Medical Parasitology
16.1 Introduction
A parasite is a living organism, which takes its nourishment and
other needs from a host; the host is an organism which supports the
parasite. The parasites included in medical parasitology are protozoa,
helminths, and some arthropods. The hosts vary depending on whether
they harbor the various stages in parasitic development.
• Ectoparasite – a parasitic organism that lives on the outer
surface of its host, e.g., lice, ticks, mites etc.
• Endoparasites – parasites that live inside the body of their host,
e.g., Entamoeba histolytica.
• Obligate Parasite - This parasite is completely dependent on the
host during a segment or all of its life cycle, e.g., Plasmodium
spp.
• Facultative parasite – an organism that exhibits both parasitic
and non-parasitic modes of living and hence does not absolutely
depend on the parasitic way of life, but is capable of adapting
to it if placed on a host. e.g., Naegleria fowleri
• Accidental parasite – when a parasite attacks an unnatural host
and survives. e.g., Hymenolepis diminuta (rat tapeworm)
• Erratic parasite - is one that wanders in to an organ in which it
is not usually found. e.g., Entamoeba histolytica in the liver or
lung of humans.
Most of the parasites which live in/on the body of the host do not
cause disease (non-pathogenic parasites). In Medical parasitology we will
focus on most of the disease causing (pathogenic) parasites. However,
understanding parasites which do not ordinarily produce disease in
healthy (immunocompetent) individuals but do cause illness in
individuals with impaired defense mechanism (opportunistic parasites) is
becoming of paramount importance because of the increasing
prevalence of HIV/AIDS.
• Definitive host – a host that harbors a parasite in the adult stage
or where the parasite undergoes a sexual method of
reproduction.
• Intermediate host - harbors the larval stages of the parasite or
an asexual cycle of development takes place. In some cases,
larval development is completed in two different intermediate
hosts, referred to as first and second intermediate hosts.
• Paratenic host – a host that serves as a temporary refuge and
vehicle for reaching an obligatory host, usually the definitive
host, i.e., it is not necessary for the completion of the parasite’s
life cycle.
• Reservoir host – a host that makes the parasite available for the
transmission to another host and is usually not affected by the
infection.
• Natural host – a host that is naturally infected with certain
species of parasite.
• Accidental host – a host that is under normal circumstances not
infected with the parasite.
There is a dynamic equilibrium which exists in the interaction of
organisms. Any organism that spends a portion or all of its life cycle
intimately associated with another organism of a different species is
considered as Symbiont (symbiote) and this relationship is called
symbiosis (symbiotic relationships). The following are the three common
symbiotic relationships between two organisms:
• Mutualism is an association in which both partners are
metabolically dependent upon each other and one cannot live
without the help of the other; however, none of the partners
suffers any harm from the association. One classic example is
the relationship between certain species of flagellated protozoa
living in the gut of termites. The protozoa, which depend
entirely on a carbohydrate diet, acquire their nutrients from
termites. In return they are capable of synthesizing and
secreting cellulases; the cellulose digesting enzymes, which are
utilized by termites in their digestion.
• Commensalism is an association in which the commensal takes
the benefit without causing injury to the host. e.g., Most of the
normal floras of the humans’ body can be considered as
commensals.
• Parasitism is an association where one of the partners is harmed
and the other lives at the expense of the other. e.g., Worms like
Ascaris lumbricoides reside in the gastrointestinal tract of man,
and feed on important items of intestinal food causing various
illnesses.
Direct effects of the parasite on the host:
• Mechanical injury – may be inflicted by a parasite by means of
pressure as it grows larger, e.g., Hydatid cyst causes blockage
of ducts such as blood vessels producing infraction.
• Deleterious effect of toxic substances – in Plasmodium
falciparum production of toxic substances may cause rigors and
other symptoms.
• Deprivation of nutrients, fluids and metabolites – parasite may
produce disease by competing with the host for nutrients.
Indirect effects of the parasite on the host:
• Immunological reaction: Tissue damage may be caused by
immunological response of the host, e.g., nephritic syndrome
following Plasmodium infections. Excessive proliferation of
certain tissues due to invasion by some parasites can also cause
tissue damage in man, e.g., fibrosis of liver after deposition of
the ova of Schistosoma.
Basic Concepts of Medical Parasitology
In medical parasitology, each of the medically important parasites
are discussed under the standard subheadings of morphology,
geographical distribution, means of infection, life cycle, host/parasite
relationship, pathology and clinical manifestations of infection, laboratory
diagnosis, treatment and preventive/control measures of parasites.
Morphology - includes size, shape, color and position of different
organelles in different parasites at various stages of their development.
This is especially important in laboratory diagnosis which helps to identify
the different stages of development and differentiate between
pathogenic and commensal organisms.
Geographical distribution - Even though revolutionary advances in
transportation has made geographical isolation no longer a protection
against many of the parasitic diseases, many of them are still found in
abundance in the tropics. Distribution of parasites depends upon:
(a) The presence and food habits of a suitable host:
(i) Host specificity, for example, Ancylostoma duodenale
requires man as a host where Ancylostoma caninum requires
a dog.
