INTRODUCTION TO

PARASITOLOGY
Pamanatasan ng Lungsod ng Maynila
Modified by: Maria Cielo B. Malijan, MD, DPPS, FPSDBP
Biological Relationships
• Symbiosis:
– is the living together of unlike organisms
– may also involve protection or other advantages to
one or both partners

• Different forms of symbiosis:

– distinguished on whether or not the association is
detrimental to one of the 2 partners.
• Commensalism
• Mutualism
• Parasitism
 Biological Relationships
Biological Relationships

Commensalism Mutualism Parastitism

one species benefits from

the relationship without
harming or benefiting the
other

e.g. Entamoeba coli in the

intestinal lumen is supplied
with nourishment and is
protected from harm,
while it does not cause any
damage to the tissues of its
host.

Organism 1 = (+)
Organism 2 = (0)
Biological Relationships
Biological Relationships

Commensalism Mutualism Parasitism

2 organisms mutually
benefit from each other

e.g. termites and the

flagellates in their digestive
system, which synthesize
cellulase to aid in the
breakdown of ingested
wood

Organism 1 = (+)
Organism 2 = (+)
Biological Relationships
Biological Relationships

Commensalism Mutualism Parastitism

one organism, the parasite,

lives in or another (the
host), depending on the
latter for its survival and
usually at the expense of
the host

e.g. Entamoeba histolytica

derives nutrition from the
human host and causes
amebic dysentery

Organism 1 = (+)
Organism 2 = (-)
Biological Relationships
Biological Relationships

Commensalism Mutualism Parasitism

Organism 1 = (+) Organism 1 = (+) Organism 1 = (+)

Organism 2 = (0) Organism 2 = (+) Organism 2 = (-)
 What is a parasite?

• a pathogen that simultaneously injures and

derives sustenance from its host
• Parasitology
– area of biology concerned with the
phenomenon of dependence of one
living organism on another

• Medical Parasitology
– Concerned primarily with the animal
parasites of humans and their medical
significance, as well as their
importance in human communities
 PARASITOLOGY
• Parasite
• Host
• Vector
 PARASITES
Parasites

According to Habitat

Endoparasite Ectoparasite Erratic

lives INSIDE Lives OUTSIDE when it is found in an

the body of a the body of a organ which is not its
host host usual habitat

Presence of an presence of an
endoparasite in a ectoparasite
host is called an inside the host is
INFECTION called an
INFESTATION
 PARASITE
Parasites

According to Depemdence on Host

Obligate Parasite Facultative Parasite

need a host at
may exist in a free-
some stage of
their life cycle to
living state or may
complete their become parasitic when
development and the need arises
to propagate their
species

e.g. tapeworms
depend entirely upon
their host for
existence
• Accidental or Incidental parasite: establishes itself
in a host where it does not ordinarily live

• Permanent parasite: remains on or in the body of

the host for its entire life cycle

• Temporary parasite: lives on the host only for a

short period

• Spurious parasite: a free-living organism that

passes through the digestive tract without
infecting the host
 Host: classified based on their role in
the life cycle of the parasite
• Definitive or final host: is one • Paratenic host: one in which
in which the parasite attains the parasite does not
sexual maturity develop further to later
– Humans are the definitive host stages. However, the
in taeniasis parasite remains alive and is
able to infect another
• Intermediate host: harbors susceptible host
the asexual or larval stage of – Paragonimus metacercariae
the parasite in raw wild boar meat can
– Pigs or cattle as intermediate pass through the intestinal
hosts of Taenia spp. while wall of humans and complete
snails are hosts of Schistosoma its development
spp.
 Host
• Reservoir hosts: • Humans are not always
• allow the parasite’s life cycle to
continue and become additional the final host
sources of human infection
– Pigs are reservoirs of Balantidium coli
– Field rats of Paragonimus westermani • Man may be the most
– Cats of Brugia malayi important host in the
spread of the disease or
• Humans are not always the final an incidental host of
host parasites prevalent in
• Man may be the most important
host in the spread of the disease or
other animals
an incidental host of parasites
prevalent in other animals
 Vectors: Responsible for transmitting the
parasite from one host to another
• Biologic vector: transmits • Mechanical or phoretic
the parasite only after vector: transports the
the latter has completed parasite
its development within the
host
• Flies and cockroaches that
• Aedes sucks blood from a feed on fecal material may
patient with filariasis, the carry enteric organisms and
parasite undergoes several transfer these to food
stages of development from the
first stage larva to 3rd stage
larva before it is transmitted
to another susceptible host
 Exposure and Infection
• Carrier: harbors a pathogen without manifesting any signs and
symptoms

