MEDICAL PARASITOLOGY

Lecture # 7
Medicobiologic basics of
parasitism. Protozoa
 1. Objects and goals of medical parasitology
Medical parasitology studies structure, features and life cycles of
parasites, interactions in “parasite – host” system, diagnostics,
treatment and prevention techniques of invasive diseas.

Diseases, caused by animals, are called invasive or parasitical diseases.

Subdisciplines of parasitology:
- medical protozoology (Protozoa);

- medical helmintology (Plathelminthes, Nemathelminthes);

- arachnoentomology – biology of Arthopods

Parasites may live in any human organ: brain, lungs, liver, blood,
skeletal muscles, urogenital system, large and small intestine.
 2. Forms of interspecies biotic bonds in
biocoenosis
1) Antibiosis – impossibility of coexistence of two species,
based on competition for nutrition (saprophitic bacteria –
mold fungi, predator and prey).
2) Symbiosis (coexistence):

- mutualism – separate existence of organisms is

impossible (human – microflora of intestine);

- commensalism – one species use food rests of

another species (amoebas);
- parasitism – one species use another as
nutrient source and life environment.
 Key definitions: What is ….?
• Host: “the organism in, or on, which the parasite
lives and causes harm”
- definitive host: “the organism in which the adult
or sexually mature stage of the parasite lives”
- intermediate host: “the organism in which the
parasite lives during a period of its development only”
• Zoonosis: “a parasitic disease in which an animal is
normally the host - but which also infects man”
• Vector: “a living carrier (e.g. an arthropod) that
transports a pathogenic organism from an infected to
a non-infected host”.
A typical example is the female Anopheles mosquito that
 3. Parasitism and parasites classification

True parasitism. Obligatory

Interactions between host and parasite are
legitimate and have evolutionary basis.

False parasitism Random phenomenon for the species (larvae of

flies in case of accidental penetration into the intestine can live
for some time and cause harm)
Facultative Parasite can have gregarious
habit, but when it enters the organism of
the host, it lives in and damages vital
functions of an organism.
Superparasitism Superparasites use other parasites as nutrient
source and life environment.
 Parasitism
Temporary
Parasite visits the host for nutrition
(bloodsucking arthropods)

Permanent
- Stationary (all time is inside the host)
(lice, itch mite)

Periodic (some part of life cycle a parasite lives inside the host)
(follicle mite of intestine)

Larval parasitism
Larva is parasitic form
(botflies)
 4. Adaptations of parasites
Universal – are typical for all parasites: high fertility,
features of reproductive system.
Adaptations for affixion: suctorial disks, cupules, spinelets.
Integuments with antienzymatic covering (endoparasites).
Encystment (in tissues).
Organs for orientation in environment:
photosensitive eyes, thermoreceptors,
Chemoreceptors, organs for movement.
Organs for penetration.
 5. Cycle of development in the host
Life cycle – summation of all ontogenetic stages of the parasite and ways
of passing from one host to the next.
Larvae can have either gregarious habit or parasitic mode of life.
Intermediate host – animal in which development occurs but in which
adulthood is not reached.
Definitive host – animal harbouring the adult or sexually mature stage of
the parasite.
Reservoir host – in this organism pathogenic agent may live for a long
time, accumulating, reproducing and disseminating in surrounding
environment. Often reservoir host = definitive host.
Vector: an arthropod or other living carrier that transports a pathogenic
organism from an infected to a non-infected host. This can be passive
transport or as an essential host in the life cycle of the pathogenic
organism (i.e. a biologic vector).
Carrier: a host that harbours a parasite but exhibits no clinical signs or
symptoms.
 Modes of acquisition
Inoculative - injection of pathogenic agent into
host with carriers spit.
Contaminative - pathogenic agent passively
injects the host (infriction of recurrent fever
agent (typhus) into the injury).
Percutaneous - pathogenic agent actively
injects the host
(larvae of filaria).

