Parasitic Infections of Humans

Although parasitology (the study of parasites) is

considered a branch of microbiology, not all
organisms studied in a parasitology course are
microbes.

In fact, of the three categories of organisms

(parasitic protozoa, helminths, and arthropods)
that are studied in a parasitology course, only one
category—parasitic protozoa—contains microbes.

Therefore, in this chapter, parasitic protozoa are

discussed in greater detail than are helminths and
arthropods.
Parasitism - is a symbiotic relationship that is of
benefit to one party or symbiont (the parasite) at the
expense of the other party (the host). Although many
parasites cause disease, some do not. Even if a parasite
is not causing disease, it is depriving the host of
nutrients; therefore, parasitic relationships are always
considered detrimental to the host.

Parasites - are defined as organisms that live on or in

other living organisms (hosts), at whose expense they
gain some advantage. In addition to parasites of
humans, there are many types of plant parasites (i.e.,
parasites of plants) and many types of animal parasites
(i.e., parasites of animals).
The life cycle of a particular parasite may involve one
or more hosts. If more than one host is involved, the
definitive host is the one that harbors the adult or
sexual stage of the parasite or the sexual phase of the
life cycle.

The intermediate host harbors the larval or asexual

stage of the parasite or the asexual phase of the life
cycle. Parasite life cycles range from simple to
complex. There are one-, two-, and three-host
parasites.
Knowing the life cycle of a particular parasite
enables epidemiologists and other health care
professionals to control the parasitic infection
through intervention at some point in the life cycle.

In addition, parasitic infections are most often

diagnosed by observing and recognizing a particular
life cycle stage in a clinical specimen.
An accidental host is a living organism that can serve
as a host in a particular parasite’s life cycle, but is not
a usual host in that life cycle. Some accidental hosts
are dead-end hosts, from which the parasite cannot
continue its life cycle.
A facultative parasite is an organism that can be
parasitic but does not have to live as a parasite. It is
capable of living an independent life, apart from a
host.
The free-living amebae that can cause
keratoconjunctivitis and primary amebic
meningoencephalitis (PAM) are examples of
facultative parasites
An obligate parasite, on the other hand, has no choice;
to survive, it must be a parasite. Most parasites that
infect humans are obligate parasites.

Medical parasitology is the study of parasites that

cause human disease. The overall responsibility of the
Parasitology Section of the Clinical Microbiology
Laboratory is to assist clinicians in the diagnosis of
parasitic diseases—primarily, parasitic diseases caused
by endoparasites, such as parasitic protozoa and
helminths.
In general, parasitic infections are diagnosed by
observing and recognizing various parasite life cycle
stages in clinical specimens. Some life cycle stages
(e.g., amebic cysts and Cryptosporidium oocysts) are
extremely small. Finding them in specimens represents
one of the greatest challenges faced by clinical
microbiologists.
 HOW PARASITES CAUSE DISEASE

The manner in which parasites cause damage to

their host varies from one species of parasite to
another, and often depends on the number of
parasites that are present. For helminths, the
number that is present is often referred to as the
“worm burden.”
Some parasites produce toxins, some produce
harmful enzymes, some invasive and migratory
parasites cause physical damage to tissues and organs,
some cause the destruction of individual cells, and
some cause occlusion of blood vessels and other
tubular structures.

Some parasites interfere with vital processes of the

host, whereas others deprive their host of essential
nutrients. In some cases, the host immune response
to the presence of parasites or their products causes
more injury than do the parasites themselves
 PARASITIC PROTOZOA

In the Five Kingdom Classification System of living

organisms, protozoa are in the Kingdom Protista,
together with algae. Some taxonomists prefer to
place them in a kingdom by themselves—the
Kingdom Protozoa. Most protozoa are unicellular,
but some are multicellular (colonial).
Protozoa can be classified taxonomically by their
mode of locomotion. Amebas (amebae) move by
means of pseudopodia (literally, “false feet”).

Flagellates move by means of whiplike flagella. Ciliates

move by means of hairlike cilia. Protozoa classified as
Sporozoa (sporozoans) have no pseudopodia, flagella,
or cilia, and, therefore, exhibit no motility.
Not all protozoa are parasitic. For example, many of the
pond water protozoa (e.g., Paramecium and Stentor spp.)
studied in introductory biology and microbiology courses
are not parasites;

Although most protozoal parasites of humans are

obligate parasites, some are facultative parasites—
capable of a free-living, nonparasitic existence, but also
able to become parasites when they accidentally gain
entrance to the body.
Acanthamoeba spp. and Naegleria fowleri are examples
of facultative parasites. These free-living amoeba's
normally reside in soil or water, but can cause serious
diseases when they gain entrance to the eyes or the
nasal mucosa. From the nasal mucosa, they travel via
the olfactory nerve into the brain and cause diseases
affecting the central nervous system (CNS).
Because protozoa are tiny, protozoal infections are
most often diagnosed by microscopic examination of
body fluids, tissue specimens, or feces. Peripheral
blood smears are usually stained with Giemsa stain,
whereas fecal specimens are stained with trichrome,
iron hematoxylin, or acid-fast stains.

