HOST PARASITE INTERACTION
Sitti Wahyuni, MD, PhD
Department of Parasitology
Medical Faculty, Hasanuddin University
Pathogenesis: the dynamics of any
disease process
Host-parasite interaction may produce:
No damage (opportunistic)
Produce damage (pathogen)
Damage location may:
localized
extend to distant parts of the host's body
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The damage may produce:
1. trauma or physical damage
2. lytic necrosis
3. stimulation of host-tissue reactions
4. anemia
5. neoplastic growth
6. toxic
7. allergic phenomena
8. Anaphylactic shock
9. open the pathway for entry of other pathogens
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1. Traumatic Damage
Superficial: when the parasite invades the skin
scabic mite ([Link])
fly maggots
Internal:
rupture of the pulmonary capillaries: migration of
larval stages of several
extensive trauma & hemorrhage: when the eggs of
Schistosoma spp. escape from mesenteric or vesical
venules
traumatic destruction of the villi when the
hookworms attach into the intestinal wall
acute intestinal obstruction: by Ascaris or [Link]
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Traumatic damage by S. scabies
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2. Lytic Necrosis
Due to enzyme produce by parasite
Function of enzyme:
make parasite possible to digest availale food
transform the nutriment into their protoplasm
store it for the production of energy
Example :
[Link]: lyses tissues for nutritional needs &
to penetrate into tissues of the colon and extraintestinal viscera
intracellular parasites: cause necrosis of the host
cells during the growthment & multiplication
extensive necrosis in the liver by F. hepatica
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3. Stimulation of Host Tissue Reaction
Host tissue reaction:
cellular proliferation & infiltration at the site of
infection
involve systemic increase in certain types of
cells, especially those circulating in the blood
Function:
destroy the parasite
wall it off by fibrous encapsulation
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[Link] in the lymphatic vessels
retrograde to lymph nodes :
hyperplasia of the endothelial
vessels
cellular infiltration into their lumens
perilymphatic fibrosis &
lymphadenitis
temporer or permanent
sequestration of the worms
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Blood flukes in the
intrahepatic portal
veins :
acute hepatitis
in mesenteric or
vesical venules
after the females
ovipositing a
pseudotubercle is
formed around
each egg
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4. Anemia
a certain degree of erythropoiesis may
stimulated in infections which cause
mechanical loss or destruction of the
erythrocytes:
deep extensive amebic invasion of the colon
attachment of hookworms to the intestinalwall
in malaria
commonly associated with chronic
parasitoses
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5. Neoplasma growth
Result of the irritation of parasites to host
tissues
Found in:
Ca colon with amebic granulomas
The flukes in the bile ducts provoke progressive
hepatic cirrhosis in heavy infections
Blood fluke infections associate with colonic,
rectal & hepatic carcinoma
[Link] eggs trapped in the bladder wall
& vesical carcinorma in Egypt
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6. Toxic & Allergic Phenomena
Spiders & ticks: introduce venom when
they insert their mouth parts into the skin
caterpillars elaborate toxins in glands at
the base of delicate hollow hairs
jelly fishes: roultiple stinging cells, each
containing a nematocyst
Blister beetles: have a painful vesicating
fluid
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Anaphylactic shock
occurs when there is a sudden release of
the foreign protein in the host's body
gravid female [Link] begins to migrate
from the viscera to the skin
hydatid fluid is released from the rupture of an
Echinococcus cyst in a body cavity
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8. Intolerance
A greater degree of intolerance may result
from entry of a non adapted parasite
schistosome dermatitis caused by percutaneous
entry of the cercarial larvas of non-human blood
flukes
visceral larva migrans due to migration through
the tissues of the larvas of the dog ascarid, T.
canis.
