INTRODUCTION TO

PARASITOLOGY
PARASITOLOGY
● An area of science which deals with the study of organisms living
permanently or temporarily on or within another organism.

● The branch of biology or medicine concerned with the study of

parasitic organisms.

● It is the study of parasites, their hosts, and the relationship

between them.

○ Parasite — the one who is benefiting (macroscopic &

microscopic)
○ Host — one who is harmed

● Concerned with the phenomena of dependence of one living

organism on another.
3 Divisions of Parasitology

Protozoology
● Protozoans: small, unicellular organisms, which contain nucleus
and functional organelles.

Helminthology
● Worms: larger, multicellular organisms, normally visible to the
naked eye in their adult form.
● Some worms in their life cycle are not visible to the naked eye (Ex:
eggs & ova)

Medical Entomology
● Insects
● Arthropods
● Most parasites are transmitted through vectors
Medical Parasitology
● Concerned primarily with the parasite that affects humans
and their medical significance, as well as their importance in
human communities.

Tropical Medicine
● Branch of medicine which deals with tropical diseases and other
special medical problems of tropical regions.
● Tropical countries have 2 seasons: wet & dry
○ humid temperature
Tropical Disease:
● An illness which is indigenous to or endemic in tropical area but
may also occur in sporadic or epidemic portions in areas that are
not tropical.
● Many tropical diseases are parasitic in nature
● Most commonly transmitted through mosquito bites

Parasite
● Lives on or in the host usually on a larger organism which
provides physical protection and nourishment.

Host
● Harbours parasite and gives nourishment.
● Larger than the parasite
HOST-PARASITE RELATIONSHIP
Symbiosis
● Living together of unlike organisms
● May also involve protection or other advantages to one or both
partners
● Different forms of symbiosis may be distinguished on the basis of
whether or not the association is detrimental to one of the two
organisms

1. Mutualism
● A symbiosis in which 2 organisms mutually benefit from each other
● Association of 2 different species of organisms that is beneficial to
both
● Ex: Termites and the flagellates
○ Termites — provide flagellates a habitat in their digestive system
○ Flagellates — synthesize cellulase to aid in the breakdown of
ingested wood
2. Commensalism
● 1 species benefits from the relationship without harming or
benefiting the other
● Parasite derives benefit without reciprocating and without injury
to the host or both
● Association of two different species of organisms that is
beneficial to 1 and neutral to the other
● Ex: Entamoeba coli in the intestinal lumen
○ Supplied with nourishment and are protected from harm
○ Does not cause any damage to the tissues of its host

3. Parasitism
● 1 organism, the parasite, lives in or on another, depending on the
latter for its survival and usually at the expense of the host
● Association of two different species of organisms that is
beneficial to 1 at the other’s expense
● Ex: Entamoeba histolytica
○ Derives nutrition from the human host
○ Causes amebic dysentery
PARASITES ACCORDING TO THE MODE OF
LIVING
Ectoparasites: living outside the body of the host.
● Ex: Lice, fleas
● Infestation — the presence of an ectoparasite in a host

Endoparasites: living inside the body of the host.

● Infection — the presence of an endoparasite on a host

Facultative Parasites
● Parasite that is capable of existing independently of a host
● Able to live outside or inside the host and lead both to a free and
parasitic existence.
● They can survive with or without a host
● May exist in a free-living state (living outside the host) or may
become parasitic when the need arises
Obligate Parasite
● Completely dependent to the host for its existence throughout
its life
● Parasite that cannot survive outside of a host
● Most parasites
● Ex: Tapeworms — depend entirely upon their host for existence

Accidental / Incidental Parasite

● Establishes itself in the host in which it does not ordinarily live.
● Parasites that are accidentally acquired by humans
● Ex: Humans harbor animal parasites

Occasional / Periodic Parasite

● Seeks its host intermittently to obtain nourishment.
● Parasites that only visit the host during the feeding time
● Ex: Mosquitos bite humans
Saprophytes
● Live in organic substances in state of decomposition.
● Ex: Maggots

Erratic
● Those that live in an organ different from the one it usually
parasitize.
● Ex: A parasite usually lives in the intestine but isolated from the
lung

Zoonotic
● Animal parasites, non-human parasites that may cause human
infections.
PARASITES ACCORDING TO THE
DURATION PARASITISM

Temporary Parasites
● Free living during part of existence
● Larval stage has a different host from its adult stage.
● Ex: Immature stage in fishes but mature stage in humans

