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Medical

Parasitology consists of 3

sections:
Medical protozology

2.

Medical Helminthology

3.

Medical Entomology

By:Gessessew B

By:Gessessew B

1.

Learning objectives

Cont.Assessment(Assignment,quiz,test).
60%
Class attendance & Participation...
Mid-term exam....
3
Final Exam... 40%

At the end of this section the students are expected to:

Explain the various types of parasites &hosts.

Describe

By:Gessessew B

Evaluation Methods:

GENERAL PARASITOLOGY
By:Gessessew B

Teaching Methods:
Lecture
Discussion
Lab. Demonstration
Presentation (by students)

the association of organisms

Explain the relationship between a parasite & the

host & their effects.

Explain

hosts

the direct & indirect effects of parasites on

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Discuss

the routes infections to parasitic diseases

Analyze

of

medically

important

parasites.

Describe the difference between Metazoa &

protozoa

What is medical parasitology?

Medical

parasitology is a science that deals

with parasites that have medical importance
on human.

More

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classification

Parasitology is a science that deals with parasites.

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List

What is Parasitology?

the concepts of Medical parasitology

specifically, it is the science that deals with

the interactions between a host & the population

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By:Gessessew B

of parasites that are found on or in that host.

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What is parasite?
A

Parasite is a living organism w/c acquires its

nourishment & other needs through its intimate
contact with another organism( host).
is physically or physiologically dependent upon
the host.

Smaller than their host,

Outnumber the host,

Short life span than their host, and

Have greater reproductive potential than

What is Host?

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It

Features of Parasites

their host.

A host is an organism which supports the parasite.

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Definition of Terms
Medical Parasitology

Diagnostic

Stage:-A stage of a pathogenic organism that

can be detected in stool, blood, urine, sputum, CSF or

Host

other human body secretions.

Infective

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Parasitic diseases

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Parasites

Stage:- The stage of parasite at w/c it is capable

Prevention

Transmission

Treatment

Diagnosis

Pathogenesis

Life Cycle

Morphology

of entering the host & continue development within the

host.
Infection:11

Invasion of the body by any pathogenic

organism (except )arthropods.

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Infestation:-

The establishment of arthropods upon or within

a host.
Zoonosis:-

diseases that are transmittable from animal to

parasites or their stages in excreta, blood, aspirate etc.

Superinfection

(Hyperinfection):- When an individual

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By:Gessessew B

Biological Incubation (Prepatent) Period:- It is time elapsing

b/n initial infection with the parasite & demonstration of the

An infected individual acts as a source

for hyperinfection to her/himself.

man.

Autoinfection:-

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

Clinical Incubation Period:- It is the interval b/n exposure & the

earliest manifestation or infestation.
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region to reach the colon, where the adolescent form of

the parasite develop.

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KINDS OF PARASITES

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II. Endoparasites :
parasites that live inside the body of their host,
e.g. Entamoeba histolytica.

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I.Ectoparasite :
a parasitic organism that lives on the outer surface
of its host, e.g. lice, ticks, mites etc.

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KINDS OF PARASITES..contd

III.Obligate (Permanent) Parasite :

This parasite is completely dependent on the host during

a segment or all of its life cycle, for metabolites, shelter,

This parasite can not live outside its host.

exhibits both parasitic & non-parasitic modes of

living & hence does not absolutely depend on the
parasitic way of life, but is capable of adapting to
it if placed on a host.
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and transportation.

IV. Facultative parasite :

E.g. Naegleria fowleri, strongloids stercoralis

e.g. Plasmodium spp., Trichmonas vaginalis, etc.

V. Accidental parasite :
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VIII.Opportunistic parsites:

KINDS OF PARASITES......CONTD

VI. Erratic parasite :

is

parasites

which cause mild disease in

immunologically healthy individuals but they
cause severe disease in immunodeficient
hosts.
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one that wanders in to an organ in which it

is not usually found.
E.g. E.histolytica in the liver or lung of humans.

