HOST-PARASITE

INTERACTION
Department Parasitology
Faculty of Medicine, Hasanuddin University

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• Pathogenesis: the dynamics of any disease process
• Host-parasite interaction may produce:
– No damage (opportunistic)
– Produce damage (pathogen)
• Damage 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. Congenital anomaly
7. Toxic
8. Allergic phenomena
9. Anaphylactic shock
10. Open the pathway for entry of other pathogens

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1. Traumatic damage
• Superficial: when the parasite invades the skin
– scabic mite (S.scabiei)
– fly maggots

• Internal:
– rupture of the pulmonary capillaries: migration of larval
stages of several helminth
– 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 T.saginata
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 Superficial traumatic damage by S. scabies

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 Superficial traumatic damage by fly maggots

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 2. Lytic necrosis
Due to enzyme produce by parasite
• Function of enzyme:
– make parasite possible to digest available food
– transform the nutriment into their protoplasm
– store it for the production of energy

• Example :
– E.histolytica: lyses tissues for nutritional needs & to
penetrate into tissues of the colon and extra-intestinal
viscera
– extensive necrosis in the liver by F. hepatica

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 Lytic necrosis by Entamuba hystolitica

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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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• W.bancrofti 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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 Pseudotubercle formed around
blood fluke eggs in the liver

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 4. Anemia
• Commonly associated with chronic parasitoses
– Blood loss by hookworm
– Hemolysis by Plasmodium
– Erythropoesis disturbance by Oxyuris vermicularis

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5. Neoplasma growth
• Result of chronic irritation of host tissues
due to parasite
• Found in:
– Ca colon with amebic granulomas
– Schistosoma japonicum/ S. mansoni : hepatic
cirrhosis, colonic, rectal & hepatic carcinoma
– S.haematobium eggs trapped in the bladder
wall & vesical carcinorma in Egypt

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 6. Toxic & 7. 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

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8. Anaphylactic shock

• occurs when there is a sudden release of

the foreign protein in the host's body
– gravid female D.medinensis 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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 Cystisercosis by Taenia soelium

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9. 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
– cutaneus larva migrans due to animal
hookworm

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• schistosome dermatitis

Intolerance (dermatitis) caused by

the cercaria of Schistosome

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 Intolerance (creeping eruption) by animal hookworm

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10. 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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Secondary invasion

Larva migran of animal hookworm

Scabies

Amebiasis

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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
– number of parasites
– organs affected
– sensitivity of the host
– condition 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 or
gastric 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.
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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

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 Treatment
• Best 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 anti-parasitic drug is entirely nontoxic to
human
• The best drug: minimal toxic effect to the host & lethal
action to the parasite
• The successful of the drug depend on:
– 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
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