Medical Parasitology – branch of medical sciences dealing with organisms (parasites) which live

temporarily or permanently on or within the human body.

 Is the science dealing with parasites that infect man, causing disease and misery in most
countries of the tropics

History of Microbiology

Antonie Van Leeuwenhoek of Holand in 1681 – pioneer Dutch microscopist that first introduced
single lens microscope and observed Giardia in his own stools.
 October 24, 1632 – August 26, 1723
 Dutch tradesman and scientist
 Invented the first practical microscopes
 The Father of Microbiology
 Discovered many organisms

Louis Pasteur in 1870 – first published scientific study on a protozoa – disease leading to its
control and prevention during investigation of an epidemic silk worm in South Europe

 Developed a method to remove the undesired microbes from juice with affecting its quality
 Heating the juice at 62.8 degrees celsius for 30minutes killed microbes (71.7-15 seconds)
 Pasteurization – widely used in milk industries; heat treatment process that destroys pathogenic
microorganisms in certain foods and beverages.
 Discovered the parasites (Protozoa) causing pebrine disease of silk worm

Patrick Manson in 1878 – a seminal discovery about the role of mosquitos in filariasis. This was
the first evidence of vector transmission.

Alphonse Laveran in Algeria discovered the malarial parasite (1880)

Ronald Ross in Secunderabad and Calcuna in India showed its transmission by mosquitoes.
(1897).
A large number of vector-borne disease have since then identified

By mid-20th century with dramatic advances in antibiotics and chemotherapy, insecticides, and
antiparasitic drugs, and improved lifestyles, all infectious diseases seemed amenable to
control.

Parasites – living organisms which depend on a living host for their nourishment and survival. They
multiply or undergo development in the host

The term parasite is usually applied to Protozoa (unicellular organisms) and Helminths (multicellular
organisms)

According to the nature of the host- parasite interactions and the environmental factors, the parasite
may be one of the following types.
 1. Obligatory Parasitism – dependent to its host and can’t survive without it. Ex. Headlice,
tapeworms, plasmodium spp – causative agents of malaria
2. Facultative Parasitism – can change its lifestyle between free- living in the environment and
parasitic according to the surrounding conditions. Ex. Stronglyoides stercoaralis, Toxoplasma
Gondli, Crab Hacker, Dodder
3. Accidental Parasite – affects an unusual host. Ex. Toxocara Canis (a dog parasite) in a man.
4. Temporary Parasites – visits the host only for feeding and then leaves it. Ex. Bed bug visiting a
man for blood meal
5. Permanent parasite – lives in or on its host without leaving. Ex. Lice, head louse, body louse,
crab louse
6. Opportunistic Parasite – capable of producing disease in an immunodeficient host (like AIDS and
cancer patients). In the immune- competent host, it is either found in a latent form or causes a
self-limiting disease. Ex. Toxoplasma Gondii
7. Zoonotic Parasite – primarily infects animals and its transmittable to humans. Ex. Fasciola
Species
- Parasite that can be transmitted between animals and people

Hosts – defined as an organism, which harbors the parasite and provides nourishment and shelter to
latter and is relatively larger than the parasite.

Hosts are classified according to their role in the life cycle of the parasite into:

Definitive Host – harbours the adult or sexually mature stages of the parasite (or in whom sexual
reproduction occurs)
Ex. Man is a DH for Schistosoma Haematobium, while female Anopheles mosquito is DH
for Plasmodium species. (Malaria Parasites)

Intermediate Host – harbours larval of sexually immature stages of the parasite (or in whom
asexual reproduction occurs)
Ex. Man is IH of malaria parasites. Two intermediate hosts termed 1st and 2nd IH may be
needed for completion of a parasite’s life cycle, Ex. Pirenella Conica Snail in the 1st IH,
while Tilapia (Bolty) fish is the 2nd IH for Heterophyes Heteropphyes

Reservoir Host - harbours the same species and same stages of the parasite as man. It maintains
the life cycle of the parasite in nature and is therefore, a reservoir source of infection for man.
e.g. sheep are RH for Fasciola hepatica.