Most parasitic protozoal infections are diagnosed by

observing trophozoites, cysts, oocysts, or spores in
the specimen.
The trophozoite -is the motile, feeding, dividing stage in
a protozoan’s life cycle, whereas cysts, oocysts, and
spores are dormant stages (much like bacterial spores).

Protozoal infections are primarily acquired by ingestion

or inhalation of cysts, oocysts, or spores, or injection
via the bite of an infected arthropod. Because of their
fragile nature, only rarely do trophozoites serve as the
infective stages
 PROTOZOAL INFECTIONS OF HUMANS
Protozoal Infections of the Skin
Leishmaniasis Disease.

There are three forms of leishmaniasis:

cutaneous,
mucocutaneous (or mucosal), and
visceral.
The cutaneous form starts with a papule that
enlarges into a craterlike ulcer . Individual ulcers
may coalesce, causing severe tissue destruction and
disfigurement.

Visceral leishmaniasis, also known as kala-azar, is

characterized by fever, enlarged liver and spleen,
lymphadenopathy, anemia, leukopenia, and
progressive emaciation and weakness. Death may
result in untreated cases.
 Geographic Occurrence

Leishmaniasis occurs in many regions of the world,

including Pakistan, India, China, the Middle East, Africa,
South and Central America, and Mexico. Cases have also
occurred in South Central Texas. It is estimated that
between 1.5 and 2 million people have leishmaniasis
and that about 57,000 people die each year from the
disease.
 Parasites

Leishmaniasis is caused by various species of

flagellated protozoa in the genus Leishmania. The
nonmotile, intracellular form of the parasite is called
an amastigote. The motile, extracellular form of the
parasite is called a promastigote.
 Reservoirs and Mode of Transmission

Reservoirs include infected humans, domestic dogs,

and various wild animals. Leishmaniasis is principally a
zoonosis and is usually transmitted via the bite of an
infected sand fly. Transmission by blood transfusion
and person-to-person contact has been reported.
 Laboratory Diagnosis

Diagnosis of cutaneous and mucocutaneous

leishmaniasis is made by microscopic identification of
the amastigote form in stained preparations from
lesions or by culture of the extracellular promastigote
form on suitable media.
 Protozoal Infections of the Eyes

Protozoal infections of the eyes include

conjunctivitis and keratoconjunctivitis
(inflammation of the cornea and conjunctiva),
caused by amebas in the genus Acanthamoeba,
and toxoplasmosis, caused by the sporozoan,
Toxoplasma gondii.
 Protozoal Infections of the Genitourinary Tract
Trichomoniasis Disease

Trichomoniasis is a sexually transmitted protozoal

disease affecting both men and women. The
disease is usually symptomatic in women, causing
vaginitis with a profuse, thin, foamy, malodorous,
greenish-yellowish discharge.

It has been estimated that trichomoniasis accounts

for approximately one-third of the cases of vaginitis
in the United States.
In women, trichomoniasis may also present as
urethritis or cystitis. Although rarely symptomatic in
men, trichomoniasis may lead to prostatitis,
urethritis, or infection of the seminal vesicles.
Persons with trichomoniasis often also have other
sexually transmitted diseases, especially gonorrhea

Trichomoniasis is caused by a flagellated protozoan

named Trichomonas vaginalis and is transmitted
by direct contact with vaginal and urethral
discharges of infected people. Trichomoniasis is
usually symptomatic in females and asymptomatic
in males.
Geographic Occurrence:
Trichomoniasis occurs worldwide.

Parasite :
Trichomoniasis is caused by T. vaginalis, a flagellate.

Reservoirs and Mode of Transmission :

Infected humans serve as reservoirs. Transmission
occurs by direct contact with vaginal and urethral
discharges of infected people during sexual
intercourse. Because this organism exists only in the
fragile trophozoite stage (there is no cyst stage), it
cannot survive very long outside the human body.
Laboratory Diagnosis:

Vaginitis caused by T. vaginalis can be diagnosed by

performing a saline wet mount examination of freshly
collected vaginal discharge material and observing the motile
trophozoites (Fig. 21-4).

Culture procedures are also available, but are rarely performed

in clinical microbiology laboratories. T. vaginalis trophozoites
are sometimes seen in urine and Papanicolaou smears.
Diagnosis of trichomoniasis in men can be accomplished by
performing a saline wet mount of urethral discharge material or
prostatic secretions. Recently, a molecular diagnostic assay has
become available for diagnosing trichomoniasis in males and
females, often in conjunction with testing for chlamydia and
gonorrhea.
Protozoal Infections of the Central Nervous System

Protozoal infections of the CNS include Toxoplasmosis ,

amebic abscesses, African Trypanosomiasis and PAM.

