INTRODUCTION TO

PARASITOLOGY
PHM 210

Ms. Akosua Dufie Ankomah

Department of Pharmaceutical Microbiology, UCC
LEARNING OBJECTIVES

At the end of this section, the student is expected to:

• Explain the various types of basic associations in an ecosystem

• Explain the various types parasites and hosts and discuss the relationship
between them.

• Understand the concept of parasitism and the diversity of parasites of

medical importance (parasitic protozoa, helminths and arthropods).

• Discuss in detail the classification of medically important parasites with

examples and also noting differences.

2
Introduction

• Symbiosis- a close relationship between two different

species in which at least one specie benefits.

• Type depends on whether either or both organisms benefit

from the relationship.
• Mutualism
• Commensalism
• Parasitism
3
Mutualism
• Interaction between individuals of different species in which
both species benefit. This is a (+/+) relationship.
• Per capita reproduction
• survival

• Interspecific interactions span from facultative to obligate

mutualist relationships
• Facultative- persists without mutualist (honey bees and flowering
plants)
• Obligate- go extinct without mutualist (ants and Acacia plant) 4
 Examples of mutualism

Bees and flowering plants Ants and Aphids

5
Commensalism

This is an association in which the one organism

(commensal) takes the benefit without causing injury

to the host. This is a (+/0) association.

6
Types of commensalism
Metabiosis- often a deceased
Microbiota- commensals grow
host creates a favourable
inside the host to form a
environment for the
community.
commensal.

Types of
commensalism

Inquilinism- a permanent
Phoresy- the commensal
association in which the
latch to the host for the
commensal resides on the host
purpose of dispersal only.
for a lifetime. 7
 Examples of Commensalism

Hermit crabs residing in the Gut microbiota in humans

shells of dead snails

8
 Cont’
Woodpecker drills a nest in the Barnacles latches on whales
cactus for transportation

9
Parasitism

An association where one of the organisms (host) is

harmed whereas the other (parasite) isn’t harmed, but
benefits. (+/-) association.

Parasitology - Study of parasites

10
Facts about parasites
• Parasites live at the expense of their host

• Parasites derive nutrients, shelter, transport etc.

from their host

• Parasites do not usually kill their host

• In a case where the host dies due to parasitic invasion, the invader
(parasite) is known as a ‘parasitoid’.

11
Cont’

• Smaller than their host

• Some parasites undergo part of their life cycle in the

host whereas others do not

• Outnumber the host

• Short lifespan than their host

• Have greater reproductive potential than their host

12
Classification of parasites

According to the habitat, they are classified as;

• Ectoparasites- ticks, fleas, leeches and lice
• Endoparasites-
• Intercellular- Plasmodium spp
• Intracellular- Trypanosoma

13
 According to Duration of the Parasite on\in Host
• Temporary parasite – are those which lead free life during a part of life
cycle and parasites at other points, e.g. Fleas, Fisciola sp, etc.

• Permanent parasites - are those which spend their entire lives as

parasites e.g. Helminths, Trichomonas vaginalis etc.

• Periodic parasites or sporadic parasites - are those parasite which make

short visit to their hosts to obtain nourishment or other benefits, e.g.
Female Anopheles Mosquito. (Take note- may find it in some literature)
14
According to the specificity of the parasites.

• Host specific parasites - confined host

• Plasmodium vivax is specific to human being,

• Babesia bigemina is specific to cattle

• Non host specific parasite - can develop in large number of

unrelated animals
• e.g. Fasciola gigantica, Toxoplasma gondii, Trypanosoma evansi etc.

15
 According to the Degree of parasitism

• Obligate Parasites - They are completely dependent on the host

during a segment or all of its life cycle, e.g. Plasmodium spp.

• Facultative parasites – They exhibit both parasitic and non-

parasitic modes of living and hence does not absolutely depend
on the parasitic way of life. E.g. Naegleria fowleri

16
 According to the pathogenicity

• Pathogenic parasite -They have the potential to cause disease in

a host.
• e.g.Trichostrogylus , Haemonchus, Sarcocystis cruzi , Fasciola hepatica etc.

• Non pathogenic parasite -They do not cause much or disease in

a host (nutrition and protection).
• e.g. Entamoeba coli

17
According to type of host required in life cycle of parasites

• Monoxenous parasite - they live in only one type of host during the
course of their normal life cycle e.g. Coccidia, Hookworms, etc.

• Hetroxenous parasite - parasite live in two or more types of hosts

during the course of their normal life cycle e.g. tapeworms,
Plasmodium etc.

18
 Cont’

• Euryxenous parasite:-They have a broad or wide host range

e.g.Trypanosome , Toxoplasma, etc.

• Stenoxenous parasite - They have a narrow host range e.g.

coccidian, hookworms, nodular worms etc.

19
 According to development in the host

• Proliferous parasite -The parasite enters the body of the host as one
individual, grows, multiplies and eventually produces a number of
daughter individuals. e.g. Theileria , Babesia, etc.

• Non proliferous parasite -The parasite enters the body of the host as
one individual and grows likewise but the daughter individuals do
not multiply in the host in whom they are born.eg. Helminthes.

