasite lives and
causes harm
Protozoa: unicellular organisms,
e.g. Plasmodium (malaria)
Metazoa: multicellular
organisms, e.g. helminths
(worms) and arthropods (ticks,
lice)
Vector - “carrier” of a parasite
from one host to another. Often
an insect.
Zoonosis: animal infection that is
naturally transmissible to humans
either directly or indirectly via a
vector
Parts of parasitology
1.Protozoa (single-celled organisms)
Ameoba
Gardia
Malaria
Toxoplasma
2. Helminths: are multicellular organisms
Flukes
Tapeworm
Round worm

3. Arthropods
Mosquito and Fly
 Symbiosis
Symbiosis - “living together,” a close association
between two organisms.
Types of Symbiosis
 Mutualism - both organisms are benefited
(bacteria in bowel).
 Commensalism - “eating at the same table;” One
organism is benefited, the other is unaffected.
 Parasitism - one organism is benefited at the
expense of another (the host).
 Kinds of hosts
 Definitive host - the host in which sexual maturity
and reproduction takes place.
 Intermediate host - the host in which the parasite
undergoes essential development.
 Reservoir (carrier) host - the host harboring a
parasite in nature, serving as a source of infection
for other susceptible hosts. Reservoir hosts show
no sign or symptom of disease.
 Paratenic host - an accidental host serving as a
holding place for a parasite.
9
 Kinds of life cycle

Direct life cycle : Needs one Host

Indirect life cycle: Needs more

than Two Hosts
11
 Types of parasites
 endoparasite: a parasite
that lives within another
living organism – e.g.
malaria, Giardia
 ectoparasite: a parasite that
lives on the external surface
of another living organism –
e.g. lice, ticks
 Transmission of parasites

1. Inadequate sanitation and unhygienic

living conditions leading to faecal
contamination of the environment.
2. Lack of health education.
3. Insufficient water and contaminated water
supplies.
4.Failure to control insecticide resistance,
Transmission of parasites Continues

5. Poverty, malnutrition increases susceptibility due to

co-existing HIV infection.
6. Failure of drugs to treat parasitic infections
effectively.
7. Climate change.
8. Population migrations causing poor health, loss of
natural immunity, exposure to new infections, and
people being forced to live and work in overcrowded
conditions, e.g. refugee camps.
END
Parasitology Course
Dr Abdullahi Suleiman
MBBS, MPH, Candidate of MSc. TID
 PROTOZOA
 Definition – A microscopic unicellular organism which is
morphologically and functionally complete i.e. a single
cell can perform all the functions like reproduction,
respiration, digestion, excretion, etc.

 Morphology – Cytoplasm & Nucleus

 Cytoplasm – divided into
1. Ectoplasm: protective, locomotive (pseudopodia, cilia & flagella) &
sensory function
2. Endoplasm: nutritive & reproductive function.

09.04.09 Dr Abdullahi Suleiman

 Terms
 Mastigophora – movement with flagella e.g. giardia,
trichomonas

 Sarcodina – pseudopodia e.g. entamoeba

 Apicomplexa – apical complex, no locomotor apparatus;

sexual reproduction e.g. plasmodium, toxoplasma,
cryptosporidium

 Ciliophora – Movement with cilia e.g. Balantidium

09.04.09 Dr Abdullahi Suleiman

 Ecological Niches in the Human Body
1. Skin Leishmania
2. Eye Acanthamoeba
3. Mouth Amoebae and flagellates (usually
non - pathogenic)
4. Gut Entamoeba (liver), Giardia,
Cryptosporidium, Isospora, Balantidium
5. G.U. tract Trichomonas

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 Ecological Niches in the Human Body
6. Bloodstream Plasmodium, Trypanosoma
7. Spleen Leishmania
8. Liver Leishmania, Entamoeba
9. Muscle Trypanosoma cruzi
10. CNS Trypanosoma, Naegleria,
Toxoplasma, Plasmodium

09.04.09 Dr Abdullahi Suleiman

Amoebas: Entamoeba histolytica
Flagellates: Giardia lamblia, Trichomonas
vaginalis, Trypanosoma, and Leishmania
Ciliophora: Balantidium coli
 Protozoa – Intestinal & Luminal
Pathogenic

