PARASITOLOGY

FUNDAMENTALS OF PARASITOLOGY
 I. BIOLOGICAL RELATIONSHIPS
• Biological relationships
• Symbiosis: relationship between 2 unlike organisms
• Symbiont/Symbiote: the members of the symbiotic relationship
• Examples of Symbiotic Relationships
• Mutualism: both benefit (Ex: termites and flagellates)
• Commensalism: one benefits, one is not affected/unharmed (Ex:
Entamoeba coli in the intestinal lumen)
• Phoretic relationship: one that involves “Phoresis”
• Phoresis: means “to carry”
• The organism is carried and nothing else happens
• Phoront: organism being carried
• No physiologic interaction is involved between the host and the phoront
• Ex: Cockroaches carrying Ascaris eggs

• Parasitism: one benefits (parasite) and one is harmed (host)

• Ex: Entamoeba histolytica in humans
 I. BIOLOGICAL RELATIONSHIPS
• Parasitology: an area of biology that deals with the
dependence of one organism on another
• Study of parasites, its hosts, and their relationships
• Characteristics of parasitic diseases
• Prevalence in developing countries and in lower
socioeconomic population
• Low mortality and morbidity (not deadly per se, usually
neglected, very few people die)
• Limited drug development
• No current vaccines
 II. HOSTS

• Host: species which harbors the parasite

• May show no harmful effects
• May suffer from the pathogenic effects of the parasite

1. Final Host
- Also known as Definitive Host
- Harbors the mature form of the parasite
- Sexual reproduction and maturity takes places in
these hosts
- Common FH are man
 II. HOSTS
2. Intermediate Host
- Harbors immature/larval form of the parasite
- Asexual reproduction takes place
- Ex: Lower animals, vegetation, insects, sometimes
humans (in Plasmodium infections)
3. Vectors
- Responsible for transmission
a. Biologic Vector: there is morphologic change or
transformation of parasite before transmission to
another host
o Parasite is always inside
o Ex: Aedes, mosquitoes, Tsetse fly, ticks
 II. HOSTS
b. Mechanical/Phoretic Vector: no morphologic
change occurs
o Parasite always outside
o Ex: Cockroaches and flies
4. Accidental Host
- Host that harbors a parasite that usually does not
infect it
Ex: Man infected with Toxocara canis
5. Paratenic Host
- Also known as Transfer Host
- Harbors parasites that do not develop to further
stages
 II. HOSTS
- Only transfers from one host to another
- Widens parasite distribution and bridges ecological
gap between definitive and
intermediate hosts
Ex: Boars for Paragonimus westerman
6. Dead-end Host
- Also known as Incidental Host
- Host that does not anymore allow the life cycle of
the parasite to continue
Ex: Humans for Trichinella spiralis
 II. HOSTS
7. Reservoir Host
- Host other than the parasite’s usual hosts that
allows the life cycle to continue
- Animals that can continue the life cycle even in
absence of humans
- Becomes additional sources of human infection
• Examples
o Pigs for Balantidium coli
o Field rats for Paragonimus westermani
o Beavers for Giardia lamblia
o Cats for Brugia malay
 III. PARASITES
1. Obligate
• Parasite that always requires a host to survive
• Most parasites
• Ex: Ascaris, Hookworms, Trichuris, Tapeworms
2. Facultative
• Has a free-living and parasitic phase
• Free-living: phase found in the environment
• When conditions are unfavorable, enters the parasitic
phase
• Ex: Threadworms
3. Commensal
• Non-pathogenic
• Does not cause disease
• Ex: Entamoeba coli
 IV. PARASITES ACCORDING TO HABITAT
1. Ectoparasite
• Parasite lives outside the host
• Infestation: presence of an ectoparasite in a host
• Ex: Ticks, Lice, Fleas
2. Endoparasite
• Parasite lives inside the host
• Infection: presence of an endoparasite in a host
• Most parasites
3. Erratic Parasite
• Parasite not living in its natural habitat
• Ex: Ascaris (when it is not in the small intestine)
4. Accidental Parasite
• Also known as an Incidental Parasite
• Parasite that does not live in its usual host
 IV. PARASITES ACCORDING TO HABITAT