20
 According to the size of the parasite
• Macro parasites –
• can be seen by naked eye.
• they often cannot replicate within the host
• level of infection is determined by the number of infection events and the
number of infective stages acquired e.g. trematodes , cestodes nematodes and
arthopods.

• Micro parasites –
• cannot be seen by naked eye unless identified by microscope.
• these parasite replicate within the host
• level of infection can rise rapidly even after a single infection or a single
21
organism e.g. protozoans.
 According to the transmission to man or animals
• Zoonotic parasite - are transmissible from animals to man or vice versa. e.g.
Faciolopsis buski , Hydatid (echinococcus), Trichinella etc.
Protozoal zoonoses, e.g. toxoplasmosis, leishmaniasis, balantidiasis, and
cryptosporodiasis

Helminthic zoonoses, e.g. hydatid disease, taeniasis

Anthropozoonoses: Infections transmitted to man from lower vertebrate animals, e.g.

cystic echinococcosis

Zooanthroponoses: Infections transmitted from man to lower vertebrate animals, e.g.

human tuberculosis to cattle.

• Non zoonotic parasites - are not transmissible from animal to man. They
complete their life cycles without involving man . e.g. Ascaridia ,
Oesophagostomum and others . 22
According to the invasion of the tissue of the host

• Histozoic parasite - live within the tissue of the host e.g.

Coccidian parasites in the intestinal mucosa of the animals and

birds and others .

• Coelozoic parasite – are found in the lumen of the intestine or

other hollow organs of the hosts. E.g. Ascaris suum in the small
intestine of pig and others .

23
According to the laying stages by the parasites
• Oviparous parasites - females lay eggs e.g. Ascaris, Ascridia, Ancylostoma etc.

• Ovo-viviparous parasites - females lay eggs which contain fully developed

larvae to hatch e.g. Habronema etc.

• Viviparous or Larvaeparous parasites – eggs are hatched in the uterus of the

female and larvae passed out e.g. Filarid worms .

• Pupiparous parasites - eggs hatch and larvae developed in the uterus and
when passed outside they are ready to pupate e.g. Hippobosca, Melophagus,
24
etc.
Other parasites
• Hyperparasites -are those parasites whose hosts are themselves
parasites, eg. Protozoa (hyperparasite) living in the digestive tract of a
flea (parasite/ host), living on a dog (host).

• Pseudoparasites – objects or organisms which are mistaken for

parasites , e.g. small white thread for trichostrongylus.

• Accidental parasites – those parasites found in a hosts in which they do

not usually live, eg. Ascaris lumbricoides in sheep; Echinococcus
granulosus (dog tapeworm) infects man accidentally, giving rise to
hydatid cysts.

• Free- living parasite – an organism which is capable of living in the

environment and leading a non-parasitic existence. Eg., cystic stage of
Naegleria floweri. 25
Cont’
• Erratic parasite - one which wanders from its usual site of invasion into an
organ or location in which it does not ordinarily live, e. g. Fasciola, when
found in lung, kidney,etc .

• Opportunistic parasites – those which often invade immunocompromised

individuals and cause severe diseases e.g. Cryptosporidium parvum,
Toxoplasma gondii, etc.

• Aberrant/ wandering parasites: Parasites, which infect a host where they

cannot develop. E.g., Toxocara canis (dog roundworm) infecting humans.
26
 Different kinds of hosts
• Definitive host – a host that harbors a parasite in the adult stage or where the
parasite undergoes a sexual method of reproduction. Eg, Man for Taenia
saginata

• Intermediate host - harbors the larval stages of the parasite or its asexual cycle.
Eg, cow for Taenia saginata
• first and second intermediate hosts.

• Amplifier host- hosts in which infectious agents (including medically relevant

parasites) undergo high levels of multiplication, thus becoming an important
source of infection to vectors.
• E.g. Pigs amplify Japanese Encephalitis Virus, (JEV) which are transmitted to man through
the bite of Culex sp of mosquitoes. 27
Cont’
• Paratenic host – harbours parasites but not necessary for the
completion of the parasites development cycle. (Transport host).
• No detectable morphological change in parasite. E.g. fleas or mice for
certain tapeworms.

• A host, in which larval stage of the parasite remains viable without

further development is referred as a paratenic host. Such host
transmits the infection to another host.

• Reservoir host – a host that makes the parasite available for the
transmission to another host and is usually not affected by the
infection. 28
Cont’

• Carrier host:- A host harboring and disseminating a parasite

but exhibiting no clinical sign.

• Accidental host – a host that is under normal circumstances

not infected with the parasite.

• Natural host – a host that is naturally infected with certain

species of parasite.
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• A living carrier (e.g. an arthropod) that transports a pathogenic organism
from an infected to a non-infected host. A typical example is the female
Anopheles mosquito that transmits malaria.

• Biological vectors
• These vectors complete the life cycles of parasites.
• Eg, Female Anopheles (vector of Plasmodium falciparum)
• Simulium (vector of Onchocerca), etc.