Primary Amebic Meningoencephalitis Disease

PAM is an amebic disease causing inflammation of the

brain and meninges, sore throat, severe frontal
headache, hallucinations, nausea, vomiting, high fever,
and stiff neck. Unless diagnosed and treated promptly,
death occurs within 10 days, usually on the fifth or sixth
day.
Geographic Occurrence:
PAM has been reported worldwide.

Parasite.

PAM is caused by N. fowleri, an ameboflagellate.a

Amebas in the genera Acanthamoeba and
Balamuthia can cause similar conditions..
 Reservoirs and Mode of Transmission.

Water and soil serve as reservoirs. The amebas usually

enter the nasal passages of a person diving and/or
swimming in ameba-contaminated water, such as
ponds, lakes, “the old swimming hole,” thermal springs,
hot tubs, spas, and public swimming pools.

After the amebas colonize the nasal tissues, they

invade the brain and meninges by traveling along the
olfactory nerves.
Laboratory Diagnosis:

Diagnosis of PAM can sometimes be made by

microscopic examination of wet mount preparations
of fresh cerebrospinal fluid (CSF). However, because
they are a colorless and transparent, amebas are
difficult to see in wet mounts, unless the microscope
light is turned very low.

Leukocytes and amebas are similar in appearance

unfortunately, most cases of PAM are diagnosed after
the patient’s death through observation of amebas in
stained sections of brain tissue.
 HELMINTHS

The word helminth means parasitic worm.

Although helminths are not microorganisms, the
various procedures used to diagnose helminth
infections are performed in the Parasitology
Section of the Clinical Microbiology Laboratory.
These procedures often involve the observation
of microscopic stages—eggs and larvae—in the
life cycles of these parasites. Helminths infect
humans, other animals, and plants. The helminths
that infect humans are always endoparasites.
Helminths are multicellular, eukaryotic organisms in
the Kingdom Animalia.

 The two major divisions of helminths are

roundworms (nematodes) and
 flatworms

The flatworms are further divided into tape-worms

(cestodes) and flukes (trematodes).
The typical helminth life cycle includes three stages:
the egg, the larva, and the adult worm.

Adults produce eggs, from which larvae emerge, and

the larvae mature into adult worms. Adult nematodes
are either male or female.

Cestodes and many trematodes are hermaphroditic;

that is, adult worms contain both male and female
reproductive organs. Thus, it only takes one worm to
produce fertile eggs
The host that harbors the larval stage is called the
intermediate host, whereas the host that harbors the
adult worm is called the definitive host. Sometimes
helminths have more than one intermediate host or
more than one definitive host.
The fish tapeworm, for example, is what is known as a
three-host parasite, having one definitive host
(human) and two intermediate hosts (a freshwater
crustacean called a Cyclops and a freshwater fish) in its
life cycle. Fleas serve as intermediate hosts in the life
cycle of the dog tapeworm, whereas dogs, cats, or
humans can serve as definitive hosts.
Helminth infections are primarily acquired by
ingesting the larval stage, although some larvae are
injected into the body via the bite of infected
insects, and others enter the body by penetrating
skin.

Helminth infections are usually diagnosed by

observing whole worms or segments of worms in
clinical specimens (usually, fecal specimens), or
larvae or eggs in stained or unstained clinical
specimens.
Adult Ascaris lumbricoides worms. This CDC technician is
holding Ascaris worms that had been passed with the feces of a 5-year-
old child in Kenya, Africa. Adult female worms may reach 20 to 35 cm in
length, whereas adult male worms are usually 15 to 31 cm in length.
 MEDICALLY IMPORTANT ARTHROPODS
There are many classes of arthropods, but only
three are studied in a parasitology course: insects
(class Insecta), arachnids (class Arachnida), and
certain crustaceans (class Crustacea).

The insects studied include lice, fleas, flies,

mosquitoes, and reduviid bugs. Arachnids include
mites and ticks. Crustaceans include crabs,
crayfish, and certain Cyclops species. Arthropods
may be involved in human diseases in any of four
ways, as shown in
Arthropods may serve as mechanical or biologic
vectors in the transmission of certain infectious
diseases. Mechanical vectors merely pick up the
parasite at point A and drop it off at point B, similar
to an overnight delivery service.

For example, a housefly could pick up parasite cysts

on the sticky hairs of its legs while walking around on
animal feces in a meadow.
The fly might then come through an open kitchen
window and drop off the parasite cysts while walking
on a pie cooling on the counter. A biologic vector, on
the other hand, is an arthropod in whose body the
pathogen multiplies or matures (or both).

Many arthropod vectors of human diseases are

biologic vectors. A particular arthropod may serve as
both a host and a biologic vector
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