PARASITOLOGY

Medical parasitology: the

study and medical implications of
parasites that infect humans

Parasitism - a way of life

Parasite and Parasitism are terms that define
a way of life rather than a coherent and
evolutionary related group of organisms
Symbiosis, Commensalism, Mutualism,
Parsitism
PARASITE A living organism dependent on
another living organism for its survival in the
form of nutrition as well as shelter. Parasites
may be simple unicellular protozoa or
complex multicellular metazoa

Parasitism - a way of life

Symbiosis: Any two organisms living in
close association, commonly one living in
or on the the body of the other, are
symbiotic, as contrasted with free living.
De Bary 1879
Commensalism: Sharing the table. One
partner benefits but the other is not hurt.
Mutualism: Both partners benefit.
Parasitism: One partner (the parasite)
harms or lives on the expense of the
other (host).

Who is a parasite?
Parasites are
usually much
smaller than their
hosts, they also do
no kill before eating.

Parasites are found in all

groups of organisms

Parasites can be
ECTOPARASITE: live on,
but not in their hosts
(they can nevertheless
cause severe illness). Eg
lice
ENDOPARASITE: live
within the body and
tissues of their hosts.
Trypanosomes (which
cause sleeping sickness)
within the blood of an
infected animal.

TEMPORARY PARASITE
PERMANENT PARASITE
FACULTATIVE PARASITE
OBLIGATORY PARASITE

Infection & infestation

Infectious diseases are caused
by transmittable parasitic agents
including bacteria, viruses,
fungi, protozoa and a variety of
metazoans commonly referred
to as helminths or worms
Infection usually implies
replication of the agent resulting
in a growing number of
pathogens
Infestation are characterized by
a constant number of
pathogens. Severity of disease
often depends on infection
dose.

Hosts and life

cycles
Host: the organism in, or
on, which the parasite lives
and causes harm

The definitive host is by

definition the one in which
the parasite reproduces
sexually
intermediate hosts the
organism in which the
parasite lives during a period
of its development only
Host which actively transmit
parasites to humans are
often called vectors
In paratenic or transport
hosts no parasite
development occurs
Reservoir host are alternate
animal host from which the
parasite can be transmitted
to humans (zoonosis) or
domestic animals
Accidental host, not suitable
for parasite development, but
can cause disease

Disease terminology
Prepatency: infected but parasite presence can not
be detected yet
Patency: established infection, parasite stages can
be detected (malaria parasites in blood smears,
worm eggs in feces etc.)
Incubation period: time between infection and the
development of symptoms
Acute disease can lead to crisis which can resolve in
spontaneous healing, chronic infection or death
Convalescence: Period after healing, absence of
infectious agents, no symptoms, in certain case
immunity to reinfection

Epidemiology
Although parasitic infections occur globally, the
majority occur in tropical regions, where there is
poverty, poor sanitation and personal hygiene
Often entire communities may be infected with multiple,
different organisms which remain untreated because
treatment is neither accessible nor affordable
Effective prevention and control requires "mass
intervention strategies and intense community
education. Examples include:
General improved sanitation: pit latrines, fresh water
wells, piped water
Vector control: insecticide impregnated bed nets,
spraying of houses with residual insecticides,
drainage, landfill
Mass screening and drug administration programmes
which may need to be repeated at regular intervals

CLASSIFICATION
Parasites --- two main groups:
1. Protozoa
2. Metazoa (Helminthes)
Protozoa are further divided into:
1.
2.
3.
4.

Sarcodina (amebas)
Sporozoa (sporozoans)
Mastigophora (flagellates)
Ciliata (ciliates)

Metazoa (helminthes) are further

divided into:
1.
i.
ii.

Platyhelminthes (flatworms)
Trematodes (flukes)
Cestodes (tapeworms)

2. Nemathelminthes (roundworms)

PROTOZOA
Single-celled Eukaryotes
Free-living or parasitic
2 forms:
1. Cyst form (infective for humans) &
2. Trophozoite form

1.
2.
3.