• Mechanical Vectors
• Passive carrier of parasites. Not needed to complete any life cycle.
Eg. House fly, Cockroach (vectors for Amoebae and Giardia) etc. 30
Direct effects of the parasite on the host
Mechanical injury – growing pressure e.g. Hydatid cyst causes
blockage of ducts such as blood vessels producing infarction. E.
histolytica lyses intestinal cells and produces amoebic ulcers.

Obstruction of passages –Intestinal obstruction by adult Ascaris

(heavy infestation). Plasmodium falciparum malaria may produce
blockage of brain capillaries in cerebral malaria.

Allergy development, e.g., Bite of arthropods; anaphylactic shock

31
in rupture of hydatid cyst.
Cont’
• Deprivation of nutrients, fluids and metabolites -parasite may
produce disease by competing with the host for nutrients. Eg.
Hook worm – sucks blood.

• Destruction of tissues: e.g. Trophozoites of E. histolytica causes

necrosis of liver; infection with Leishmania donovani results
marked destruction of marrow elements.

• Bleeding- Schistoma eggs.

32
Cont’
Predisposition to malignancy-e.g., The liver fluke, Clonorchis may
induce bile duct carcinoma, and S. haematobium may
cause urinary bladder cancer.

Opening path way to secondary infections e.g. Ulcer formed as a

result of Dracunculus medinensis infection exposes ulcer to
bacterial, viral infection

• Transmission of pathogens to man, e.g., lice transmitting

Rickettsia 33
Indirect effects of the parasite on the host
• Immunological reaction: this can cause tissue damage in the
host, e.g. nephritic syndrome following Plasmodium infections.

• Excessive proliferation of certain tissues may result in organ

damage, e.g. fibrosis of liver after deposition of the ova of
Schistosoma.

• Chronic immune stimulation leading to unresponsiveness to

infections.
34
Medical parasitology
• Medical Parasitology is the branch of medical sciences which deals
with organisms (parasites) that live temporarily or permanently, on
or within the human body (host).

• It involves the study of three major groups : parasitic protozoa

(unicellular), parasitic helminths (multicellular) and those
athropods (multicellular) that directly cause disease or act as
vectors of various pathogens.
• Kingdom Protista and Animalia. 35
 Cont’
• Medical parasitology is generally classified into
• Medical Protozoology - Deals with the study of medically
important protozoa

• Medical Helminthology - Deals with the study of

helminthes (worms) that affect man.

• Medical Entomology - Deals with the study of arthropods

which cause or transmit disease to man. 36
Cont’
• Helminths and Arthropods (possess an external skeleton) are
collectively known as Metazoa

• Major Differences between Parasitic Protozoa and Metazoa

Differences Protozoa Metazoa

Number of cells Unicellular Multicellular

Mode of multiplication Mostly asexual Mostly sexual

Cause of infection Multiplication Accumulation

Rate of multiplication Fast Slow

Longivity Short Long

37
Cont’
• Most parasites of humans live inside the host
(Endoparasites)

• Endoparasites
• Helminthic parasites (multicellular organisms)
• Protozoan parasites (unicellular organisms) and
• *sometimes larval stages of arthropods (insects, mites, etc.)
• Myiasis by larvae of flies in wounds

38
Cont’
• Helminthic and protozoan parasites can infect different tissues and
organs of the human body.

• The intestines are invaded by endoparasites through ingestion of

contaminated food or water.

• Some parasites like Trichinella spp. and Toxoplasma gondii live in the
muscles.

• Larvae of Echinococcus spp. and liver flukes invade the liver.

• The urinary bladder is a target for Schistosoma hematobium.

• Most of the protozoan parasites circulate in blood. 39

Medical parasitology focuses on

• Morphology
• Geographical distribution
• Means of infection
• Life cycle
• host/parasite relationship
• Pathology and clinical manifestations of infection
• Laboratory diagnosis
• Treatment
• Preventive/control measures of parasites

40
Morphology

This includes size, shape, color and position of

different organelles in different parasites at various
stages of their development.
• Useful in laboratory diagnosis
• Used to differentiate between pathogenic and commensal
organisms.
• For example, Entamoeba histolytica and Entamoeba coli

41
Geographical distribution

Distribution of parasites depends upon:

a. The presence and food habits of a suitable host:

•Host specificity, for example, Ancylostoma duodenale requires man as a

host where as Ancylostoma caninum requires a dog.

• Food habits, e.g. consumption of raw or undercooked meat or

vegetables predisposes to Taeniasis (Taenia solium).

b. The presence of an appropriate vector or intermediate host

42
Cont’

c. Environmental conditions favoring survival outside the

body of the host,
- i.e. temperature, the presence of water, humidity etc.

d. Easy escape of the parasite from the host

- Parasites which are spread by feaces and urine are widely
distributed in many parts of the world as compared to those
parasites which require a vector or direct body fluid contact for
transmission.
43
Life cycle of parasites
The route followed by a parasite from the time of entry to the host to exit,
including the extracorporeal (outside the host) life.
• Simple- one host
• Complex- one or more intermediate hosts.