VII.Temporary parasites:

When a parasite attacks an unnatural host &

survives.
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E.g.Hymenolepis diminuta (rat tapeworm).

e.g. Toxoplasma gondi, Isospora belli

parasites

that eat and run

E.g.Bedbug
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Types of Hosts

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1. Definitive (Final) host:

a host that harbors a parasite in the adult stage or
where the parasite undergoes a sexual method of
reproduction.
Sexually mature stages (most highly developed form
of the parasite) and fertilization occurs in this host.
E.g.1.Human is the definitive host of Taenia saginata
2.

Mosquito is the
Plasmodium species

definitive

host

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for

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TYPES OF HOSTS..... CONTD

2. Intermediate host:

No

fertilization takes place in it.

E.g. cow is the intermediate host for T.saginata
Human is IH for Plasmodium species

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harbors the larval (immature) stages of the

parasite or where an asexual cycle of development
takes place.

In
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some cases, larval development is completed in

two different intermediate hosts, referred to as first
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& second intermediate hosts.
E.g. liver flukes

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TYPES OF HOSTS ... CONTD

dead-end host is an intermediate host that does generally

not allow transmission to the definitive host, thereby
preventing the parasite from completing its development.
example,

humans

are

for Echinococcus canine tapeworms.

dead-end

hosts

As infected humans are not usually eaten by dogs, foxes etc.,

the immature Echinococcus - although it causes serious disease
in the dead-end host - is unable to infect the primary host and
mature.

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4. Accidental(incidental) (dead-end host) host :

a host that is under normal circumstances not infected
with the parasite.
The parasite may or may not continue full
development in this host.
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E.g. Human beings for H.diminuta(primarily it is tape
worm of rats & mice)

TYPES OF HOSTS....... CONTD

5. Natural host:
a host that is naturally infected with certain species
of parasite.
E.g. Rats are naturally infected with H.diminuta
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For

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By:Gessessew B

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3. Reservoir host:
A wild or domestic animal which harbors a
parasite and acts as source of infection to humans.
The parasite causes no or only mild disease on
this host.

6.Carrier host:
A host harboring & disseminating a parasite but
exhibiting no clinical sign.
e.g:Human beings harboring cyst of E.histolytica 28

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TYPES OF HOSTS ..CONTD

Hence,

7. Paratenic host:
is

an animal that harbor the parasite in a dormant

based on the number of hosts involved,

life cycle of parasite is divided in to:

1.

Monexenous

cycle in a subsequent suitable host.

2.

Hetrexenous

The

By:Gessessew B

By:Gessessew B

state of development but capable of continuing its

host that serves as a temporary refuge and

vehicle for reaching an obligatory host(definitive

host)
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ASSOCIATION OF ORGANISMS
There are 2 general categories of organisms

within the ecosystem based on whether or not they

ASSOCIATION ...CONTD

Symbiosis
The

term symbiosis is an umbrella that can be

defined as "life /living together, from the Greek sym
(together) and bios (life).

organism of a d/t spp during all or part of their

life cycles.

1) free-living organisms: they do not enter into

intimate association.
2)

symbionts:

association.

they

do

enter

into

intimate
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Any

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enter into intimate association with another

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organism that spends a portion or all of its life

cycle intimately associated with another organism of
a different species is considered as Symbiont
(symbiote)

The

above relationship is called symbiosis (symbiotic

32
relationships).

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ASSOCIATION.....CONTD
The

organisms with which the

associated are called hosts.
There are four kinds of symbiosis:

symbionts

Association.....Contd

are

The

protozoa
ruminants.

their

nutrients

In

from

return, they are capable of synthesizing &

secreting cellulase; the cellulose digesting enzymes,
which are utilized by ruminants in their digestion.
E.g selection of ciliates from the rumen. The

However, none of the partners suffers any harm

from the association.
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This association is beneficial to both partners.

rumen contains enormous numbers of ciliates

that break down cellulose in the feed.