Protozoa are grouped as :

Intestinal protozoa
Urogenital protozoa
Blood and tissue protozoa

1. Intestinal protozoa
i.
ii.
iii.

Entamoeba histolytica (ameba)

Giardia lamblia (flagellate)
Cryptosporidium parvum
(sporozoan)
2. Urogenital Protozoa:
i. Trichomonas vaginalis (flagellate)

3.
i.
ii.
iii.
iv.
v.

Blood & Tissue Protozoa:

Leishmania species (flagellate)
Trypanosoma species (flagellate)
Toxoplasma gondii (sporozoa)
Plasmodium species (sporozoa)
Pneumocystis carinii

ENTAMOEBA
HISTOLYTICA
Occurs worldwide,
endemic in tropics & subtropics
ROUTE OF TRANSMISSION:
fecal-oral route
BY contaminated food & water

Sources of infection carriers

(asymptomatic & convalescent),
houseflies, cockroaches
Risks poverty, lack of hygiene, poor
sanitation, mental retardation, male
homosexuals

MORPHOLOGY
E. histolytica has 2 stages:

1. Trophozoite
Non-infective stage
Found in intestinal & extra-intestinal lesions
diarrhoeal stools
Motile (amoeboid movement) & ingest
RBCs.
Mature trophozoite has a single nucleus,
even lining of peripheral chromatin &
prominent nucleolus (karyosome)

2. Cyst:
Infective form for humans
Mature cyst has 4 nuclei (diagnostic
feature)
Found in non-diarrheal stools
Not killed by chlorination
Readily killed by boiling or filtration of
water

DISEASES:
E. histolytica causes:
1. Asymptomatic infection (90%)
2. Acute intestinal amebiasis (Amebic
Dysentery)
3. Chronic amebiasis
4. Amebic liver abscess
5. Infrequently abscess in brain, lungs
& other organs

LIFE CYCLE
Cysts (infective stage) in contaminated food
or water excystation in intestinal tract
trophozoite (ileum) --- each divides to form 8
trophozoites colonize cecum & colon
invasion of epithelium till muscularis layer
(flask shaped ulcers) reaches sub mucosa--- portal blood liver abscess.
Some trophozoites in intestine encyst
passed in stools contaminate food & water.

Clinical presentation
1. Acute intestinal amebiasis: dysentry,
lower abdominal discomfort, tenesmus,
& flatulence.
2. Chronic amebiasis
3. Amebic abscess: if in liver, cause
right upper quadrant pain, weight loss,
fever & a tender, enlarged liver.

LABORATORY DIAGNOSIS:
1.

i.

i.

Stool Examination:
(Formed stools contain cysts & diarrheal stools
contain trophozoites)
Wet mount in saline, Iodine-stained, or fixed
trichrome stained preparation
For motile trophozoites, stools should be examined
within 1 hour.Trophozoite of E. histolytica is
differentiated from other amoeba (E.coli) by:
Nucleus of trophozoite
For cysts, at least 3 samples should be collected.
Size of cyst & number of its nuclei. (Newly formed
cyst has 2 nuclei, glycogen mass & chromidial bars)

Other tests
Detection of E. histolytica antigen
in stool
PCR assay.
Serology to diagnose invasive
amebiasis (IHA indirect
hemagglutination test)

PREVENTION
Purification of water supplies
Good personal hygiene (esp. hand
washing)
Prohibit use of night soil
Cook vegetables

AMOEBIC
DYSENTERY

BACILLARY
DYSENTERY

Gradual onset
Copious amount
of stools
Offensive odor
Dark red
Few pus cells
Trophozoites of
E. histolytica
seen

Acute onset
Small amount of
stools
Odorless
Bright red
Many pus cells
Not seen

AMOEBIC
LIVER ABSCESS

PYOGENIC LIVER
ABSCESS

Gradual onset

Malaise to acute
presentation

Organism
responsible is E.
histolytica
trophozoites of
E. histolytica
sticking to wall of
abscess.
Anchovy sauce

Organism may be
E.coli, anaerobes
eg Bacteroides
Many pus cells
No trophozoites