• A parasite’s life cycle consists of two common phases

• Phase one- involves the route a parasite follows inside the body.
• symptomatology and pathology of the parasite.
• diagnosis and selection of appropriate treatment options

• Phase two- the route a parasite follows outside of the body

• provides crucial information pertinent to epidemiology, prevention and
control. 44
 Host parasite relationship
Host reactions to parasite include:

• Carrier state - a perfect host parasite relationship where tissue

destruction by a parasite is balanced with the host’s tissue repair.

• Disease state – a state where the parasite dominates as a result of

either a lower resistance of the host or a higher pathogenecity of the
parasite.

• Parasite destruction – occurs when the host takes the upper hand. 45
Host Factors FIND OUT!

• Genetic constitution

• Age

• Sex

• Level of immunity: natural and acquired immunity.

• Nutrition (malnutrition or under nutrition)

• Intensity and frequency of infections

• Presence of co-existing disease or conditions which reduces

immune response. e.g. Pregnancy, HIV

• Life style and occupation 46

Parasite factors

• Strain of the parasite and adaptation to human host

• Parasite load (number of parasite )

• Site(s) occupied in the body

• Metabolic process of the parasite, particularly the nature of
any waste products or toxins produced by the parasite
during its growth and reproduction.

47
Laboratory diagnosis

Specimen type is dependent on the type of parasitic infection

a) Blood
i. Used where the parasite finds itself in the blood stream at any stage
of its development
• in malaria, the parasites are found inside the red blood cells.
• In Bancroftian and Malayan filariasis, microfilariae are found in the blood
plasma.

48
Cont’
ii. Indirect evidences – changes indicative of intestinal

parasitic infections include:

• changes in the blood – eosinophilia often gives an indication of
tissue invasion by helminthes.

• a reduction in white blood cell count is an indication of kala-azar

• anemia is a feature of hookworm infestation and malaria.
• serological tests – are carried out only in laboratories where
special antigens are available.

49
Cont’

b) Stool –often used in diagnosis for intestinal parasitic

infections and also helminthic parasites that localize in the
biliary tract and discharge their eggs into the intestines.
• Protozoan infections – Trophozoites (active phase) or cystic forms
(chronic phase) may be detected.
• Example, Amoebiasis, Giardiasis, etc.
• Helmithic infections - the adult worms, their eggs, or larvae are
found in the stool.

50
Cont’

c) Sputum –

• In cases where the habitat of the parasite is in the respiratory

tract. Eg. Paragonimiasis - eggs of Paragonimus westermani.

• In amoebic abscess of lung / in amoebic liver abscess-

trophozoites of E. histolytica burst into lungs and are detected in
the sputum.

51
Cont’
d) Biopsy material – this varies with different parasitic infections. For example
• spleen punctures - of kala-azar,
• muscle biopsy - Cysticercosis, Trichinelliasis, and Chagas’ disease,
• Skin snip - Onchocerciasis.
• Bronchial biopsy - P. carnii

e) Urethral or vaginal discharge – for Trichomonas vaginalis

f) Urine – when the parasite localizes in the urinary tract. For example,
• Urinary Schistosomiasis -eggs of Schistosoma
• Chyluria - microfilariae of Wuchereria bancrofti
52
Cont’
• Aspirates
• Cerebro-Spinal fluid - Trypanosoma rhodisense and Naegleria
fowleri.
• Lymphgland aspirates - T. rhodisense, L. donovani and T. gondii
• Liver aspirate - E. histolytica, L. donovani and T. gondii
• Spleen aspirate - L. donovani and T. gondii

• Duodenal aspirate - G. lamblia, F. hepatica and S. stercoralis

• Bone marrow - L. donovani and T. gondii

• Rectal scraping - Schistosoma sp.

• Perianal swab - E. vermicularis 53

 Antigen Detection
• Malaria antigen P. falciparum lactate dehydrogenase (pLDH) and
histidine rich protein 2 (HRP2) are detected by rapid
immunochromatographic test.

• Filarial antigens detected in current infection by enzyme linked

immune sorbent assay (ELISA)

54
Antigen detection in parasitic infections

55
 READ ABOUT THESE TESTS!
Antibody Detection

• The following antibody detection procedures are useful in

detecting various parasitic infection like amoebiasis,
echinococcosis, and leishmaniasis in man:
• Complement fixation test (CFT)
• Indirect hemagglutination (IHA)
• Indirect immunofluroscent antibody test (IFA)
• Rapid immunochromatography test
• ELISA test.

56
• Xenodiagnosis
Some parasitic infection like Chagas’ disease caused by T. cruzi can be
diagnosed by feeding the larvae of reduviid bugs with patients blood and then
detection of amastigotes of T. cruzi in their feces.

• Imaging
Imaging procedures like Xray, ultrasonography (USG) computed tomography
(CT) scan and magnetic resonance Imaging (MRI) are now being extensively
used for diagnosing various parasitic infection like neurocysticercosis and
hydatid cyst disease.

57
• Molecular Diagnosis

Moleculular method most frequently used to diagnose human

parasitic infection are DNA probes, polymerase chain reaction
(PCR), and microarray technique. These tests are very sensitive
and specific.

58
Treatment
Usage of specific chemotherapy.
• Intestinal helminthiasis- drugs are given orally for direct
action on the helminthes.