5. Spurious Parasite
• Free-living organism that passes through the GI tract
without infecting the host
6. Temporary
• Transient parasites
7. Permanent
• Remains on host for its entire life
V. PARASITES ACCORDING TO EGG LAYING
CAPACITY
1. Oviparous
• Lays immature eggs (eggs not yet embryonated, egg
has no larva yet)
• Ex: Ascaris, Trichuris
2. Ovoviviparous
• Lays mature eggs (embryonated, larva present)
• Ex: Schistosoma, Clonorchis
3. Larviparous
• Larva-laying
• Ex: Trichinella
 VI. PARASITES ACCORDING TO SEXES
1. Monoecious
• Also known as Hermaphrodites
• Both testes and ovaries found in one parasite
• Ex: Flukes and Tapeworms
2. Dioecious
• Presence of separate sexes
• Female and male parasite
• Ex: Nematodes (except Strongyloides)
3. Parthenogenetic
• Females capable of self-fertilization
• Ex: Strongyloides stercoralis
 VII. PARASITE STAGES
Stages for Helminthes
1. Adult - Mature form
2. Larva - Immature form ; Stages include L1-L3
3. Egg/Ovum
- Nonmotile form
- Resistant stages
- Infective stage (for most parasites): stage that once
ingested, infects the host

Stages for Protozoans

1. Trophozoite - Motile/vegetative stage
2. Cyst – Nonmotile ; Usually the infective stage
 VIII. TRANSMISSION
1. Soil Transmitted Helminthes (STH)
• Hookworms
• Ascardis lumbricoides
• Trichuris trichiura
• Strongyloides stercoralis
2. Vector Borne
• Mosquitoes and ticks (arthropods)
• Plasmodium, Hemoflagellates, Filarial worms
3. Food Borne
• When you are fond of eating different types of food
• Undercooked or raw food
• Fasciola, Opisthorchis, Clonorchis, Echinostoma,
Heterophes, Taenia
 VIII. TRANSMISSION
4. Water Borne • Drinking contaminated water
• Giardia, Cryptosporidium
5. Vertical Transmission • Congenital transmission
• Toxoplasma gondii
6. Transmammary • Drinking of breast milk
• Ancylostoma, Strongyloides
7. Skin Penetration • Exposure of skin to soil or water
• Hookworms, Strongy, Schistosoma
8. Inhalation • Of airborne eggs
• Enterobius
9. Intimate Contact • Sexual contact
• Trichomonas vaginalis
 IX. LIFE CYCLES
Life cycles: how the parasite develops

