Parasitology

Parasitology
Divisions of Parasitology:

1. Protozoa
2. Helminthes
a. Roundworms (nematodes)
b. Flatworms - Cestodes (tapeworm) and Trematode (fluke)

• Parasitism:
organism depend upon another for living, one is living at the
expense of the other and harmful, called Parasite, the other
organism is called Host.
• Host: organism harboring the parasite species

• Classification of Hosts:
1-Definitive host:
harbors the adults or final stages or sexual stages
in the development of parasite; ex: man.

2-Intermediate host:
in which you have the larva stages or intermediate
stages in the development.

Ex: Taenia Adult------ man

Larva------ cattle
• Classification of Hosts:
3-Vector:
intermediate/definitive host that actively transmits
a disease organism

4-Paratenic host:
host which the parasite enters, does not undergo
any development or reproduction, but remains
infective to the definitive host.

5-Reservoir host (carrier)

a "living source" of the parasite; not host of
primary concern

Cats are the reservoir of Bartonella henselae.

 LOCATION OF PARASITES WITHIN THE HOST:

1. Coelozoic ‑ lives in cavities of the host; i.e. blood vessels,

peritoneal cavity, lumen of the gut, etc.

2. Histozoic ‑ lives in the tissues of the host, but not within

cells.

3. Cytozoic ‑ intracellular parasites; live within cells of host.

LIFE CYCLES:

1. Direct life cycle

• one host cycle (monoxenous parasite)

2. Indirect life cycle

• one requiring two or more hosts (heteroxenous
parasite).
 Classification of parasites
• General classification: animal parasites are classified according to international
code taxonomy – Each parasite belongs to a:
• Kingdom = Katy = King
Phylum = Perry = Philip
Class = comes = came
Order = over = over
Family = for = for
Genus = Grape = good
Species = Soda = Spaghetti

• in classification, scientific parasitic name is of 2 parts:

Genetic name (one word): plasmodium

Species name (two words): plasmodium falciperum.

• Genus: means group of close related species.

• Species: means population with the same genetic characters.
 Classification of parasites

Parasites

Protozoa Helminthes

Blood and
Intestinal Urogenital Cestodes Trematodes Nematodes
tissue
 Intestinal Urogenital tract Blood and tissue

Leishmaina
Entamoeba histolytica
Trypanosoma
Giardia lamblia Trichomonas Vaginalis
Malaria
Toxoplasma
PROTOZOANS
 Protozoans
General Characteristics
• Protozoa are microscopic unicellular organisms
composed of a nucleus and cytoplasm.
• The nucleus is concerned with reproduction.
 Protozoans

• Protozoans are categorized according to their

method of movements
– Amoeba (Greek meaning: Change)
• Moves with change in shape; while movement it looks like
pseudopod “false feet”
• include the pathogenic Entamoeba which causes dysentery
in humans
– Flagellates
• with whip-like appendages called flagella
• three of the most common and medically significant include
Giardia lamblia, Trichomonas vaginalis, and Trypanosome sp.

– Ciliates
• with presence of hair-like organelles called cilia
• the only parasitic ciliate that causes disease in humans in
Balantidium coli
 Important Terms
• Amoebas move by changing the
shape of their body, forming
pseudopods (temporary foot-
like structures). The word
pseudopod means "false foot."

• Amoeba = from the Greek word

amoibe, which means change.
• Amoeba is sometimes spelled
ameba.
 Important Terms
• Cyst- a tough protective capsule enclosing the larva of a
parasite
• Larva- a distinct young form of parasites
• Trophozoites- a growing stage in the life cycle of some parasites,
when they are absorbing nutrients from the host.
 Entamoeba histolytica
• from Class Sarcodina
– Sarcodina is known class of amoeba

1. Disease: Amoebiasis aka amoebic dysentery; amoebic colitis,

amoebic liver abscess; amoebic lung and brain abscess; cutaneous
amoebiasis, hepatitis

2. Habitat: Large Intestine

NOTE: E. histolytica is the only amoeba that infects the human bowel.
 Entamoeba histolytica
3. Mode of transmission:
Food and drink contaminated w/ feces containing the cysts

4. Diagnosis: Fecalysis

5. Treatment:
Specific treatment for amebic colitis includes Metronidazole.

NOTE: Metronidazole is the DOC for Amoebiasis, Giardiasis, and Trichomonas vaginalis
infection.
 Giardia lamblia
• from class Mastigophora
– Mastigophora is known class of flagellate
• a lumen flagellate
• “Leningrad's curse”
• the first intestinal microorganism to be observed under
microscope