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ASSOCIATION..CONTD

2. Commensalism:
Both partners are able to lead independent

The

By:Gessessew B

association when they are together and at least

not damage to the other.

live in, on, or with the host & feed directly on

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By:Gessessew B

host serves as a food provider, but the

symbiont feeds on unmodified food, not food
that the host has altered, not on the host itself.

lives, but one may gain advantage from the

food that the host captured or ingested.

acquire

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1. Mutualism:
an association in which both partners are
metabolically dependent upon each other & one
cannot live without the help of the other.

E.g. ciliated protozoa living in the gut of ruminants.

the host is unaffected, no true physiological

dependency involved.

E.g.

normal floras of the humans body can be

considered as commensals.
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ASSOCIATION..CONTD

3. Phoresis
a

no

physiological dependency & both can

survive independent of each other.
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By:Gessessew B

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"phoront" is
mechanically carried by
larger species that serves a purely
transportation role in disseminating the
phoront within biosphere.

Pseudoscorpions hitching ride on a flys (Diptera) leg

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4. Amensalism: association b/n organisms of 2 d/t spp in w/c one

is inhibited or destroyed and the other is unaffected. Two basic modes:
1. Competition: a larger or stronger organism excludes a smaller or
weaker one from living space or deprives it of food
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2. Antibiosis: one organism is unaffected but the other is damaged or

killed by a chemical secretion.
destructive effect that the bread mold penicllium upon certain bacteria
(penicillin is a potent medicine in combating bacterial infections.)
Some higher plants secrete substances that inhibit the growth ofor kill
outrightnearby competing plants.
black walnut (Juglans nigra) secretes juglone w/c destroys 39many
herbaceous plants within its root zone.

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ASSOCIATION....CONTD

ASSOCIATION...CONTD

5. Parasitism:

The former that is beneficial to is called parasite,

the latter that is harmed is called host.

The parasite is metabolically/physiologically

dependent on the host(lives on the expense of
the host).

Q: What is the

PARASITIC ORGANISMS

difference B/n

Parasitism & Predation????

hosts are usually larger and fewer than the

41
parasites.

NOMENCLATURE AND TAXONOMIC CLASSIFICATION OF

By:Gessessew B

An association which is beneficial to one partner

and harmful to the other partner.
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Predation
a predator is an animal that kills and eats other
animals.
predator is larger than its prey.

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In binomial nomenclature:
The

In

first name is the genus name to which the

organism belongs
second is that of the species(specific
designation of the organism)

first letter of the genus name is

capitalized
The name of the genus & species should be
italicized or underlined separately.
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The

binomial scientific
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naming plants &animals,

name is used.

E.g. Plasmodium falciparum, Giardia lamblia

The

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Plasmodium falciparum
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Describing animal parasites follow certain rules of zoological

nomenclature and each phylum may be further subdivided as
follows:

Classification of Parasites
Parasites are classified into 2 sub-kingdoms:

There are 45,000 protozoa species.

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1. Protozoa (unicellular)

2. Metazoa (multicellular)
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include the worms (helminths) and arthropoda

(posses an external skeleton) e.g. ticks, lice

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CLASSIFICATION...CONTD

Medical Parasitology is generally classified into:

Medical Protozoology :
protozoa.

Medical Helminthology :

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with the study of medically important

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deals

CLASSIFICATION OF MEDICALLY IMPORTANT PARASITES

deals

with the study of helminthes (worms) that

affect man

Medical Entomology :
deals with the study of arthropods w/c cause47 or
transmit disease to man.

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TAXONOMIC CLASSIFICATION OF HELMINTHS

Sub
kingdom

Phylum

Metazoa

Class

Ascaris (roundworm)
Trichuris (whipworm)

Nematodes
Round
worms;
appear
round in cross section, they
have body cavities, a
straight alimentary canal
and an anus

Ancylostoma (hookworm)
Necator (hookworm)

By:Gessessew B

Enterobius (pinworm or
threadworm)
Strongyloides

Platyhelminthes
Flat worms; dorsoventrally
flattened, no body cavity and,
if present, the alimentary canal
is blind ending

Cestodes

Trematodes
Non-segmented,
usually
leafshaped, with two suckers but no
distinct head
They have an alimentary canal and
are usually hermaphrodite and leaf
shaped
Schistosomes are the exception.
They are thread-like, and have
separate sexes

Mode of
mutiplication

Asexual(with
exception)

Sexual(with
exception)

Infection caused by

Multiplication

Accumulation

What is vector?