Transfer mechanisms:
1. fecal-oral;
2. transmissible.
 Ways of parasite penetration into human

1. aquatic
2. alimentary (with food)
3. transplacental
4. blood transfusion
5. sexual
6. domestic
7. percutaneous
 Parasites localization:
Ectoparasites: live on integuments of the host
- external (live on external integuments – lice, fleas, mosquitoes)
- cutaneous (live in and on skin - itch mite)
- cavitary (live in cavities, that are connected with external
environment – in external auditory passage, nasal cavity)

Endoparasites: are located inside the host

- endocavitary (live in cavities of internal organs – ascarid,
seatworm)
- tissular (are located in tissues and closed cavities – in muscles,
nervous tissue - trichina)
- endocellular (are located in cells – sporozoa, flagellates)
 6. Parasite opposition to the hosts immunity
- Protozoa organisms live inside the cells – there are no
antibodies.
- Parasites localization in tissue fluid – the concentration of
antibodies is five times less, than in blood plasm.
- Parasites in bowel lumen are covered with thick pellicle.
- encapsulating of parasites in tissues.
- antigenic masking.
- Multi-level life cycle (each stage is characterized by its
specific antigenic composition).
- Protozoa are able to change the antigenic structure of
their envelopes.
 7. General Characteristics of Protozoa
Protozoa: a subkingdom consisting of
unicellular eukaryotic animals.
Cells of Protozoa are able to:
- independent nutrition;
- movement;
- protection against enemies;
- persistence in disadvantaged conditions.

Specific organelles of Protozoa:

1) Digestive vacuoles – contain digestive enzymes, are connected with
lysosomes in origin. Nutrition is possible due to phago- or pinocytosis.
2) Organelles for movement – ciliae, flagellae, pseudopodia.
3) Water-expulsion vacuoles – expulse water overplus from the cell
(limnetic Protozoa).
Reproduction of Protozoa:
Asexual – different types of division (mitosis)
Sexual – copulation (fusion of sex cells) and conjugation
(exchange of genetic material)

Life cycle features:

Trophozoite – actively moving and feeding form.
Cyst – motionless form, covered with thick envelope,
has slow metabolism.

Medical significance have next phyla: Sarcomastigophora,

Apicomplexa, Ciliophora.
Diseases caused by Protozoa are named protozoan.
 Classification

Phylum: Class Genera:

Sarcomasti- Trypanosoma, Leishmania, Giardia,

Zoomastigophora
gophora Trichomonas

Entamoeba, Naegleria,
Lobozea
Acanthamoeba

Plasmodium,Toxoplasma,
Apicomplexa Sporozoea Cryptosporidium, Isospora

Ciliophora Rimostomatea Balantidium

Protozoa of large intestine
Entamoeba hystolitica,
subph. Sarcodina:
Trophozoite -
metabolically active stage,
moves with pseudopodia,
ingests erythrocytes, lives
in colon and is found in
fresh diarrheal stool;
divides by binary fission.
Cyst - "vegetative"
inactive form resistant to
unfavourable environmental
conditions outside human
host.
Entamoeba
histolytica

Cysts with 4 visible nuclei. The

mature quadrinucleate cyst measures
8-15 µm in diameter. Survives up to 30
days; excysts to trophozoite on
passing through stomach. Contains
chromotoidal body.
E.histolytica: trophozoite
forma minuta
10-20 µm in diameter. Bacteria and fungi
are present in cytoplasm.
Non-pathogenic form
E.histolytica: trophozoite

forma magna
20-45 µm, with ingested
erythrocytes in the
endoplasm. Cytoplasm is
divided into transparent glassy
ectoplasm and granular
endoplasm. Nucleus with
karyosome. Wide
pseudopodia.

Рathogenic form
 Transfer mechanisms: fecal-oral
Ways of parasite penetration into human: alimentary

Disease states:
- asymptomatic carrier;
- symptomatic infection;
- amoebic dysentery -
mucoid bloody;
- amoebic - liver or lung
abscess.