• To obtain maximum parasiticidal effect, it is desirable that

the drugs administered should not be absorbed and the
drugs should also have minimum toxic effect on the host.

59
Prevention and control (breaking the transmission cycle )

• Sanitary control of drinking water and food.

• Proper waste disposal

• The use of insecticides and other chemicals used to control the vector
population.

• Good personal hygiene.

• Avoidance of unprotected sexual practices.

• Reduction of the source of infection- prompt diagnosis and treatment.

• Protective clothing that would prevent vectors from introducing pathogens.

60
 Terms to consider
• Biological Incubation (Prepatent) Period:- It is time elapsing
between initial infection with the parasite and demonstration of
the parasites or their developing stages in excreta, blood,
aspirate and other diagnostic material. (Take note – may find this
definition in some researches)

• Clinical Incubation Period:- It is the interval between exposure

and the earliest manifestation of symptoms. This is the preferred
definition in clinical settings.
61
Exposure and Incubation

Exposure moment

Latent
period
Infection stage Incubation period

Earliest clinical symptoms

62
Cont’
• Autoinfection:- An infected individual acts as a source for
hyperinfection to himself.

• Superinfection (Hyperinfection):- When an individual harboring

the parasite is reinfected by the same parasite.

• Retroinfection:- A retrograde infection caused by the newly

hatched larva of E. vermicularis from the perianal region to reach
the colon, where the adolescent form of the parasite develop. 63
Cont’
• Diagnostic Stage:- A developmental stage of a pathogenic organism
that can be detected in stool, blood, urine, sputum, CSF or other
human body secretions.

• Infective Stage:- The stage of parasite at which it is capable of

entering the host and continue development within the host.

• Infection:- Invasion of the body by any pathogenic organism and

the reaction of the hosts tissue to the presence of the parasite or
related toxins. 64
Sources of Exposure to Parasitic Infections
• Contaminated soil:- Soils polluted with human excreta.
• Eg, Ascaris lumbricoides, S.stercolaris, Trichuris trichuria and hook
worms.

• Contaminated water:- Water may contain;

(a) Viable cysts of Amoeba, flagellates and T. solium eggs,
(b) Cercarial stages of human blood fluke,

(c) Cyclops containing larva of Dracunculus medinesis,

(d) Fresh water fishes which are sources for fish tape worm, and
intestinal flukes infection
(e) Crab or cray fishes that are sources for lung fluke

(f) Water plants which are sources for Fasciolopsis buski. 65

Cont’
• Insufficiently cooked meat of pork and beef which contains
infective stage of the parasite. E.g., Trichenilla spiralis, Taenia
species.

• Blood sucking arthropods - responsible for transmission of: e.g.,

Malaria parasites by female anopheles mosquito
Leishmania by phlebotomus
Trypanosoma by tsetse fly
Wuchreria by Culicine mosquito

66
 Cont’

• Animals (domestic or wild animals harbouring the parasite), e.g.

• Dogs are direct sources for human infection with the hydatid cyst
caused by E. granulosus and cutaneous larva migrans caused by
Toxocara canis, etc.

• Herbivores commonly constitute the source for human infection

with Trychostrongylus species.

67
Cont’
• Human beings - Clothing, bedding or the immediate
environment that has been contaminated by an individual
is/are directly responsible for all or a considerable amount of
infection with a pathogenic amoeba E. histolytica, E.
vermicularis, H. nana .

Sexual intercourse - e.g., Trichomonas vaginalis

Autoinfection - e.g., S. stercoralis, E. vermicularis, and T. solium

68
Mode of Transmission of parasitic infections

Direct mode of Transmission

• The parasite dose not require biological vectors and/or
intermediate hosts and require only a single host to
complete its life cycle.
• It may use mechanical vectors for transmission.
• Two classifications involved.
• Horizontal Direct Mode of Transmission
• Vertical Direct Mode of Transmission

69
Cont’
Vertical Direct Mode of Transmission – parasites transmitted from
parent to off spring before or at birth
• Transplacental

• Transmammary (breast milk)

Horizontal Direct Mode of Transmission: Transmission is mainly

through contact with bodily secretions or fluids eg sputum or blood.

Most intestinal parasites transmitted in this way.

• Sexual intercourse

• Blood transfusion

• Direct skin penetration (soil transmitted helminthes)

70
71
Cont’

Indirect Mode of Transmission

• The parasite has complex life cycle and requires

biological vectors and/or one or more intermediate
hosts for transmission.

72
73
 Contact and penetration of eyes
Methods of Infection / Invasion Acanthamoeba

Inhalation
Acanthamoeba
Entarobius

Faecal- oral ingestion

Ascaris
Entamoeba
Vector – borne Fisciola
Kissing bug Giardia
Trypanosoma Taenia

Mosquito Kissing
Plasmodium Trichomonas gingivalis
Sexual Contact Trichomonas tenax
Sand fly Trichomonas
Leishmania Entamoeba
Giardia
Tsetse fly
Trypanosoma Others
Transmammary
Contact and S. Stercoralis
penetration of skin
Encylostoma
Routes of escape Schistosoma
Transplacental
• Sputum Necator
T. gondii
• Faeces or urine
• Vector removes parasite
while feeding

74
Classification

75
Classification

76
 Medical Protozoology
• Study of medically relevant protozoa
• Greek word ‘protos’ and ‘zoon’ meaning “first animal”
• Eukaryotic protists
• ranging in size from 2 to more than 100μm.