A vector is any arthropod or other carrier w/c

transports a

Longivity

Fast

slow

short

long

pathogenic microorganism from an

infected to non-infected host.

Vectors

Rate of
multiplication

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Number of cells

Multicelluar
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Metazoa

Unicelluar

Fasciolopsis (liver
fluke)
Schistosoma (not leaf
shaped!)

Vector

Differences between Protozoa and Metazoa

Protozoa

Taenia (tapew orm)

Adult tapeworms are found in

the intestine of their host
They have a head (scolex) with
sucking organs, a segmented
body but no alimentary canal
Each
body
segment
is
hermaphrodite

49

feature

Genus examples

are classified based on their importance to

the life cycle of the parasite.

1.

Biological vector

2.

Mechanical vector

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Biological vector:
is

Biological

an insect or organism responsible for the

also

supports

the

development

and/or

multiplication of the pathogen.

essential

propagative,

e.g. Anopheles(vector of plasmodium)

Propagative:

there is multiplication of the parasites but

no change in form in the vector.

e.g. Yersinia pestis in fleas

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Cyclopropagative:
When

and

cyclodevelopmental.

when

to complete the life cycle of the parasite

cyclopropagative

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It

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transmission of the pathogen.

vectors are further divided in to

54

Mechanical Vector (Parathenic or transport vectors):

both multiplication & cyclical development

These

are passive carriers of the parasite.

of the parasite occurs in the vector.

These

are not essential in the life cycle of the

When

parasite.

By:Gessessew B

Cyclodevelopmental:

By:Gessessew B

e.g. Plasmodium vivax in Anopheles mosquitoes.

e.g. House fly and coachroches are mechanical

there is cyclical development but no

vectors for Amoeba, Giardia etc.

multiplication of the parasite in the vector.

e.g. onchocerca volvulus in black flies.

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Host-parasite relationship
Interaction of

the host &parasite may result in :

The

damage which pathogenic parasites produce

in the tissues of the host may be described in the
following two ways:
1.
Direct effects of the parasite on the host
2.
Indirect effects of the parasite on the host
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A. Carrier state:
due to perfect host-parasite r/ship (tissue destruction
balanced with the hosts tissue repair).
The parasite & the host live harmoniously (at equilibrium).
B. Disease State:
due to an imperfect host-parasite r/ship (z parasite
dominates z upper hand).
Results from: 1.lower resistance of the host or
2.higher pathogenecity of the parasite.
C. Parasite Destruction
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occurs when the host takes the upper hand

58

E FFECT OF PARA....CONT

1. Direct effects of the parasite on the host

A. Mechanical injury : may be inflicted by a parasite

by means of pressure/blockage as it grows larger,

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By:Gessessew B

E.g. Hydatid cyst blockage of ducts (blood vessels)

producing infraction
Ascaris Perforate/intestinal obstruction
Schistosoma eggs Bleeding

E.histolytica necrosis of liver

L.donovani destruction of marrow

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By:Gessessew B

By:Gessessew B

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EFFECT OF PARA....CONTD

B. Deleterious effect of toxic substances : parasites

release some toxic substance
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By:Gessessew B

E.g:

P.falciparum produces toxic substances, cause

rigors.
Rupture of E.granulosus cyst anaphylactic shock

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Host Susceptibility Factors

C. Deprivation of nutrients, fluids & metabolites :

produce

disease by competing with the parasite

E.g. Hookworm Suck blood Anemia

D.latum selectively remove B12

D. Transmission of pathogens to man

E.g. Lice transmitting Rikettisia

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1. Strain of the parasite and adaptation to human