Diagnostics: stool examination - for trophozoites and cysts,

amoebic serology, abscess aspirate.
E.histolytica: hepatic abscess

E.histolytica, hepatic
abscess: amebic trophozoites
may reach the liver via the portal
vein.
Dissemination to lung, brain and
skin may also take place.
Amoebae usually are not seen in
aspirates and diagnosis is possible
by means of serologic tests.
Entamoeba coli, subph. Sarcodina
The identification of intestinal amoebae
depends on the size and shape of trophozoites
and cysts and on number of nuclei and aspect of
karyosome and chromatin.
E. coli is an harmless commensal of the colon
with a world-wide distribution.

Entamoeba coli trophozoites

measure 20-30 µm and have
a vescicolous nucleus with a large
eccentric karyosome
and an irregulary distributed
peripheral chromatin.
The cytoplasm is vacuolated
containing bacteria and yeast.
 Entamoeba coli
E.coli cysts are spherical and measure
14-30 µm (usually 15-20).
Mature cysts have 8 nuclei with a
large karyosome (central or eccentric)
and an irregular (sometimes regular)
chromatin.

Transfer mechanisms:
- fecal-oral
Ways of parasite penetration
into human: - alimentary
 Protozoa parasites of cavities, connected with
environment
Parasites of mouth cavity
Entamoeba gingivalis, is a non-pathogenic protozoa, reported by some to
cause diseases: amphodontosis, genyantritis , osteomyelitis of jaws. It lives
in/on the teeth, gums, and sometimes tonsils. Entamoeba gingivalis is found
in 95% of people with gum disease and in 50% of people with healthy gums.
No cysts are formed and transmission is entirely by oral-oral contact.
Trophosoite is 10-20 micrometer in
diameter.
It has pseudopodia that allow it to move
quickly.
Spheroid nucleus is 2-4 micrometer.
Numerous food vacuoles, cellular debris,
blood cells and bacteria.
Life cycle of Balantidium coli, ph. Ciliophora:
Balantidiosis is a zoonotic
disease and is acquired by
humans via the fecal-oral
route from the normal host, the
pig, where it is asymptomatic.
Contaminated water is the most
common mechanism of
transmission.
Balantidium coli can produce
hyaluronidase for
implementation into
undamaged walls of intestine.
Diagnostics:
stool examination - for
trophozoites and cysts,
amoebic serology, abscess
aspirate.
 Balantidium coli

Cyst is round and has a tough, heavy

cyst wall made of two layers. It is 50-60
µm in diameter. Usually only the
macronucleus and sometimes cilia and
Trophozoite: contractile vacuoles are visible in the
Two nuclei are visible. The cyst.
macronucleus is long and sausage-
shaped, and the spherical micronucleus
is nested next to it, often hidden by the
macronucleus. Cytostome and
cytopharynx are present. Covered with
cilia. 200 µm long. Pellicula covers
transparent ectoplasm.
 Vaginal protozoa
Trichomonas vaginalis,
Life cycle
subph. Mastigophora

A unicellular (13 µm) flagellate which

moves with 3-4 terminal flagella and a
flagella in an undulating membrane. No
cystic form.
Multiples by binary fision.
Lives in close association with vaginal,
urethral and prostatic tissue.

Causes degeneration and desquamation

of local tissues; mechanism unclear.

Only in humans; no animal reservoir.

Sexual transmission, but also on fomites.
Can persist for 2 years in host.
Trichomonas vaginalis
Trophosoite:
14-30 µm. Pear-shaped. 4
flagella on the front end,
undulating membrane,
axostyle stands proud from the
back end.
Nucleus is oval, picked at both
ends.
There are leukocytes,
erythrocytes and bacteria in
cytoplasm.
 Parasites of small intestine (just 1 species)
Giardia lamblia (lamblia intestinalis), phyllum Mastigophora is
a reason of lambliasis. Occurs as both a flagellated trophozoite and a non-
flagellated cyst form