Paratenic or transport host in whom the parasite does not undergo any development but
remains alive and infective to another host. Paratenic hosts bridge gap between the
intermediate and definitive hosts. For example, dogs and pigs may carry hookworm eggs from
one place to another, but the eggs do not hatch or pass through any development in these
animals.
 Accidental host: The host, in which the parasite is not usually found, e.g. man is an accidental
host for cystic echinococcosis.
Vector is an arthropod that transmits parasites from one host to another, e.g. female sand fly
transmits Leishmania parasites ((Bogitsh et al., 2005)

HOST-PARASITE RELATIONSHIP

The term refers to the relationship between the host and the parasite and the competition for
supremacy that takes place between them.

In biology, the relationship between two organisms is mainly in the form of symbiosis, defined as "life
together", i.e., the two organisms live in an association with one another. Thus, there are at least three
types of relationships based on whether the symbiont has beneficial, harmful, or no effects on the other
(Todar, 2011).

Mutualism is a relationship in which both partners benefit from the association.

Commensalism: in which one partner benefits from the association, but the host is neither helped nor
harmed.
Parasitism: in which one of the participants, the parasite, either harms or lives at the expense of the
host.

Classification and General Character of Parasites

Parasites form part of the animal kingdom which comprises about 800,000 identified species
categorized into 33 phyla.
The most acceptable taxonomic classification of human parasites includes Endoparasites and
Ectoparasites.
 Endoparasites are sub-classified into Helminthic parasites (multicellular organisms) and
Protozoan parasites (unicellular organisms).
Helminthic parasites are either flat worms (Trematodes), segmented ribbon like worms
(Cestodes) or cylindrical worms (Nematodes).

Endoparasites
Most parasites of humans live inside the host (endo- means internal). These are Helminthes
(worms of various types), protozoa, or sometimes larval stages of arthropods (insects, mites,
etc.)
Both helminthic and protozoan parasites can infect different tissues and organs of the human
body.
A great number of endoparasites live in the intestines, or at least pass through the intestines,
having been swallowed in food or water.
Virtually any organ can be affected, however some parasites like Trichinella spp. and Toxoplasma
gondii live in muscles, larvae of Echinococcus spp. and liver flukes occupy the liver, Schistosoma
haematobium targets the urinary bladder and most of the protozoan parasites circulate in blood.

Ectoparasites
Human ectoparasites live on the host (ecto- means outside of). They include fleas, lice, mosquitoes,
bugs, mites, ticks etc. In general, ectoparasites attach to the skin to feed and do not remain on the host
for their entire lives.
LIFE CYCLE OF PARASITES

Direct life cycle: When a parasite requires only single host to complete its development, it is
called as direct life cycle, e.g. Entamoeba histolytica requires only a human host to complete its
life cycle (Table 1)

Indirect life cycle: When a parasite requires two or more species of host to complete its
development, the life cycle is called as indirect life cycle, e.g. malarial parasite requires both
human host and mosquito to complete its life cycle (Tables 2 and 3).

SOURCES OF INFECTION

CONTAMINATED SOIL AND WATER:

 Soil polluted with embryonated eggs (roundworm, whipworm) may be ingested or infected
larvae in soil, may penetrate exposed skin (hookworm).
 lnfective forms of parasites present in water may be ingested (cyst of ameba and Giardia).
 Water containing the intermediate host may be swallowed (cyclops containing guinea worm
larva).
 Infected larvae in water may enter by penetrating exposed skin (cercariae of schisotosomes).
 Free-living parasites in water may directly enter through vulnerable sites (Naegleria may enter
through nasopharynx).

FOOD:
 Ingestion of contaminated food or vegetables containing infective stage of parasite (amebic
cysts, Toxoplasma oocysts, Echinococcus eggs).
 Ingestion of raw or undercooked meat harboring infective larvae (measly pork containing
cysticercus cellulosae, the larval stage of Taenia solium)

VECTORS:
 A vector is an agent, usually an arthropod that transmits an infection from man to man or from
other animals to man, e.g. female Anopheles is the vector of malarial parasite.