• Distinguished from other eukaryotic protists by

• ability to move at some stage of their life cycle
• lack of cell wall.

• They are common in moist areas such as;

• sea
• soil
• fresh water
77
Cont’
• Protozoa may be divided into free-living forms and symbiotic
forms. Some of the symbiotic ones are parasitic and may cause
diseases

• Protozoan (unicellular) parasites are classified according to

morphology and means of locomotion.

• Most species that cause human disease belong to the phyla

sarcomastigophora and apicomplexa. 78
Morphology

Cell membrane

Matrix

Protozoa Cytoplasm Organelles

(Basic structure)

Nourishment materials

Nucleus
79
Cont’

• Morphologically and functionally complete and can perform

all functions of life.

• The nucleus
• clumped / dispersed chromatin

• central nucleolus / Karyosome

(useful structures to distinguish protozoan species from one

another) shape, size and distribution of these structures

80
Cont’

• Parasites can transform themselves from active forms to resistant

forms.
• Trophozoite- active form
• Cyst- tough wall formed around trophozoite to become inactive and non –
motile. (E. gingivalis, T. vaginalis etc. have only the trophozoite from)

• Cyst formation ensures survival during unfavourable conditions in

the likes of desiccation, low nutrient supply, low oxygen supply, etc.

• Cyst can infect the human host

81
Importance of protozoa

• Serve as an important link in the food

• They are also important in biological sewage treatment,

which involves both anaerobic digestion and/or aeration.

• Their asexual reproduction enables clones to be

established with the same genetic make-up for research
purposes
82
 PROTOZOA

Sarcomastigophora

Mastigophora Sarcodina Apicomplexa

Intestinal (Sporozoans)
(Amoeba)
Giardia Blood
Plasmodium Cilophora
Intestinal
Genital
Entamoeba Balantidium
Trichomonas Tissue
Toxoplasma coli
Others
Blood and tissue
Iodameba
Trypanosoma Intestines
Dientmeba
Leishmania Coccidians
Pseudopodia Exhibit a slight Cilia
Flagella 83
Amoeboid movement
Structures of Protozoa;
Trypanosoma, Amoeba

84
Structures of Protozoa; Plasmodium, a ciliate

Ciliate

85
Transmission

• Feacal – oral transmission of contaminated foods and

water

• Insect bite inoculums / rubbing infected insect feaces on

the site of bite

• Sexual intercourse
86
 Important pathogenic protozoa and
commonly caused diseases

Blood and tissue

Plasmodium species
Malaria
Intestinal tract
Entamoeba
Toxoplasma gondii
histolytica
Toxoplasmosis Urogenital tract Amoebiasis
Trichomonas vaginalis
Trypanasoma Trichomoniasis Giardia lamblia
species
Giardiasis
Trypanosomiasis
Balantidium coli
Leishmania species
Balantidiasis
Leishmaniasis
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Pathogenesis
Factors important for pathogenecity include:

• Attachment to the host tissue followed by replication to establish

colonization.

• Toxic products released by parasitic protozoa.

• Shifting of antigenic expression to evade the immune response

and inactivate host defences.
88
Reproduction

• Asexual multiplication
• Simple binary fission – in this process, after division of all the
structures, the individual parasite divides either
longitudinally or transversely into two equal parts.

• Multiple fission or schizogony – in this process more than

two individuals are produced, e.g. asexual reproduction in
Plasmodia.
89
 Cont’
• Sexual reproduction:
(a) Conjugation – in this process, a temporary union of two

individuals occurs during which time interchange of nuclear material

takes place. Later on, the two individuals separate.

(b) Syngamy – in this process, sexually differentiated cells,

called gametes, unite permanently and a complete fusion of the
nuclear material takes place. The resulting product is then known as
a zygote.
90
RESISTANCE

Ability of host to protect itself against a pathogen.

• Resistance to protozoa infections involves three interrelated

mechanisms:
• Nonspecific factors
• Humoral immunity
• Cellular immunity

91
Nonspecific factors: (phagocytosis, inflammation)

• This involves the mobilization of phagocytic elements / cells

(neutrophils, eosinophils, basophils, monocytes and

macrophages) to the area of infection.

92
Humoral immunity
Immune responses mediated by cell products of the
lymphoid tissues referred to as antibodies ie, B-cells
and plasma cells

93
Cellular immunity

Immune responses mediated by specifically sensitized

lymphocytes themselves

ie, T-lymphocytes and their products.