Permanent Parasites
● Remain on the body of the host in all stages of its life cycle.
PARASITES ACCORDING TO PATHOLOGIC
LOCATION
Spurious/Coprozoic Parasite: passes digestive tract of humans
without infecting them

Coprophilic Parasite: parasite multiply in fecal matter outside the

human body

Hematozoic Parasite: lives inside the red blood cells

Cytozoic Parasite: lives inside the cells or tissues

Coelozoic Parasite: lives in body cavities

Enterozoic Parasite: lives in the intestine

TYPES OF HOST (ROLE)
Definitive Host / Final Host
● Harbours the adult and sexually mature form (capable of fertilization)

Intermediate Host
● Harbors the larvae or asexual stage (intermediate) of the parasite
● Examples:
○ Pigs or cattle — Taenia spp
○ Snails — Schistosoma spp.

Reservoir Host
● Animal that harbours the same parasite of man
● Allow the parasite’s life cycle to continue and become additional sources of human infection
● Examples:
○ Pigs — Balantidium coli
○ Field rats — Paragonimus westermani
○ Cats — Brugia malayi

Paratenic Host
● Harbours a stage of the parasite where no further development in parasite takes place
● Dead-End Host: Humans
● Example: Paragonimus metacercaria in raw wild boar meat can pass through the intestinal
wall of humans and complete its development.
SOURCES OF EXPOSURE TO INFECTION
Pathogens
● Can be animal parasites that are harmful and frequently cause
mechanical injury to their host
● Pathogenic: Disease-causing
● Non-Pathogenic: Not disease-causing

Carrier / Asymptomatic Carriers

● Harbours a particular pathogen without manifesting signs and
symptoms (generally healthy)

Exposure
● Process of inoculating an infective agent

Infection
● Establishment of the infective agent in the host
Incubation Period / Clinical Incubation Period
● Time Frame: Period between infection and evidence of symptoms
● Ex: Malaria = interval for the infection to develop (before fever,
chills, paroxysm)

Prepatent Period / Biologic Incubation Period

● Time Frame: Period between infection and acquisition of the
parasite and evidence or demonstration of infection.
● Checking for evidence or demonstration parasite or parasitic
elements and morphology in the sample
● Malaria = ring forms in RBC
Autoinfection
● Infected individual becomes his own direct source of infection
● In enterobiasis / pinworm infection, infection may occur through
hand-to-mouth transmission.
○ A common, contagious, parasitic infestation found mainly in children. The disorder
is spread by swallowing or inhaling the tiny eggs of the pinworm. Enterobiasis
rarely causes any serious physical problems except for the main symptom, which is
severe rectal itching.
○ Infective eggs may end up in the hands by scratching the perianal areas where the
gravid females lay their eggs.
● Alternatively, parasites may multiply internally, such as Capillaria
philippinensis.
Superinfection / Hyperinfection
● Already affected individual is further infected with the same
species leading to the massive infection with the parasite
○ An alteration in the normal life cycle of Strongyloides results in a large increase in
worm burden, which may lead to severe debilitation or even death due to an
increase in the proportion of rhabditiform larvae that transform into filariform
larvae while in the gut.

Co-infection
● Simultaneous infection of a host by two or more parasite most
common in soil helminths
● Example: Infection of Ascaris lumbricoides and Trichuris trichiura
simultaneously
SOURCES OF EXPOSURE TO INFECTION
Contaminated soil and water
● The most common sources
● Lack of sanitary toilets and use of night soil (use of human excreta
as fertilizer)

● Soil:
○ Ascaris lumbricoides
○ Trichuris trichiura
○ Strongyloides stercoralis
○ Hookworm

● Water:
○ Amoeba
○ Flagellates
○ Blood flukes
○ cercariae of Schistosoma
Food containing immature infective stage of parasite

● May contain the infective stage of parasite

● Exemplified by a number of trematode and cestode infections

● Consumption of undercooked or raw freshwater fish, crab, snail,

beef and pork = several intestinal and liver fluke infections

○ Raw crabs — considered a delicacy in areas where

paragonimiasis is endemic

○ Raw Bullastra snails — associated with Artyfechinostomum

malayanum infection
Arthropods, blood sucking insects and other wild or domesticated
animals

● Mosquitoes — vectors of malaria and filarial parasites

● Triatoma bugs — carriers of Trypanosoma cruzi causing Chagas
disease / American trypanosomiasis
● Sand flies (e.g., Phlebotomus spp.) — natural vectors of all types
of Leishmania
● Cats — direct sources of Toxoplasma infection
● Rats — may be infected with Hymenolepis nana

Another Person
● Beddings and clothing
● Immediate environment he has contaminated
One’s self

● Autoinfection where the infected person himself is the source of

infection is seen in the life cycles of:
○ Capillaria philippinensis
○ Enterobius vermicularis
○ Hymenolepis nana
○ Strongyloides stercoralis

● Asymptomatic carriers of Entamoeba histolytica working as

food handlers in food establishments may be important sources
of infection
TYPES OF VECTORS
Vector: The most often responsible for transmitting the parasite
from one host to another.