BIOLOGICAL VECTORS: The term biological vector refers to a vector, which not only assists in the
transfer of parasites but the parasites undergo development or multiplication in their body as
well. They are also called as true vectors. Example of true vectors are:
• Mosquito: Malaria, filariasis
• Sandflies: Kala-azar
• Tsetse flies: Sleeping sickness
• Reduviid bugs: Chagas disease
• Ticks: Babesiosis.
Mechanical vectors: The term mechanical vector refers to a vector, which assists in the transfer
of parasitic form between hosts but is not essential in the life cycle of the parasite.
Example of mechanical vectors is: Housefly: Amebiasis
In biological vectors, a certain period has to elapse after the parasite enters the vector, before it
becomes infective.
 This is necessary because the vector can transmit the infection only
 after the parasite multiplies to a certain level or undergoes a developmental process in its body.
This interval between the entry of the parasite into the vector and the time it takes to become
capable of transmitting the infection is called the EXTRINSIC INCUBATION PERIOD.
Carrier: A person who is infected with parasite without any clinical or subclinical disease is
known as carrier.
He can transmit parasite to others. For example, all anthroponotic infections, vertical
transmission of congenital infections.
Self(autoinfection) Finger-to-mouth transmission, e.g. pinworm Internal reinfection, e.g.
Strongyloides.
MODES OF INFECTION

ORAL TRANSMISSION: The most common method of transmission is through oral route by
contaminated food, water, soiled fingers, or fomites. Many intestinal parasites enter the body in
this manner; the infective stages being cysts, embryonated eggs, or larval forms. Infection with
E. histolytica and other intestinal protozoa occurs when the infective cysts are swallowed.
SKIN TRANSMISSION: Entry through skin is another important mode of transmission. Hookworm
infection is acquired, when the larvae enter the skin of persons walking barefooted on
contaminated soil. Schistosomiasis is acquired when the cercarial larvae in water penetrate the
skin.
VECTOR TRANSMISSION: Many parasitic diseases are transmitted by insect bite, e.g. malaria is
transmitted by bite of female Anopheles mosquito, filariasis is transmitted by bite of Culex
mosquito. A vector could be a biological vector or a mechanical vector.
DIRECT TRANSMISSION: Parasitic infection may be transmitted by person-to-person contact in
some cases,
e.g. by kissing in the case of gingivaJ amebae and by sexual intercourse in trichomoniasis.
VERTICAL TRANSMISSION: Mother to fetus transmission may take place in malaria and
toxoplasmosis.
IATROGENIC TRANSMISSION: It is seen in case of transfusion malaria and toxoplasmosis after
organ transplantation.

PATHOGENESIS
Parasitic infections may remain inapparent or give rise to clinical disease. A few organisms, such as E.
histolytica may live as surface cornmensals, without invading the tissue.
CLINICAL INFECTION produced by parasite may take many forms: acute, subacute, chronic, latent, or
recurrent.
PATHOGENIC MECHANISMS, which can occur in parasitic infections are:
- LYTIC NECROSIS: Enzymes produced by some parasite can cause lytic necrosis. E. histolylica lyses
intestinal cells and produces amebic ulcers.
TRAUMA: Attachment of hookworms on jejunal mucosa leads to traumatic damage of villi and bleeding
at the site of attachment.
ALLERGIC MANIFESTATIONS: Clinical illness may be caused by host immune response to parasitic
infection, e.g. eosinophilic pneumonia in Ascaris infection and anaphylactic shock in rupture of hydatid
cyst.
PHYSICAL OBSTRUCTION: Masses of roundworm cause intestinal obstruction.
Plasmodium falciparum malaria may produce blockage of brain capillaries in cerebral malaria.
INFLAMMATORY REACTION: Clinical illness may be caused by inflammatory changes and consequent
fibrosis, e.g. lymphadenitis in filariasis and urinary bladder granuloma in Schistosoma haemalobium
infection.
NEOPLASIA: A few parasitic infections have been shown to lead to malignancy. The liver fluke, Clonorchis
may induce bile duct carcinoma, and S. haematobium may cause urinary bladder cancer.
SPACE OCCUPYING LESIONS: Some parasites produce cystic lesion that may compress the surrounding
tissue or organ, e.g. hydatid cyst.
LABORATORY DIAGNOSIS
Most of the parasitic infection cannot be conclusively diagnosed. On the basis of clinical features and
physical examination laboratory diagnosis depends upon:
Microscopy
Culture
Serological test
Skin test
Molecular method
Animal inocuJation
Xenodiagnosis
Imaging
Hematology

Microscopy - An appropriate clinical specimen should be collected for definitive diagnosis of parasitic
infections.
• The following specimens are usually examined to establish a diagnosis:
Stool
Blood
Urine
Sputum
Cerebrospinal fluid (CSF)
Tissue and aspirates
Genital specimens.