Amoeba Entamoeba histolytica Amoebiasis (Dysentry & soft tissue

abscesses)

Giardia lamblia Giardiasis (malabsorbtion)

Flagellates
Trichomonas vaginalis Vaginitis

Ciliates Balantidium coli Diarrhoea

Free living amoeba

Acanthamoeba Meningoencephalitis & Keratitis

Naeglaria Primary Meningoencephalitis

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 Blood Protozoa

Plasmodium Malaria

Leishmania Leishmaniasis (Visceral, Cutaneous)

Trypanasoma African sleeping sickness, Chagas disease

Toxoplasma gondii Toxoplasmosis (congenital infections)

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 Intestinal Protozoa
Pathogenic Commensal/ Non-pathogenic
 Entamoeba histolytica  Entamoeba coli
 Balantidium coli  Entamoeba hartmanii
 Giardia lamblia  Iodamoeba bütschlii
 Cryptosporidium parvum  Dientamoeba fragilis
 Cyclospora cayetanensis
 Isospora belli
 Microsporidia

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 Entamoeba histolytica
 Habitat – large intestine
Morphological forms –
1. Trophozoite - ameboid shape,
15-30µ in diameter, motile form
2. Cyst - spherical, 12-15µ, the
cytoplasm contains dark staining
chromatoid bodies and 1 to 4
nuclei with a central karyosome,
infective form, non motile.
 Disease - Amoebiasis.

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 Methods of Reproduction
 Excystation – process of transformation of cysts to trophozoites
that occurs only with the entry of cyst in the alimentary canal of
man.
Each cyst gives rise to eight amoebulae.
One amoebule – one trophozoite.

 Encystation – process of transformation of trophozoites to cysts,

occurs in the lumen of large intestine of an infected individual.
* cysts never seen in tissues of man

 Multiplication – by binary fission, occurs only in trophozoite phase

(inside tissues)
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 Epidemiology: Amoebiasis
 Man is the commonest source of infection

 Infective form: Mature quadrinucleate cyst

 Mode of infection: feco-oral route by ingestion of food & drink

contaminated with cyst.
- food handling by infected individuals /carriers (contact /
convalescent carriers)
- houseflies

 Incubation period: 4-5 days

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Life cycle of
E. histolytica

09.04.09 Dr Ekta,Microbiology
 Pathogenicity of Entamoeba histolytica
 Amoebiasis – all clinical conditions produced by
E. histolytica in human host.

 Pathogenic lesions – two types:

 Primary or intestinal lesions – confined to large intestine
 Secondary or metastatic lesions (extraintestinal) – due
to migration of trophozoites to liver, lungs & brain.

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 Amoebiasis
1) Acute amoebic dysentery - Frequent
dysentery with necrotic mucosa and
abdominal pain: flask shaped ulcers
in colonic mucosa

2) Extraintestinal amoebiasis – liver

(amoebic liver abscess), lung &
brain abscess

3) Asymptomatic carrier state

4) Amoeboma – granulomatous tumour

like growth.
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 Amoebic liver abscess
 About 2 to 10% suffer from hepatic complications
 Generally appears about one to three months after the
disappearance of dysentery

 Trophozoites are carried to the liver via portal vein

 Multiplication of trophozoites – obstruction to circulation –
thrombosis of sinusoids – necrosis of surrounding liver cells –
formation of liver abscess begins – liquefaction of centre of
abscess (cytolysis – pus).

 Trophozoites can be seen in the peripheral zone of abscess.

 Pus can be seen

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 LABORATORY
DIAGNOSIS
Fecal smear/Nested PCR)
Serological/Immunological tests.
Biopsy
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 Complications of Amoebic Liver Abscess

 Rupture of abscess:
1. Externally
2. Internally into
 Right pleural cavity
 Right lung
 Peritoneal cavity
 Below diaphragm – subphrenic abscess
 Metastasis – lungs, brain, skin, spleen

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 Laboratory diagnosis - Amoebiasis
Type Intestinal Extraintestinal / Hepatic

Specimen Stool Liver aspirate / stool

(Anchovy sauce pus)