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HUMORAL IMMUNITY CELLULAR IMMUNITY
• Antibody mediated • Cell mediated
• B- cells play a major role • Controls intracellular pathogens
• Often target extracellular antigens • T-cells play a major role

Antigens
Antigen
Antigen presenting cell
APC
B-cells

T-cell

T-helper cell
Memory cell
Plasma cells

Cytotoxic T- cell Activated macrophage

Antibodies
Apoptosis of target cell
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Medical Helminthology
The heliminthic parasites are:

• multicellular

• bilaterally symmetrical animals

• have three germ layers

• Ectoderm- nervous system and epidermis
• Mesoderm-muscle cells and connective tissues
• Endoderm-gut and other internal organs
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Cont’

The helminthes of importance to human

beings are divided into three main groups
• Class: Trematodes (flukes)
• Class: Cestodes (tapeworms)
• Phylum: Nematodes (roundworms)- have psedocoelom

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Classification

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DIFFERENTIATING FEATURES OF HELMINTHES

Cestode Trematode Nematode

Shape Tape like, Leaf like, Elongated,
segmented unsegmented cylindrical
Sexes Not separate Not separate Separate
(monoecious) (monoecious) (dioecious)
Except blood flukes
which are
dioecious

Head ‘end’ Suckers: with Suckers: no hooks No suckers, and

hooks hooks
Alimentary canal Absent Present but Present but
incomplete complete
Body cavity Absent Absent Present
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Cont’
• The life cycles of helminths may be quite complex and
include both direct and indirect cycles.

• The clinical sign and symptoms of helminthic infections

depend on the location of the organisms
• adults, larva, or eggs.

• The host response to the presence of parasite may be

prominent
• often includes eosinophilia, especially in the early stages of infections
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when the parasites are in tissue
Leukocytes

• Neutrophils- first responder of immune cells

• Basophils- release histamine to mount non-specific immune response

• Eosinophils- fight bacteria and parasites but also provoke allergy

symptoms

• Lymphocyte B and T cells- defend the body against specific invaders

• Monocytes- clean up dead cells

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Trematode

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Cestode

103
Taenia solium

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Nematode
Ascaris lumbricoides

105
?
106
Cont’
Routes of entry:
• They enter the body through different routes including:
mouth, skin and the respiratory tract by means of
inhalation of airborne eggs.

• Disease states:
• They cause anemia and malnutrition.
• In children, they cause a reduction in academic
performance
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Sources of the helminthic parasites
• Contaminated
• soil (Geo-helminthes),
• water (cercariae of blood flukes)
• food (Taenia in raw meat)

• Blood sucking insects or arthropods (as in filarial worms, Loa loa)

• Domestic or wild animals harboring the parasite (as in

echinococcus in dogs).

• Person to person (Enterobius vermicularis, Hymenolopis nana).

• Oneself (auto-infection) as in Enterobius vermicularis

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 Medical Entomology

Kingdom Animalia

Phylum Athropoda

Class Class Class

Class Class
Insecta Chilopoda Pentatosmida
Crustacia Arachnida
Eg, Mosquito Eg, Eg, tongue worms
Eg. Scorpion Eg, Ticks
Centipedes

Crustacia, Arachnida and Insecta are the three most common classes of arthropods of
medical significance 109
Medical Entomology
Arthropods affect the health of man by being:

(a) Direct agents for disease /discomfort.

• Annoyance- flying around

• Entomophobia - delusory parasitosis which causes undue alarm and anxiety

(unwarranted use of insecticides).

• Envenomization - introduction of a poison into the body of humans and animals

(athropods)

• Allergic reactions - hypersensitive response to insect proteins (human deaths from bee
and wasp stings)

• Dermatosis and dermatitis- acute skin irritations

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Cont’

(b) Agents for disease transmission

Arthropods can carry disease causative agents in the following two ways.

• Mechanical carrier- they introduce the disease causative agent without

altering its development or multiplication
• e.g. house fly

• Biological carrier- Certain stages in the life cycle of parasite takes place
in the body of the athropod.
• e.g. Anopheles mosquitoes.
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Cont’
Biological carrier is any of the following types:
• Propagative- where there is multiplication of the parasite with no
developmental change. Eg. Yellow fever virus in Aedes mosquito.

• Cyclopropagative – in this type both multiplication and developmental

change are going on. Eg. Plasmodium species in Anopheles mosquito

• Cyclodevelopmental – here there is developmental change of the parasite

but no multiplication. E.g. Wucherera bancrofiti in Culex mosquito

• Transovarial- when the pararasite passes to progeny arthropods through the

ova. E.g. Ricketsia typhi in ticks 112
MEDICAL CONDITIONS RELATED TO ARTHROPODS
Fly related conditions
• Myiasis is invasion of tissue of humans and other vertebrate animals
with dipterous fly larva.

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Fly related conditions

• Houseflies can transmit a number of diseases to humans by

depositing feaces and other unhygienic matter and people’s
food. Pathogens can be transmitted by three possible ways:
• By contaminated feet, body hairs and mouthparts of flies.
• Flies frequently vomit on food during feeding
• defecation, which often occurs on food.

• Sand flies transmit leishmaniasis, tsetseflies transmit trypanosomes.

• Chrysops deefly species (Chrysops silacea, Chrysops dimidiate) transmit

loiasis.
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Fly related conditions
• The case of Loiasis transmitted by
Chyrysops deer fly sp.

Loa loa.

115
• The case of leishmaniasis transmitted by the Sand fly

116
• The case of African Trypanosomiasis,
transmitted by the Tsetse fly (Glossina sp.)