Stool Examination
o Examination of stool is very important for the detection of intestinal infections like Giardia,
Entamoeba, Ascaris, Ancylostoma, etc.
o Cysts and trophozoites of E. histolytica, C. lamblia can be demonstrated in feces.
o Eggs of roundworm and tapeworm are also found in stool.
o The larvae are found in the feces in S. stercoralis infection

Blood Examination
o Examination of blood is of vital importance for demonstrating parasites which circulate in blood
vessels (Table 6).
 o Malarial parasite is confirmed by demonstration of its morphological stages in the blood.
PROTOZOA- NEMATODES
Plasmodium spp. Wuchereria bancrofti
Babesia spp. Brugia malayi
Trypanosoma spp. Loa-loa
Leishmania spp. Mansonella sp

Urine Examination
o The characteristic lateral-spined eggs of S. haematobium and trophozoites of T. vaginalis can be
detected in urine.
o Microfilaria of W bancrofti are often demonstrated in the chylous urine

Sputum Examination
o The eggs of P. westermani are commonly demonstrated in the sputum specimen. Occasionally,
larval stages of S. stercoralis and A. lumbricoides may also be found in sputum.
Cerebrospinal Fluid Examination
o Some protozoa like T. brucei, Naegleria, Acanthamoeba, Balamulhia and Angiostrongylus can be
demonstrated in the CSF.

Tissue and Aspirates Examination

o The larvae of Trichinella and eggs of Schistosoma can be demonstrated in the muscle biopsy
specimens. By histopathological examination of brain, Naegleria and Acanthamoeba can be
detected. In bodies can be demonstrated in spleen and bone marrow aspirate.
o Trophozoites of Giardia can be demonstrated in intestinal aspirates. Trophozoites of E. histolytica
can be detected in liver pus in cases of amebic liver abscess.

Genital Specimen Examination

o Trophozoites of T. vaginalis are found in the vaginal and urethral discharge.
Eggs of E. vermicularris are found in anal swabs.

Culture
 o Some parasites like Leishmania, Entamoeba and Trypanosoma can be cultured in the laboratory
in various axenic and polyxenic media.

Serological Tests
Serological tests are helpful for the detection and surveillance of many protozoa! and helminthic
infections. These tests are basically, of two types:
1. Tests for antigen detection
2. Tests for antibody detection.
Antigen Detection
o Malaria antigen like P. falciparum lactate dehydrogenase (pLDH) and histidine-rich protein 2
(HRP-2) are detected by rapid immunochroma tographic test.
o Filarial antigens are detected in current infection by enzyme-linked
o immunosorbent assay (ELISA)
Antibody Detection
o The following antibody detection procedures are useful in detecting various parasitic infections
like amebiasis, echinococcosis and leishmaniasis in man:
Complement fixation test ( CFT)
Indirect hemagglutination (IHA)
Indirect immunofluoresccnt antibody (IFA) test
Rapid immunochromatographic test (ICT)
Enzyme-linked immunosorbent assay test (ELISA).
Skin Test
o Skin tests are performed by injecting parasitic antigen intradermally and observing the reaction.
o In immediate hypersensitivity reaction, wheal and flare response is seen within 30 minutes of
infection, whereas erythema and in duration seen after 48 hours of injection is called as delayed
hypersensitivity reaction
Molecular Diagnosis
o Molecular methods most frequently used to diagnose human parasitic infection are
deoxyribonucleic acid (ONA) probes, polymerase chain reaction (PCR) and microarray technique.
These tests are very sensitive and specific.
Animal Inoculation
o It is useful for the detection of Toxoplasma, Trypanosoma and Babesia from the blood and other
specimens.
Xenodiagnosis
o Some parasitic infection like Chagas disease caused by T. cruzi can be diagnosed by feeding the
larvae of reduviid bugs with patient's blood and then detection of amastigotes of T. cruzi in their
feces.

Imaging
o Imaging procedures like X-ray, ultrasonography (USG), computed tomography (CT) scan and
magnetic resonance imaging (MRI) are now being extensively used for diagnosing various
parasitic infections like neurocysticercosis and hydatid cyst disease
 .

Hematology
o Anemia is frequently seen in hookworm infection and malaria.
o Eosinophilia is frequently present in helminthic infections.
o Hypergammaglobulinemia occurs in visceral leishmaniasis.
o Leukocytosis is seen in amebic liver abscess.