66

Immunological

reaction: Tissue damage may be

caused by immunological response of the host,

host

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3. Site (s) occupied in the body

1. Genetic constitution
2. Age
3. Sex
4. Level of immunity
5. Nutrition (malnutrition or under nutrition)
6. Intensity & frequency of infections
7. co-existing disease or conditions Pregnancy, HIV
8. Life style and occupation

(2) Indirect effects of the parasite on the host:

Parasite factors

2. Parasite load ( number of parasite )

Host Factors

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By:Gessessew B

may host for nutrients.

Factors affecting development of certain diseases in an

individual are:Host factors& Parasite factors

E.g.-nephritic syndrome following Plasmodium

infections.
-fibrosis of liver after deposition of the ova of
Schistosoma.
-Allergy development by the bite of arthropods
(inflammation, itching)
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Reading Assignments
EFFECT OF THE HOST ON THE PARASITE
The host can produce certain degree resistance to parasites in
human body or re-infection.
However, the resistance (immunity) is not very strong.

By:Gessessew B

By:Gessessew B

It doesnt wipe out parasites completely, but limit number of

parasites & establish balance (concamitant immunity).

The immune system of our body has two arms of immunity to

protect parasites:
Innate immunity

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Acquired immunity

70

EFFECT OF HOST..CONTD
READING ASSIGNMENT

Evasion mechanism of parasite from the

immune system
parasites

have developed the capacity to escape from host

internal defense mechanisms.

Parasites

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Innate immunity
A.Physical barrier: Prevent parasites to invade in certain
degree.
e.g. Skin/Mucous membrance/Placenta: protect the parasites
from entry.
B. Acid in skin or stomach: can cause damage to the invading
parasites.
C. Phagocytosis: phagocytes in human body can engulf
(encapsulate) parasites & digest (kill) using their lysosomal
enzymes.
Acquired immunity: Limits infection by using two arms: cellular
71
& humoral immunity.

can evade the host immune responses by variety

mechanisms:

1. Site
Intracellular

parasites (T. cruzi, Leishmania intracellular stage

of Plasmodia) are to some extent protected from the action
of antibodies.
72

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Transmission routes & sources of parasites

2. Avoidance of recognition):
a. Antigenic Variation: Production of successive waves of

progeny with d/t surface Ags (African trypanosomes)

b. Molecular mimicry: Certain parasites are recognized as

1. Mouth:

E.g: Schistosome worms(eclipsed antigens),

3. Suppression of immune response:

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self & consequently do not stimulate immunologic

reactions in their host.

The infective stage of the parasite can get the access to

enter the body through:

Source: Ingestion from food or water containing

infective stage of the parasite through mouth.
E.histolytica, E.vermicularis-water/food

T. saginata, T.solium, T.spirallis- raw meat

suppress the ability of the host to respond immunologically.

Intestinal flukes- raw fish/vegetation/crab

E.g: Plasmodium, Toxoplasm,Trypanosoma and Trichinella

73

Water containing cyclopes. e.g. Dranculculus medinensis74

By:Gessessew B

By:Gessessew B

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ROUTES OF...CONTD

2. Penetration of the skin:

Contact

with faecally polluted soil:

e.g. Hook worm, S.stercoralis

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with water:
e.g. Schistosoma species

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Contact

3. Insect bite:
e.g. Plasmodium species, Filarial worms,
Trypansoma species, Leishmania spp..
4. Sexual contact:-e.g. Trichomonas vaginalis

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5.Transmammary (breast milk):

Modes of transmission of parasites

e.g. S.stercoralis, hookworm(A.duodenale )???

I. Direct mode of transmission:

7. Transplacental:- e.g. Toxoplasmo gondii

If

the parasite does not require biological vector

and/or intermediate hosts & require only a single
host to complete its life cycle.
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By:Gessessew B

6. Inhalation of contaminated air:- e.g.

E.vermicularis

78

The

parasite may also use mechanical vectors for

transmission.