1. Disease: Giardiasis aka flagellate diarrhea

2. Habitat: Small intestine

NOTE: Girdiasis aka Beaver Fever- diarrheal disease

affecting the small intestine
 Giardia lamblia
3) Mode of Transmission: Ingestion of food and
water contaminated with viable cysts of the
parasite. Common among campers and
backpackers after drinking from “clear”
mountain streams.
4) Diagnosis: Direct fecal smear, duodenal
aspiration; Fluoroscopy, X-ray films reveal
mucosal defects.
5) Treatment: Metronidazole and Quinacrine HCl
are the DOC. Diloxanide furoate is used for
asymptomatic carriers.
 Giardia lamblia
• Most G. lamblia infections are usually asymptomatic, but
symptoms are present, such as diarrhea.
• Severe cases of giardiasis show signs of foul-smelling, fatty
stools (steatorrhea) because the organism interferes with the
absorption of fat and fat-soluble vitamins resulting to weight
loss (similar to celiac disease).

NOTE: Celiac disease aka sprue, is an immune reaction in small intestine to eating gluten,
a protein found in wheat, barley and rye. Eating gluten damages your small intestine's
lining and prevents absorption of some nutrients leading to diarrhea, fatigue, weight
loss, bloating and anemia.
 Giardia lamblia
• Cysts is the dormant stage and is environmentally stable.
• When the cysts are ingested, they then go through excystation
to release the active trophozoite stage.
• The trophozoite are the actively metabolizing motile form of
protozoa.
 Trichomonas vaginalis
• from class Mastigophora like G. lamblia

1) Disease: Vaginitis, Trichomoniasis

2) Habitat: Human vagina and prostate gland
3) Mode of Transmission: During sexual intercourse,
pingpong REinfection (infection through married
couples), direct contact with infected fomite, toilet
seats can be also be transmitted but rare.

NOTE: Trichomoniasis or “Trich”- itching in the genital

area, foul vaginal discharge, burning sensation
during urination, and pain with sex.
 Pingpong Reinfection
• Person A is treated during Person B's incubation period.
• Person B then becomes symptomatic after A responded to
treatment.
• This results in an infection that “bounces back and forth” from A/B
to B/A, in pingpong ball like manner.

• Incubation period is the time an infection has begun up to the

occurrence of signs and symptoms.
 Trichomonas vaginalis
4) Diagnosis: Parasite is seen in urine, vaginal
secretion or from vaginal scrapings or
prostatic massage in male.

5) Treatment: Treat infected sexual partners

simultaneously; oral metronidazole 250 mg
daily
 Trichomonas vaginalis
• Trichomoniasis is one of the most common STD.
• Trichomonas vaginalis also have the simplest protozoan life
cycle in which there is no cyst form, so infection is purely by
direct contact.
• Their trophozoites can also survive outside and on fomites for
hours, unlike G. lamblia trophozoites which disintegrate.
 Leishmania donovani
• from class Mastigophora
• a blood or tissue Flagellate (hemoflagellates)

a. Leishmania donovani
b. Leishmania braziliensis
 Leishmania donovani

1) Disease: Visceral Leishamaniasis or Kala-azar aka

“Death Fever” aka Dum-Dum Fever

2) Habitat: Reticuloendothelial cells

3) Mode of Trasmission: Skin bite by arthropod vector

called sandfly or Phlebotomus pappataci

NOTE: Viscera – plural of viscus – internal organs

Common in India = Kala-azar
 Leishmania donovani
4) Diagnosis
a) Depends on the demonstration of the parasites from
puncture of the ulcerated part.
b) Do Montenegro test and NNN culture.
NOTE: NNN stands for Novy-MCNeal-Nicolle

5) Treatment: 2% berberine sulfate as standard

treatment ; Stibufen
– Miltefosine – originally developed as an antineoplastic,
emerging drug used for leish
– Paromomycin – an aminoglycoside
 Leishmania braziliensis
b. Leishmania braziliensis
1) Disease: American leishmaniasis aka espundia aka
uta aka ulcera de los chicleros aka cutaneous-
mucocutaneous leishmaniasis aka
nasopharynngeal leishmaniasis.
 Leishmania braziliensis
2) Mode of Trasmission: Skin bite by arthropod vector called
sandfly or Phlebotomus pappataci
3) Habitat: L. braziliensis lives in tissue cells, endothelial cells
and large monouclears in the involved portions of the skin
and mucous membranes of the nose, mouth and pharynx.
Not seen in circulation and in viscera.
4) Diagnosis: same as L. donovani
5) Treatment: same as L. donovani
 Visceral and Cutaneous Leishmaniasis
• All causative agents of
leishmaniasis are transmitted
by Sandflies.
• They also exhibit marked
ulcerations on the site of
initial infection.
• The promastigote is found on
the insect host (saliva) while it
loses its tail or flagellum when
it is injected to the skin (by
macrophages) and it becomes
the amastigote (on humans).
NOTE: Proboscis is an elongated sucking mouthpart of insects that is typically tubular and flexible
 Trypanosoma brucei gambiense
• from class Mastigophora
1) Disease: Gambian trypanosomiasis, or Mid and West African
Sleeping sickness characterized by splenomegaly, uncontrolled urge to
sleep, and anorexia.
2) Method of transmission
– by Glossina (tsetse) flies, both male and female
– Metacyclic trypomastigote in the salivary gland of tsetse fly is
transmitted to another host by bite and becomes trypomastigote in
the human blood.
– Trypomastigote multiply in body fluids like blood, lymph, and CSF
thru binary fission.
– Tsetse takes a blood meal and the trypomastigote becomes procyclic
trypomastigote in the midgut of fly then becomes epimastigote.
Epimastigote multiply in salivary gland is converted back to metacyclic
trypomastigote.
 Trypanosoma brucei gambiense
3) Habitat: Blood, skin, lymph glands, brain, spinal fluid of host