Microscopy Trophozoites / Cysts Only trophozoites

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 Laboratory diagnosis - Microscopy
 Stool Examination – saline & stained preparation
 Saline – motile trophozoites with ingested RBCs
 Iodine – body stains yellow, nucleus with a central
karyosome, brown glycogen mass.
 Fixed & stained - HE

09.04.09 Dr Abdullahi Suleiman

 Laboratory diagnosis
 Serological tests – detection of anti-amoebic
antibodies in invasive amoebiasis (latex
agglutination), Ag detection in feces by ELISA
 results become negative after cure

 Detection of asymptomatic carrier – cyst in feces, at

least three stool specimen

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 Treatment & Prevention
 Treatment –
 Tissue & luminal - Metronidazole / Tinidazole

 Prevention
 Personal hygiene
 Safe drinking water

 Protection of food & water from contamination

 Avoid use of raw vegetables & fruits

09.04.09 Dr Abdullahi Suleiman

 Giardia lamblia
 Habitat: duodenum & upper
jejunum

 Morphology: two forms

1. Trophozoite – tennis racket
shaped, dorsal surface convex,
ventral surface concave with
sucking disc (falling leaf
motility)
2. Cyst – oval, diagonal axostyles

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 Falling Leaf motility

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 Life Cycle - Giardiasis

Infective form: Cysts Large intestine: encyst

Steatorrhea
Ingestion: Faeco-oral

Stomach: Resist acid Mucus Diarrhoea

Small Intestine - excyst Abnormal villous

architecture

Binds to mucosa No invasion - submucosa

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09.04.09
 Laboratory diagnosis - Giardiasis

Specimens: Stool, duodenal aspiration

Microscopy: Cysts in feces

Trophozoites in duodenal aspirate

Treatment: Metronidazole / Tinidazole

Prevention: Personal hygiene, avoid food & water contamination,

drink safe water

09.04.09 Dr Abdullahi Suleiman

 Balantidium Coli

Largest protozoal parasite of humans

Habitat: Large intestine

Morphological Forms:

Trophozoite: (60-70µ)

Ovoid shape, moves by cilia

Cyst: (40-50µ) Ovoid, macronucleus

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 Trichomonas vaginalis

No cyst form Only trophozoite form

Sexually transmitted disease

Men are usually asymptomatic

Females Vaginitis Purulent discharge

Diagnosis Demonstration of
trophozoites in wet films /
giemsa stained smear

Treatment Metronidazole
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 Amebic Meingoencephalitis

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 Free living amoeba - Naegleria fowleri

Disease Primary amoebic meningoencephalitis (PAM)

Forms Amoeba, cyst, flagellated trophozoite

Pathogenicity Swimming – nose – olfactory epithelium – cribriform plates-

cerebral cortex – hemorrahge & necrosis

Lab diagnosis Amoeboid form in CSF / never cysts

Treatment Amphotericin B / Rifampin

Prevention Chlorine level at or above 0.5 mg/L

09.04.09 Dr Abdullahi Suleiman

 Free living amoeba - Acanthamoeba

Diseases Granulomatous amoebic meningoencephalitis (GAE)

Amoebic Keratitis

Forms Amoeba, cyst, No flagellated trophozoite

Pathogenicity Immunocompromised – lungs / abrasions – blood – brain.

Keratitis: contact lens wearer – trauma / nonsterile wash solution

Lab diagnosis Amoeboid form / cyst in CSF or corneal scrapings

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 SUMMARY
Organism Transmission Symptoms Diagnosis Treatment

Entamoeba Oro-fecal Dysentery with blood and Stool: cysts with 1-4 GI: Iodoquinol or
histolytica necrotic tissue. nuclei and/or Metronidazole
Chronic: abscesses trophs. Abscess:Metronida
Trophs in aspirate. zole

Giardia lamblia Oro-fecal Fowl smelling, bulky Cyst in stool Metronidazole

diarrhoea

Trichomonas Sexual Vaginitis; occasional Flagellates in Metronidazole,

vaginalis urethritis/ prostatitis vaginal (or urethral) steroids
smear
Balantidium coli Oro-fecal Diarrhoea Trophozoites / cysts Tetracycline,
in stool Metronidazole

Free living Respiratory tract Meningoencephalitis Amoeboid forms in Amphotericin B

amoeba CSF

09.04.09 Dr Abdullahi Suleiman