8. Kissing: e.g. T.gingivalis, T.tenax

e.g. A.lumbricoides
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Modes of...contd

MODES OF...CONTD

Two kinds of direct transmission

II. Indirect mode of transmission

If

the parasite has complex life cycle and requires

biological

vectors

and/or

one

or

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By:Gessessew B

A. Horizontal direct mode of transmission

Feco-oral
Sexual intercourse
Blood transfusion
Direct skin penetration
B.Vertical direct mode of transmission
Transmission of the parasite from the mother to child
through:
Congenital/transplacental
81
Transmammary (breast milk)

more

intermediate hosts for transmission,

E.g. Plasmodium species requires intermediate
host(human host).
82

In medical parasitology, it is very important to deal with

Morphology
Geographical

Life

Of Infection

Cycle: Simple/Complex

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By:Gessessew B

Means

Distribution,

Host/Parasite Relationship,
Pathology

&Clinical Manifestations Of Infection,

Laboratory Diagnosis:
83

Treatment

Specimens

and Preventive/ Control Measures 84 Of

Parasites.

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II. Geographical distribution: depends upon

I. Morphology
size, shape, color
various stages of their development

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

in lab.diagnosis:
1.To
identify
different
stages
of
development
2.To differentiate between pathogenic &
commensal organisms.
85

E.g. E.histolytica & E. coli.

Host specificity, -A.duodenale Vs A.caninum

Food habits-consumption of raw/undercooked

meat /vegeEth, Lebanon

b. Portal of exit :
parasites released along with faeces & urine
(widely distributed)
Parasites w/c require a vector or direct body 86
fluid
contact..less distributed

Geographical distribution..contd

III. Life cycle of parasites:

c. Environmental conditions:

Route

from time of entry to exit, including

outside envt

that

do

not

require

an

IH(vector) widely distributed

By:Gessessew B

d. presence of appropriate vector /IH :

By:Gessessew B

To, H2O, humidity

parasites

By:Gessessew B

By:Gessessew B

Important

Simple life cycle: when only one host is involved,

or
Complex life cycle: one or more IH.

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LIFE CYCLE OF.CONTD

A

Laboratory diagnosis :

parasites life cycle consists of two phases

the

ff specimens could be selected for lab.

diagnosis:

1. route of parasite inside the body: helps to

89

b) Stool:

intestinal parasitic infections, helminthic

parasites

intestine,
protozoan
In

infections: Amoebiasis, Giardiasis, etc.

the case of helmithic infections, the adult worms,

their eggs, or larvae are found in the stool.

91

a) Blood: When any stage of the parasites

circulates in the blood stream,

E.g. malaria parasites are found inside the
RBCs.

90

c) Urine: when the parasite localizes in UT,

eggs of S.haematobium are found in urine.
W.bancrofti infection, microfilariae are
found in urine.
By:Gessessew B

By:Gessessew B

localizing biliary tract & discharge eggs into

By:Gessessew B

By:Gessessew B

understand : symptoms & pathogenesis of the parasite.

diagnosis & selection of appropriate
medication
2. route of parasite outside the body:
epidemiology,
Prevention & control.

d) Sputum:
When the parasite inhabits RT,(eggs of
Paragonimus westermani
In amoebic abscess of lung/liver-bursting into
the lungs,
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e) Biopsy material: a slit or section of tissue

Treatment

is taken
Many

parasitic infections can be cured by

specific chemotherapy.

By:Gessessew B

muscle biopsy for Cysticercosis,

By:Gessessew B

spleen punctures for kala-azar,

Skin snip for Onchocerciasis.

f) Urethral or vaginal discharge

Trichomonas vaginalis

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Prevention and control

Preventive measures to successful parasitic eradication:
Reduction of the source of infection

Proper waste disposal

By:Gessessew B

Sanitary control of drinking water and food

Use of insecticides & other chemicals

Protective clothing

Good personal hygiene

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Avoidance of unprotected sexual practice

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