Biological Vector
● The parasite is seen inside the body of this organism and the
parasite needs this organism for its development.
● Play an important role or part in the life cycle of the parasite
● Ex: Mosquitoes, tsetse flies

Mechanical Vector
● Responsible only for transporting the parasite
● The parasite is only seen on the surface of this organism and
there will be no development on the parasite.
● Does not play a role in life cycle
● No further development
● Ex: Cockroaches, house flies
MODES OF TRANSMISSION
Food-borne — majority of infections are with cestodes, trematodes, and
intestinal protozoans

● From eating food harboring the infective larval stages

○ Taenia solium
○ Taenia saginata
○ Diphyllobothrium latum

● From drinking water contaminated with cysts

○ Entamoeba histolytica
○ Giardia lamblia

● Through ingesting raw or improperly cooked freshwater fish containing

infective larvae
○ Clonorchis
○ Opisthorchis
○ Haplorchis
Arthropod / Vector transmitted — also serve as vectors and transmit
parasites through their bites.
● Malaria
● Filariasis
● Leishmaniasis
● Trypanosomiasis
● Babesiosis

Skin Penetration
● Enter via exposure of skin to soil
○ Hookworms
○ Strongyloides
● Enter via exposure of skin to water
○ Schistosoma
Congenital transmission
● Toxoplasma gondii trophozoites can cross the placental barrier
during pregnancy.
● In transmammary infection with Ancylostoma and
Strongyloides, the parasites may be transmitted through
mother’s milk.

Direct contact
● Example:
○ Kissing
○ Sexual intercourse (e.g., Trichomonas vaginalis)

Soil transmitted
Water-borne
Inhalation of airborne eggs of Enterobius
PORTAL OF ENTRY
● By mouth
○ Most likely portal of entry since the most common source of
parasitic infection is contaminated food and water
○ Most common area of invasion, entrance for intestinal

● Skin penetration

● Intranasal — inhalation of eggs

● Transplacental infection — pregnancy

● Transmammary — breastfeeding

● Sexual intercourse
PORTAL OF EXIT

● Stool
● Urine
● Sputum
● Blood
● Tissue aspirate and biopsy
● Orifice swab
● Discharge
NOMENCLATURE

● Classified according to the International Code of Zoological

Nomenclature

● Scientific name are Latinized

● Generic names consist of a single word written in initial

CAPITAL LETTER

● Specific names always begin with a small letter

● Names of genera and species are:

○ italicized when computerized
○ underlined when written
● Kingdom: Animalia
● Phylum: Nematoda
● Class: Secernentea
● Order: Ascaridida
● Family: Ascarididae
● Genus: Ascaris
● Species: Ascaris lumbricoides
TYPES OF LIFE CYCLE
● Simple or complicated
○ Complicated = many intermediate host

● Most parasitic organisms attain sexual maturity at the definitive

host

● Larval stage of parasite may pass through different stages in

an intermediate host

● As life cycle becomes complicated, the lesser chances are for

the individual parasite to survive.
○ Every time the parasite transfers to an intermediate host,
intervention can be applied
LIFE STAGES OF A PARASITE

Defends on the type of parasite

● Ova
● Egg
● Larva
● Trophozoite
● Cyst
● Adult
MODE OF REPRODUCTION

Sexual

● Oviparous: "Egg birth“, give birth to eggs that must develop

before hatching

● Ovoviviparous: Ones that produce eggs but retain them inside

the female body until hatching occurs, so that "live" offspring
are born

● Larviparous/Viviparous: Being born alive without eggs

Asexual

● Binary fission: Division in half, primarily in protozoans

(single-celled)

● Parthenogenesis: Unfertilized ovum develops directly into a new

individual, natural form of asexual reproduction in which growth
and development of embryos occur without fertilization by male
sex cell

○ Example: Nematodes — Strongyloides stercoralis

○ Flukes undergo asexual reproduction in the intermediate

hosts to increase the number of progeny.