Trophozoite is 9-21 µm long, motile, with 8 long

flagella, ventral sucker which attaches to
duodenal mucosa; lives only in small intestine;
non invasive.
Cyst is 8-12 µm; oval;
resistant to external
environment, to municipal
chlorination; intermittently
expelled in stool. 4
nucleuses near the front
pole, flagella scraps in
cytoplasm, thick envelope is
laminated from cytoplasm.
Life cycle of Giardia lamblia: - faecal oral spread;
- zoonosis - found in most mammals;
esp. beaver, cattle, cats, dogs, etc.
- 90% of infected are asymptomatic
carriers;
- acute giardiasis includes diarrhea,
gas, anorexia for 1-2 weeks;
- chronic giardiasis - diarrhea,
malabsorption
trophozoites in small intestine

Diagnosis:
- stool examination;
- duodenal fluid (aspirate or string
test);
- giardia antigen detection in stool
 Leishmaniasis
• A protozoan infection involving a number of species of the
genus Leishmania. There are two distinct groups of
clinical presentations - visceral leishmaniasis
(Leishmania donovani, Leishmania infantum ) and cutaneous
leishmaniasis (Leishmania tropica) .
•

It is spread by the bite of certain

types of sandflies.
• Visceral
leishmaniasis:
presenting with a
systemic illness of fever,
splenomegaly and
lymphadenopathy --
other names Kala azar,
Dum Dum fever.
• Laboratory diagnosis of
leishmaniasis can include the
following:
Isolation, visualization, and
culturing of the parasite from
infected tissue
Serologic detection of
• Cutaneous leishmaniasis: presenting
with a skin ulcer or ulcers.
• A varient can also involve mucous
membranes of nose and throat.
Immunity develops after the illness !

Leishmania tropica

Transfer mechanisms: transmissible.

Inoculative - injection of
pathogenic agent into host
with carriers spit.
Geographical distribution

Cutaneous
leishmaniasis

Visceral
leishmaniasis
 Trypanosomites
• T. gambiense and T. rhodesiense cause the
disease African sleeping sickness or
African trypanosomiasis.
 They are transmitted to
humans by the bite of an
infected tsetse fly (a vector)
with east African wild bovine
as the reservoir.

• The disease primarily

involves the lymphatic and
nervous systems of
humans and is diagnosed
by microscopically looking
for Trypanosoma in the
blood, in aspirated fluid
from lymph nodes, or in
spinal fluid.
Trypanosoma gambiense in a blood smear
• T. cruzi causes South American sleeping
sickness or Chagas' disease and is
transmitted by infected Triatomid bugs
(kissing bugs) with the Spiny Anteater as the
reservoir.
 Geographical distribution

American trypanosomiasis African

trypanosomiasis
 Phylum Apicomplexa
Сlass Sporozoa
Malaria - is a group of diseases that are caused by the introduction
of unicellular plasmodium into human erythrocytes (Plasmodium)

• Malaria is
probably one of
the oldest
diseases known
to mankind.
Human pathogens:
Plasmodium vivax,
Plasmodium malariae,
Plasmodium falciparum,
Plasmodium ovale.
• The typical recurring malarial fever
is a result of the lysis of the infected
red blood cells, causing release of
merozoites and their metabolic by-
products.
• Fever cycles of 24, 48, or 72 hours
usually occur depending on the
infecting species.
Malaria is diagnosed by
microscopically looking for
the parasite within
infected red blood cells.
Malaria affects 500 million people worldwide
and kills at least 2 million per year.
 Toxoplasma gondii

• This protozoan
causes the disease
toxoplasmosis. In
adults, the disease is
usually mild and
resembles infectious
mononucleosis.
• It also causes severe
disease in
immunosuppressed
 Symptoms
• Fever
• Sore throat
• Sore muscles and tiredness
• Swollen glands in the neck, armpits or groin
• Temporary blurred vision or loss of vision
• Most people who are infected do not show
any signs of the disease.
• Persons who are pregnant or are
experiencing a suppressed immune system
due to AIDS, cancer or following organ
transplants are at higher risk for illness.
Common ways for people to become
infected with toxoplasmosis include:

• Eating raw or
undercooked meats;
• Drinking
unpasteurized milk
• Cleaning cat litter
boxes
• Working in gardens or
playing in sandboxes
that contain cat feces.