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9. Secondary Invaders
Entry of parasite may open pathways in the
skin or the intestinal tract for invasion by
other pathogenic microorganisms
Ground itch in the skin: characteristically
complicated by pyogenic bacteria
Chronic amebic colitis & balantidiasis:
accompanied by secunder infection by bacteriae
viruses may introduce into the viscera by invading
& migrating of parasite
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Symptoms
The local or general symptoms are
manifestations of the deranged functions
of the affected organs
The response to parasite may results
- a typical clinical case
- no clinical evidence
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Symptoms depend on:
species of the parasite
condition of the host
organs affected
number of parasites
sensitivity of the host
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Systemic Symptoms
Fever (chills)
Headache
Muscle & joint pains
Lymphangitis & lymphadenitis
Weakness: fatigue, languor,
prostration,neurasthenia, syncope
Debility: loss of weight, malnutrition,
cachexia
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Gastrointestinal Symptoms
Mild: irregular or loss of appetite, hunger or
gnawing sensations, vague abdominal
discomfort
Moderate: anorexia, nausea, vomiting,
abdominal discomfort, diarrhea or
constipation
Severe: diarrhea or dysentery, epigastric,
hypochondric or other abdominal pains &
cramps
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Nervous Symptoms
Psychic
Mild (confusion, irritability, insomnia)
Severe (instability/incoordination, altered personality,
hallucinations, mental deterioration)
Neurologic
Intracranial pressure: headache, vertigo, vomiting,
convulsions, optic neuritis & retinitis & other symptoms of
brain tumor
Parasthesia & amnesia
Encephalitis
Epilepsy
Paralyses
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Allergic Symptoms
Gastrointestinal: anorexia, nausea, vomiting,
diarrhea, abdominal pain & cramps
Cutaneous & subcutaneous: pruritus,
erythematous, macular, papular, purpuric &
eczematous rashes, urticaria, edema & calabar
swellings, lymphangitis
Pulmonary: coughing, sneezing, dyspnea, slight
hemoptysis, transient thoracic pain, asthma
Systemic: fever, headache, sweating, polyarthritis,
photophobia, languor, signs of collapse
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Diagnosis
Clinical manifestations are so general
Many infections give a few & indefinite
symptoms & clinically indistinguishable
Final diagnosis & proper methods of
treatment require the identification of the
parasite in the laboratory
Successful laboratory diagnosis requires a
knowledge of certain fundamental laboratory
procedures
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Laboratory direct diagnosis
Blood: plasmodium, trypanosoma, microfilaria
Liquor cerebrospinalis: trypanosome and toxoplasma.
Sputum: paragonimus westermanii.
Mouth: Amoeba gingivalis and mycoses.
Duodenal intubation: Giardia and trematode eggs
Stool: cyst and trophozoite protozoa, egg and adult
helminth
Urine: eggs of S- haematobium.
Secretion of vagina: trichomonas vaginalis
Skin biopsy: Leshmania.
Laboratory indirect diagnosis
Serologic test : Fleig precipitation for hydatid
cyst.
Skin test : Casoni test for hydatid cyst and
Montenegro test for leshmaniasis.
Immunofluorescence: antigen - antibody
Treatment
An intelligent treatment requires a knowledge
of the parasite:
pathogenic action
intensity of the infection
physical condition of the patient
Need also to consider:
sanitary environment
epidemiology of the disease
the best methods of controlling the spread of the
infection
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No efficient antiparasitic drug is entirely
nontoxic to man
The best drug: minimal toxic effect to the host
& lethal action to the parasite
The successful of the drug depend on:
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Drug choice
patient condition & response
administration method
Dosage
auxiliary therapeutic preparation
aftercare procedures to prevent reinfection
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Prevention
Almost all parasite at some time in its life
cycle is susceptible to intervention
Such weak links in the life cycle may exist
at :
the departure of the parasite from its source
during its extracorporeal existence
at the time of its invasion of man
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Control
Strategy:
reduction of the sources of infection in man
education in personal prophylaxis to prevent
dissemination of infection
reduce opportunities for exposures
sanitary control of water, food, living & working
conditions & waste disposal
destruction or control of reservoir hosts,
intermediate host & vectors
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References :
CLINICAL PARASITOLOGY
By Faust & Russel ( 1st edition since 1937)
Published by Lea & Febiger (Library of Congress Card
Number 57-7440)
BASIC CLINICAL PARASITOLOGY
By David L. Belding (1st edition since 1958)
Published by Appleton Century Croft, Inc ( Library
of Congress Card Number 58-6554)
HUMAN PARASITOLOGY
By Bogitsh, B (Copyright 1998)
Published by Academic Press, Incorporated (ISBN
0121108708)
OXFORD H&BOOK OF TROPICAL MEDICINE
By Eddleston, M (1999)
Published by Oxford University Press,
Incorporated
(ISBN 0192627724)
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a clever person is good
but is better to be a good person
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