All tapeworms and flukes, with the exception of Schistosoma spp. are
hermaphroditic, that is, they contain a complete set of male and
female organs capable of producing thousands of ova.
EPIDEMIOLOGIC MEASURES

● Epidemiology
○ Science concerned with the propagation of the disease
○ Study of patterns, distribution and occurrence of disease

● Incidence
○ Number of new cases of infection appearing in a population in
a given period of time
○ Expressed in raw number or actual number

● Prevalence
○ Number of individuals in a population estimated to be
infected with a particular parasite at a certain time
○ Expressed in percentage
● Cumulative Prevalence
○ Percentage of individuals in the population infected with at
least one parasite

● Intensity of Infection:
○ Number of worm per infected person (worm burden)
○ Qualitative: slightly, moderately, heavily infected

○ Direct: counting expelled worms during treatment

○ Indirect: counting helminth egg excreted in feces using egg

counting techniques
■ expressed in egg per gram (epg)
DISTRIBUTION OF DISEASES
● Sporadic
○ Appears only occasionally in one or at most a few members of the
community
○ Example: Tetanus, rabies

● Endemic
○ There is a steady moderate level of disease in human population
constant number that is tolerable
○ Usual prevalence of the disease or infectious agent in a population
within geographical area
○ Constant presence of malaria in Palawan

● Epidemic
○ There is a sudden outbreak or rise of incidence in human population
○ MERS infection in Middle East — sudden increase in a period time

● Pandemic
○ When the disease have been disseminated in extensive area of the
world
○ Example: COVID-19, AIDS/HIV
PATHOPHYSIOLOGY AND SYMPTHOMOLOGY OF
PARASITIC INFECTIONS
Traumatic / Physical Damage: When parasites invade the skin and
other tissues causing destruction

● Hookworms — creeping eruption

○ Severe itching, blisters, red growing
winding rash
○ The larva of hookworm penetrated and
crawled in it

● Plasmodium — Invades red blood cells

○ After multiplication, the host’s red blood cells rupture
resulting in the release of merozoites.

● Cercariae of Schistosoma — Contain penetration glands, which

produce an enzyme capable of digesting the skin allowing entry
into the body of the host.
● Schistosoma japonicum infection
○ Cumulative deposition of eggs in the liver stimulates an
immune response mechanism
○ Resulting in granuloma formation and then fibrosis which
leads to portal hypertension and massive hemorrhage in the
venules.

● Ascaris form tangled masses

○ Can lead to intestinal obstruction.
○ An Ascaris worm in the intestine may invade other organs
like the appendix and bile ducts and may cause a surgical
emergency.
Lytic Necrosis: Secretory and excretory products elaborated by many
parasites allow them to metabolize nutrients obtained from the host
and store these for energy production.

● Entamoeba histolytica secrete cysteine proteinases

○ Allow the parasite to penetrate the mucosa and adhere to the
underlying layer and surrounding tissues
○ Do not only digest cellular materials but also degrade
epithelial basement membrane facilitating tissue invasion

Entamoeba histolytica trophozoite in

rectal biopsy
Tissue Reactions

● Cellular proliferation, white cell infiltration at the side of the

parasite

● Helminth Infection — causes increased blood eosinophil count

Eosinophil mediated cytotoxicity

against filariform larvae of
Strongyloides stercoralis in
expectoration — isolated in lungs
Toxic Allergic Phenomena

● When proteins or other metabolites of the parasites are

introduced into the body, there is sensation to the foreign
substance which may produce hypersensitisation to anaphylactic
shock.

Punctate keratitis — redness of the

eye because of the proteins /
metabolites produced by the parasite
Deprivation of the host’s essential nutrients and substances

● The parasite competes with its host for the available supply of vitamin.
● Parasites can also deprive the host of essential nutrients and substances.

● Heavy hookworm infection — causes massive intestinal bleeding which

results in chronic blood loss and iron deficiency anemia.

● Cestodes and trematodes — obtain nutrients through their tegument,

which is provided with microvilli.

● Diphyllobothrium latum — competes with its host for the available

supply of Vitamin B12 thus resulting in megaloblastic anemia

● Ascaris lumbricoides — causes malnourishment in children

FACTORS THAT DETERMINE THE
INTENSITY OF PARASITIC INFECTION
Topography of locality
● Example: Area with large body of water or area with soil

Social condition
● Example: Squatter areas without environmental sanitation

Age
● Children and elders are more susceptible

Hygienic measure
● Improper handwashing, not taking a bath regularly

Sewage disposal

Water supply
TREATMENT
There are several options for treating parasitic infections. Many of
these drugs are toxic to the host and care should be exercised when
selecting the proper course of treatment.