• Exposure: process of inoculating an infective agent

• Infection: connotes the establishment of the infecting agent in

the host

• Incubation period (clinical incubation period): period between

infection and evidence of symptoms

• NOTE: Pre-patent period (biologic incubation period): period

between infection or acquisition of the parasite and evidence
or demonstration of infection
 Sources of Infection
1. CONTAMINATED SOIL AND WATER:
most common
• Lack of sanitary toilets & use of human excreta as
fertilizer  favor infection with ascaris,
hookworm

• Water contaminated with cysts of amebae or

flagellates as well as cercariae of Schistosoma

2. FOOD
may contain the infective stage of the
parasite

3. :ARTHROPODS
e.g. mosquitoes as vectors of malaria
and filaria parasites
4. OTHER ANIMALS
(wild or domesticated) may harbor the parasite
– E.g. cats are direct sources of Toxoplasma ifnection

5. OTHER SOURCES
– Another person, his beddings and clothing, the immediate
environment he has contaminated
– E.g. asymptomatic carriers of Entamoeba histolytica working as
food handlers

AUTOINFECTION
where the self is the source of infection as seen in the life
cycles of E. vermicularis, Hymenolepis nana and Strongyloides
stercoralis
 Modes of Transmission
• Mouth
– the most likely portal of entry
– Most cestodes, trematodes and protozoans are food borne

• Skin penetration
– : e.g. hookworms & Strongyloides

• Arthropods:
– as vectors transmit parasites through bites
– Agents of malaria, filaria, leishmaniasis and trypanosomiasis

• Congenital transmission:
– Toxoplasma gondii trophozoites can cross the placenta
– In transmammary infection with Ancylostoma and Strongyloides, the
parasites may be transmitted through the mother’s milk
 Modes of Transmission
• Inhalation
– of air-borne eggs of Enterobius

• Sexual intercourse
– as in the case of Trichomonas vaginalis
 Nomenclature
• Animal parasites are classified according to the International
Code of Zoological Nomenclature

• Each phylum is subdivided into classes which are further

subdivided into orders, families, genera and species
– Further subdivisions of suborder, superfamily and subspecies are
employed at times

• Family names are formed by adding ~idae to the stem of the

genus type

• Names of the genera and species are italicized or underlined

when written
 Life Cycle
• May be simple or complicated

• As the life cycle becomes more complicated,

the lesser the chances are for the individual
parasite to survive

• Perpetuation of a species of parasite depends

upon its ability to ensure transmission from
one host to the next
 Epidemiologic measures
• Cumulative prevalence:
– percentage of individuals in a population infected with
at least one parasite

• Intensity of infection:
– number of worms per infected person
– also referred to as worm burden
– measured directly by counting expelled worms during
treatment; indirectly by counting helminth eggs
excreted in feces expressed as eggs per gram (epg)

• Morbidity:
– clinical consequences of infections that affect an
individual’s well being
 Diagnosis

• Demonstration of parasites
– E.g. eggs, adults, larvae, cysts, oocysts and trophozoites

• Detection of host immune response to the parasites

– E.g. antibodies and antigens
– In light infections when parasites are still immature,
immunoassays may become useful
 Diagnosis
• Specimens for parasitic examination:
• Stool
• Blood
• Urine
• Sputum
• Cerebrospinal fluid
• Tissue aspirate
• Tissue biopsies
• Orifice swabs
 Diagnosis
• Microscopy
• simple, informative, can establish rapid diagnosis; dependent on
skill of microscopist