• Direct: no intermediate host, only consists of a parasite

and a final host
• Indirect: has an intermediate host
o Migration of larval stages present in some parasites
o Ex: Plasmodium
• Life cycle more complicated = lesser chances for
parasite to survive
 X. EXPOSURE AND INFECTION
Disease
• Presence of signs and symptoms
Pathogen
• Any organism that causes disease
Infection
• Not equal to disease
• Establishment of an organism in one host (with
multiplication of organism)
• No destruction of tissue yet
Carrier
• Harbors the organism, but person shows no signs or
symptoms
• Also like a reservoir
 X. EXPOSURE AND INFECTION
Incubation Period
• Period between infection and appearance of signs and
symptoms
• In this period, there are no symptoms
• AKA: Clinical Incubation Period
Pre-patent Period
• Period between infection and evidence/demonstration
of infection
• Positive lab result
• Can be ahead of incubation period, or lesser
• AKA: Biologic Incubation Period
Exposure
• process of inoculating an infective agent
 X. EXPOSURE AND INFECTION
Autoinfection
• infected individual becomes his/her own source of
infection
• parasite does not need to go outside body to
replicate/multiply
• Capillaria, Strongyloides, Enterobius, Cryptosporidium,
Hymenolepis nana
Superinfection
• Also known as Hyperinfection
• Infected individual is further infected with the same
parasite
• Strongyloides
 XI. EPIDEMIOLOGY
Prevalence
• Number of patients infected at one point in time
Cumulative Prevalence
• Percentage of individuals in a population infected with
at least one parasite
Incidence
• Number of new cases
• Measures risk of developing the disease
Sporadic
• Few cases
Endemic
• Ongoing local transmission in one area
 XI. EPIDEMIOLOGY
Epidemic
• Outbreak
• Sudden increase in number of cases
Pandemic
• Whole world
• Worldwide epidemic
Eradication
• Permanent reduction to zero of worldwide incidence
of an infection
• Once achieved, continued efforts to reduce infections
no longer needed
 XI. EPIDEMIOLOGY
Elimination
• Reduction to zero of incidence of a specified disease in
an area
• Continued intervention is needed
Morbidity
• Number of cases
Mortality
• Number of deaths
Intensity of Infection
• Severity of the infection
• Ex: worm burden in Ascaris
 XII. EFFECTS OF PARASITE TO HOST
• May infect humans, but do not cause disease (commensals)
• Can cause injury by release of metabolites/enzymes (Entamoeba
histolytica)
• Can cause invasion and tissue destruction
• Can deprive certain nutrients from hosts (Diphyllobothrium latum:
deprives humans of Vitamin B12 or Cyanocobalamin)
• Tissue damage (Ex: fatty degeneration, albuminous degeneration,
necrosis)
• Tissue changes
o Hyperplasia: increase in number of cells
o Hypertrophy: increase in size of cells
o Metaplasia: change from one cell type to another
o Neoplasia: formation of tumors or neoplasms
• Streamlining: inability of parasite to synthesize certain cellular
components, so they need the help of the host to obtain these
components
 XIII. EFFECTS OF HOST TO PARASITE
• Genetic makeup of host
o Duffy Blood Group Fy(a-b-): confers resistance to Plasmodium
vivax and Plasmodium knowlesi
o Sickle Cell Anemia: confers resistance to Plasmodium falciparum
• Nutrition and diet
o High protein diet inhibits growth of protozoans
o Low protein diet favors development and appearance of
symptoms and complications of amebiasis
o High carbohydrates favors development of some tapeworms
• Natural physical barriers
o Skin: provides surface protection against invasion from parasites
o Mucous membranes: provide external barriers to parasite entry
o Tight junctions: between epithelial cells, prevent passage of
small molecules
o Low pH of vaginal secretions and gastric juices: present a hostile
environment to microorganisms.
 XIII. EFFECTS OF HOST TO PARASITE
• Chemical components of body fluids
o Lipase content of breast milk (toxic to Giardia)
o Lysozyme in tears and saliva (with the IgA content): able to destroy
microorganisms
• Physiologic function of the body
o Peristalsis: motion of the cilia in the digestive tract helps in expelling
parasites
o Coughing: enables expectoration of certain parasites
• Immunity and immune response
o Causes parasite to develop parasite evasion mechanisms
o Parasites eventually become resistant to the immune response
o Absolute immunity rarely happens
o Host can also recognize the invading parasite through its pathogen-
associated molecular patterns
▪ Can also recognize through toll-like receptors (recognize specific molecules that
are nonnative to the body, activated by bacterial components)
XIV. PARASITE EVASION MECHANISMS
• Resistance to immune response
• Immune suppression
• Antigenic variation
o Variant surface glycoproteins (VSGs)
o Variant surface proteins (VSPs)
o Parasite changes its surface proteins or glycoproteins to
avoid detection by the immune system
o Ex: Giardia and Hemoflagellates
• Host mimicry
o Parasite can copy certain proteins/antigens in the body
o Echinococcus granulosus larva: mimics the P antigen in the
P blood group
• Intracellular sequestration
o Parasites hide inside the cell
o Ex: Plasmodium, Babesia, Leishmania
XV. TAXONOMY
 XII. TREATMENT
Deworming
• Use of anthelminthic drugs in an individual or public
health program
Cure rate
• Number of previously positive subjects found to be
egg negative
Egg Reduction Rate
• Percentage fall in egg counts after deworming
Selective Treatment
• Individual-level deworming
• Selection for treatment based on presumptive grounds
• Used in whole populations or defined risk groups
 XII. TREATMENT
Targeted treatment
• Group-level deworming
• Risk group to be treated may be defined by age, sex,
etc.
Universal Treatment
• Population-level deworming
• Community is treated irrespective of age, sex, infection
status, etc.
Preventive chemotherapy
• Regular, systematic, large-scale intervention through
administration of one or more drugs to selected
population groups
 XII. TREATMENT
Coverage
• Proportion of target population reached by the
intervention
Efficacy
• Effect of a drug
Effectiveness
• Measure of the effect of a drug
Drug resistance
• Genetically transmitted loss of susceptibility to a drug
 XIII. PREVENTION AND CONTROL
Morbidity control
• Avoidance of illness caused by infections
Information-education-communication (IEC)
• Health education strategy
• Aims to encourage people to adapt and maintain
healthy life practices
Environmental management
• Planning, organization, performance, and monitoring
of activities for medication or manipulation of
environmental factors
• Done to prevent or minimize vector or intermediate
host propagation
• Also done to reduce contact between humans and
infective agent
 XIII. PREVENTION AND CONTROL
Environmental sanitation
• Intervention to reduce environmental health risks
• Includes safe disposal and hygienic management of
human and animal excreta, refuse, and waste water
Sanitation
• Provision of access to adequate facilities for safe
disposal of human excreta