● Prophylaxis

● Antiparasitic medications (chemotherapy) — deworming

● Supportive therapy (in self-limiting parasites)

○ change in diet
○ vitamin supplements
○ fluid replacement
○ blood transfusion
○ bed rest

● Non-pathogenic parasite: no treatment

Deworming
● Use of anthelminthic drugs in an individual or public health
program.

● Cure Rate
○ Usually expressed in percentage
○ Number of previously positive subjects found to be
egg-negative in examination of a stool or urine sample using a
standard procedure at a set time after deworming
○ Indicator to measure the reduction in prevalence

● Egg Reduction Rate

○ 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 deworming
○ Indicator to measure the reduction in intensity of infection
Selective Treatment

● Individual-level deworming with selection of treatment based on:

○ diagnosis of an infection / assessment of the intensity of
infection
○ presumptive grounds

● Example: When a patient have diarrhea and treated by a physician

Targeted Treatment

● Group-level deworming where the risk group to be treated (with

or without prior diagnosis) may be defined by age, gender or other
social characteristics irrespective of infection status.

● Example: Pampurga for susceptible groups (children)

Universal Treatment

● Population-level deworming in which the community is treated

irrespective of age, gender, infection status or other social
characteristics.

Coverage

● Proportion of target population reached by an intervention.

● Ex: Percentage of school age children treated during a treatment
day

Drug Resistance

● Genetically transmitted loss of susceptibility to a drug in a worm

population that was previously sensitive to the appropriate
therapeutic dose.
Efficacy

● Effect of a drug against an infective agent in deal experimental

conditions and isolated form of any context.
● Research or clinical trials of drugs
● Does the intervention or drugs work?

Effectiveness

● Measure of the effect of a drug against infective agent in a particular

host, living in a particular environment with specific ecological,
immunological, and epidemiological determinants.

● Usually measured by means of qualitative and quantitative diagnostic

tests which detect eggs or larvae in feces or urine after an optimal time
interval, which is variable for each parasite.

● Drugs are working

● Considers the safety of the drug (side effects)
● Does the intervention benefits the patient?
● How easy the drugs to be used?
PREVENTION & CONTROL
Morbidity Control
● Avoidance of illness caused by infections, may be achieved by
periodically deworming individuals or groups, known to be at risk of
morbidity
● Example: Farmers are given anti-helminthic drugs for protection from
parasite found on soil

Information-Education-Communication (IEC)
● Health education strategy that aims to encourage people to adapt
and maintain healthy life practices

Environmental Management
● Planning, organization, performance and monitoring of activities for
the modification and/or manipulation of environmental factors or
their interaction with human beings.
● Preventing or minimizing vector and intermediate host propagation
(clean up drive)
● Reducing contact between humans and the infective agent
Environmental Sanitation
● Intervention to reduce environmental health risk
● Safe disposal and hygienic management of human and animal
excreta, refuse and waste water
● Control of vectors, intermediate host and reservoir of diseases
● Provision of safe drinking water and food safety
● Housing that is adequate in terms of location, quality of
shelter and indoor living conditions
● Facilities for personal and domestic hygiene
● Safe and healthy working conditions

Sanitation
● Provision to access to adequate facilities for safe disposal of
human excreta, usually combined with access to safe drinking
water
● Sanitized place = if the water can be drink safely (potable water)
ERADICATION & ELIMINATION
Disease Eradication
● Permanent reduction to zero of the worldwide incidence of
infection caused by a specific agent, as a result of deliberate
effort.
● Once this is achieved, continued measures are no longer needed.
● Ex: Smallpox

Disease Elimination
● Reduction to zero of the incidence of a specified disease in a
defined geographical area as a result of deliberate effort.
● Continued intervention and surveillance are still required.
REFERENCES
Belizario, V. and De Leon, W. (2015). Philippine Textbook of
Medical Parasitology. Third Edition. University of the Philippines
Manila. Ermita, Manila.

Trinidad, J.A (2014). Lecture Notes for Parasitology Board Review .

Pioneer Educational review Center. Recto, Manila.

Domingo, E. (2012). Lecture Notes for Parasitology. Our Lady of

Fatima University. Valenzuela City.