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Cont’
Mosquito related conditions
the different types of mosquitoes and the parasite they
transmit are listed below;
• Anopheles – Plasmodium spp
• Culex mosquito - Wuchereria bancrofti
• Aedes mosquito - Wuchereria bancrofti, Yellow fever virus
Mansonia - Brugia malayi

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Cont’
Flea related conditions
• Fleas can be ectoparasites, which may sometimes cause allergic
dermatitis

• They are intermediate hosts for certain bacteria like Yersinia pestis
and Rickettsia typhi.

• In tropical America and Africa, the most troublesome flea is Tunga

penetrance, which is about 1 mm in length but after burrowing into
the skin, it may swell to 1 cm and cause extreme irritation. Surgical
removal is required.
• Sometimes the condition may also be complicated by secondary bacterial
infection 119
Infection caused by Tunga penetrance (a flea)

120
Cont’
Lice related conditions

• Lice are usually ectoparasites and they can live in different

parts of the body. For example;
• Pediculus humanus capitis – head lice

• Pediculus humanus corporis – body lice

• Phitrius pubis – pubic /crab lice

• Lice are also responsible for transmission of diseases such as

relapsing fever and epidemic typhus.

121
Lice related conditions

122
Cont’
Bug related conditions
• Other than being ectoparasites and a nuisance to humans, bugs like
Triatoma (Kissing bug) are disease vector of Trypanasoma cruzi, which is
seen in some countries of Latin America.

Tick related conditions

• Ticks can cause mechanical injury to the skin.

• They may sometimes produce toxins, which affect release of acetylcholine

at the neuromuscular junctions - ‘tick paralysis’.

• Ticks also transmit diseases like Rickettsial illnesses.

123
Tick paralysis

124
Cont’

Mite related conditions

• A mite called Sarcoptes scabiei causes itchy, eruptions on the

skin usually termed as scabies.

• House dust mites either produce or concentrate potent

allergens commonly found in non-ventilated houses.

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Scabies caused by Sarcoptes scabiei (a mite)

126
Vector control Methods
• Mechanical methods
• E.g. Use of bed nets, wire mesh, etc.

• Ecological control
• Ecological control procedures involve the removal, destruction,
modification or isolation of materials that might favor the survival of
vector.

• Chemical methods
• Deals with the use of natural or synthetic chemicals that directly
cause the death, repulsion, or attraction of insects. E.g. use of DDT

127
Cont’
• Biological methods
• Refers to the regulation of vector population using predators
• Some species of fish feed on the larval stages of some arthropods, and
microbial agents.

• Unlike pesticides, biological control agents are safe to use and do

not pose any threat to the environment.

• Genetic control
• Involves manipulation of the mechanisms of heredity.
• In some research centers sterilized male mosquitoes are used (decrease
in the new generation of mosquitoes)
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Neglected Tropical Diseases (NTDs)

• Neglected tropical diseases (NTDs) include several parasitic, viral and

bacterial diseases that are preventable and treatable but cause
substantial illness for more than one billion people globally (over 1.7
billion).

• NTDs are found in several countries in Africa, Asia, and Latin America.
NTDs are especially common in tropical areas where people do not
have access to clean water or safe ways to dispose off human waste.

129
Cont’

•17 diseases as focus previously

•20 diseases currently including

• Mycetoma
• Scabies
• Snake bite

130
Beating NTDs

• The following six NTDs can be controlled or even eliminated

through mass administration of safe and effective medicines or
other, effective interventions:
• Dracunculiasis (Guinea Worm Disease)

• Lymphatic Filariasis
• Onchocerciasis
• Schistosomiasis

• Soil-transmitted Helminths (STH) (i.e., Ascaris, Hookworm, and Whipworm)

• Trachoma*

131
Cont’

• Controlling the vectors (e.g., mosquitoes, black

flies) that transmit these diseases and improving
basic water, sanitation, and hygiene are highly
effective strategies against these NTDs.

132
Cont’ Reading assignment

Five interventions recommended by WHO to combat

NTDs
• Preventive chemotherapy and transmission control (PCT)
• Innovative and intensified disease management (IDM)
• Vector ecology and management
• Safe water, sanitation and hygiene (WASH)
• Veterinary public health services

Which of the 20 NTDs are parasitic? Note the diseases with their causative
organisms and any vectors involved.
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References
• CDC website
• https://www.cdc.gov/globalhealth/ntd/features/NTD_feature_2022.html
• https://www.cdc.gov/parasites/lymphaticfilariasis/index.html

• Medical Parasitology - LECTURE NOTES for Degree and Diploma Programs

For Health Science Students, Ethiopia Public Health Training

• Parasitology - LECTURE NOTES For Medical Laboratory Technology

Students, Ethiopia Public Health Training

• https://www.who.int/health-topics/neglected-tropical-diseases#tab=tab_1

• Paniker's Textbook of MEDICAL PARASITOLOGY. Indian Council of Medical

Research, new Delhi, India. Revised and Edited by. Sougata Ghosh MD,
DCH. Professor, Department of Microbiology.
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