– Limited by low density of parasites in specimens; may be affected

by stage of the disease, biology of the parasite

– PARASITE CONCENTRATION TECHNIQUES

• require additional equipment, supplies and reagents

– PARASITE CULTURE METHODS

• require a clean bench and special culture media

– Special staining procedures of fluorescent microcopy available for

better visualization
 Diagnosis

• Molecular diagnosis: molecular or DNA-based methods

– Address problems associated with microscopy and
immunodiagnosis
– DNA probes, detection of specific nucleic acid sequences

• Rapid diagnostic tests (RDTs)

– Newer and more advanced methods of immunodiagnosis
– (antigen-capture tests)
– Detects fewer parasites; faster results
– Easy to perform and require minimal training of personnel
 Diagnosis
Immunodiagnosis
• Overcome problems related to microscopic examination

• Detect antigen or antibodies in clinical specimens

– Immunofluorescent Assay ELISA, Indirect
Hemagglutination Assay, RIA, and dot blot

• Antibody detection tests

– Limited in distinguishing active from prior infections
– Useful in detecting exposure and etiology of outbreaks
and in mapping foci of infection
– Serve as alternatives when microscopic exam fails
 Treatment
• Deworming:
– use of antihelminthic drugs

• Cure rate:
– no. (expressed as percentage) of previously positive subjects
found to be egg-negative on examination of a stool or urine
sample at a set time after deworming

– Indicator used to measure reduction in prevalence of infection

• Egg reduction rate (ERR):

– percentage fall in egg counts after deworming

– Indicator used to measure reduction in intensity of infection

 Treatment
• Selective treatment:
– involves individual-level deworming with selection
for treatment based on a diagnosis of infection

• Targeted treatment:
– group-level deworming where the (risk) group to be
treated (without prior diagnosis) may be defined by
age, sex, or social characteristics irrespective of
infection status

• Universal treatment:
– population-level deworming in which the community
is treated irrespective of age, sex, infection
status, or other social characteristics
 Prevention and Control
• Morbidity control:
– the avoidance of illness caused by infections

• Information-education-communication (IEC):
– a health education strategy that aims to encourage
people to adapt and maintain healthy life practices

• Environmental management:
– manipulation of environmental factors or their
interaction with human beings

– aim: prevent or minimize vector or intermediate host

propagation & reduce contact between humans and
the infective agent
 Prevention and Control

• Environmental sanitation:
• interventions to reduce environmental health
risks
– Includes safe disposal and hygienic management of human
and animal excreta, refuse and waste water
– Involves the control of vectors, intermediate hosts, and
reservoirs of disease
– provision of safe drinking water and food safety
 Eradication versus Elimination
• Disease Eradication:
– permanent reduction to zero of the worldwide incidence of
infection caused by a specific agent, as a result of deliberate
efforts
– continued measures no longer needed

• Disease Elimination:
– reduction to zero of the incidence of a specified disease in a
defined geographic area as a result of deliberate efforts
– Continued intervention/surveillance still required
 Damage Caused By The Parasite To Teh Host

• interference with the vital processes of the host

through the enzyme systems (most common)
– Secretory and excretory products of parasites allow them to
metabolize nutrients from the host
– Ex: E. histolytica trophozoites secrete cysteine proteinases -
digest cellular materials & and degrade epithelial basement
membrane facilitating tissue invasion

• Invasion and destruction of host tissue

– Plasmodium invades rbc, and causes its rupture

• Deprivation of the host of essential nutrients &

substances
– Heavy hookworm infestation causes iron deficiency anemia
 Effects of the Host on the Parasite

• Genetic make-up of the host

– influence the interaction with the parasite
– sickle-cell trait confers some protection from
Falciparum malaria

• Nutritional status of the host

– high protein diet not suitable for the development
of intestinal protozoan

• Immune processes
– Acquired immunity important in modifying severity
of disease in endemic areas
 Immune Defense Against Parasitic Infections

• Non Specific Defenses

– intact skin: hookworms synthesize a protein that
aids in the penetration process
– acidic pH of vaginal secretion and gastric juice:
T. vaginalis trohphozoites: unable to survive the
acidic environment of the vagina

• Mucus secretions
– envelop parasites (G. lamblia) affecting its motility
and reducing pathology on the host

• Chemical components of body fluids

– Lipase content of breastmilk: toxic go G. lamblia in
vitro
Immune Defense Against Parasitic Infections