4) Diagnosis : Based on the characteristic symptoms, history of living or

having lived in an endemic area, and is established by demonstration of
the parasite successively in blood, lymph juice, sternal bone marrow or
CSF.

5) Treatment: Pentamidine, which is the recommended drug for first stage T.

b. gambiense infection. The other drugs (suramin, melarsoprol,
eflornithine, and nifurtimox) used to treat African trypanosomiasis are
also available.

Stibogluconate- the drug of choice for all forms of leishmaniasis

 Trypanosoma brucei rhodesiense

• also from class Mastigophora

1) Disease: Rhodesian trypanosomiasis or East

African Sleeping sickness.
2) Method of Transmission: Skin bite by insect
vector: male and female Glossina (tsetse) flies
3) Habitat: same as T.gambiense
4) Diagnosis: same as for T.gambiense
5) Treatment: same as for T.gambiense
 Trypanosoma brucei rhodesiense
• Gambiense and rhodisiense are morphologically similar but
gambiense only have humans as a significant reservoir,
rhodesiense have many.

• Rhodesian form also invades the CNS earlier than the

gambian form. The gambian form is more chronic, and would
sometimes take several years for the CNS effects to develop.
 Trypanosoma brucei rhodesiense
Treatment:
Suramin and pentamidine – effective but only
before CNS involvement.
Melarsoprol – effective even if with CNS, but is
highly toxic. Melarsoprol is a toxic organic
compound of arsenic.
Eflornithine – Can cross BBB, can act even at late
stages.

NOTE: Compound 606/Salvarsan/Arsphenamine is also Arsenic-based.

NOTE: Arsenic is dubbed as the “Poison of Kings” and the “Saviour of Syphilis”
This is the drug given for the treatment of African
sleeping disease
• Suramin

There is currently no approved drug for the treatment

of American sleeping disease, although there are two
drugs currently used for acute cases only. Which drug
is used for acute cases of American sleeping disease?
• Nifurtimox
 Trypanosoma cruzi
• from class Mastigophora
1) Disease: Chagas disease or south American trypanosomiasis
characterized by swollen lymph nodes,
fever, headache, and local swelling at the
site of bite (chagoma).

2) Method of Transmission
– Posterior station:
• Infective stage (trypomastigote) is transmitted when the vector bites and defecates
on the wound.
– Insect vector:
• Triatomid bug triatomine (reduviid) bug (Triatoma dimidiata). The bug is also known
as the Kissing bug because it usually bites or the lesions often appear near the lips.
 Trypanosoma cruzi
2) Method of Transmission
– Metacyclic trypomastigotes enter wound upon the bite and
defecation of the bug.
– Metacyclic trypomastigotes enter cells. Inside the cells,
trypomastigotes become amastigotes.
– These amastigotes multiply inside the cells thru binary fission.
– Intracellular amastigotes transform into trypomastigotes then burst
out of the cell and go to the bloodstream.
– The bug takes host blood meal. NOTE: The blood of host contains
trypomastigotes.
– In the midgut of bug, trypomastigotes transform into epimastigotes.
– Epimastigotes multiply in the midgut.
– Epimastigotes return to metacyclic trypomastigotes in the hindgut.
NOTE: The vector bites and defecates on the wound.
 Trypanosoma cruzi
3) Habitat: Reticuloendothelial cells of spleen, liver, lymph nodes,
Lymphatic tissue, myocardium, striated muscle cells, Bone
marrow, suprarenal glands, tests ovaries, skin, Intestinal
mucous membrane, and the CNS.

Disease: Usually causes problems cardiovascularly

4) Diagnosis: same as for T. gambiense

5) Treatment: same as for T. gambiense

 Important Notes
• Trypanosoma multiply while in body fluids
(e.g blood, lymph, CSF) while T. cruzi replicate
in gut of vector insects.
 Assignment
• Watch House MD Season 4 episode 13.