(ii) Food habits, e.g., consumption of raw or undercooked meat
or vegetables predisposes to Taeniasis
(b) Easy escape of the parasite from the host - the different
developmental stages of a parasite which are released from the
body along with feces and urine are widely distributed in many
parts of the world as compared to those parasites which require a
vector or direct body fluid contact for transmission.
(c) Environmental conditions favoring survival outside the body of
the host, i.e., temperature, the presence of water, humidity etc.
(d) The presence of an appropriate vector or intermediate host –
parasites that do not require an intermediate host (vector) for
transmission are more widely distributed than those that do require
vectors.
Life cycle of parasites - the route followed by a parasite from the
time of entry to the host to exit, including the extracorporeal (outside the
host) life. It can either be simple, when only one host is involved, or
complex, involving one or more intermediate hosts. A parasite’s life cycle
consists of two common phases one phase involves the route a parasite
follows inside the body. This information provides an understanding of
the symptomatology and pathology of the parasite. In addition, the
method of diagnosis and selection of appropriate medication may also
be determined. The other phase, the route a parasite follows outside of
the body, provides crucial information pertinent to epidemiology,
prevention, and control.
Host-parasite relationship - infection is the result of entry and
development within the body of any injurious organism regardless of its
size. Once the infecting organism is introduced into the body of the host,
it reacts in different ways and this could result in:
(a) Carrier state - a perfect host parasite relationship where tissue
destruction by a parasite is balanced with the host’s tissue
repair. At this point the parasite and the host live harmoniously,
i.e., they are at equilibrium.
(b) Disease state - this is due to an imperfect host parasite
relationship where the parasite dominates the upper hand. It can
result either from lower resistance of the host or a higher
pathogenicity of the parasite.
(c) Parasite destruction – occurs when the host takes the upper
hand.
Laboratory diagnosis – depending on the nature of the parasitic
infections, the following specimens are selected for laboratory diagnosis:
(a) Blood – in those parasitic infections where the parasite itself in
any stage of its development circulates in the blood stream,
examination of blood film forms one of the main procedures for
specific diagnosis. For example, in malaria the parasites are
found inside the red blood cells. In Bancroftian and Malayan
filariasis, microfilariae are found in the blood plasma.
(b) Stool – examination of the stool forms an important part in
the diagnosis of intestinal parasitic infections and also for those
helminthic parasites that localize in the biliary tract and
discharge their eggs into the intestine. In protozoan infections,
either trophozoites or cystic forms may be detected; the former
during the active phase and the latter during the chronic phase.
Example, Amoebiasis, Giardiasis, etc. In the case of helminthic
infections, the adult worms, their eggs, or larvae are found in the
stool.
(c) Urine – when the parasite localizes in the urinary tract,
examination of the urine will be of help in establishing the
parasitological diagnosis. For example, in urinary
Schistosomiasis, eggs of Schistosoma haematobium are found
in the urine. In cases of chyluria caused by Wuchereria bancrofti,
microfilariae are found in the urine.
(d) Sputum – examination of the sputum is useful in the
following:
(i) In cases where the habitat of the parasite is in the respiratory
tract, as in Paragonimiasis, the eggs of Paragonimus
westermani are found.
(ii) In amoebic abscess of lung or in the case of amoebic liver
abscess bursting into the lungs, the trophozoites of E.
histolytica are detected in the sputum.
(e) Biopsy material - varies with different parasitic infections. For
example, spleen punctures in cases of kala-azar, muscle biopsy
in cases of Cysticercosis, Trichinellosis, and Chagas’ disease,
Skin snip for Onchocerciasis.
(f) Urethral or vaginal discharge – for Trichomonas vaginalis
Indirect evidences – changes indicative of intestinal parasitic
infections is:
(a) Cytological changes in the blood – eosinophils often give an
indication of tissue invasion by helminths, a reduction in white
blood cell count is an indication of kala-azar, and anemia is a
feature of hookworm infestation and malaria.
(b) Serological tests – are carried out only in laboratories where
special antigens are available.
Treatment – many parasitic infections can be cured by specific
chemotherapy. The greatest advances have been made in the treatment
of protozoal diseases. For the treatment of intestinal helminthiasis, drugs
are given orally for direct action on the helminths. To obtain maximum
parasiticidal effect, it is desirable that the drugs administered should not
be absorbed and the drugs should also have minimum toxic effect on the
host.
Prevention and control - measures may be taken against every
parasite infecting human. Preventive measures designed to break the
transmission cycle are crucial to successful parasitic eradication. Such
measures include:
• Reduction of the source of infection- the parasite is attacked
within the host, thereby preventing the dissemination of the
infecting agent. Therefore, a prompt diagnosis and treatment of
parasitic diseases is an important component in the prevention
of dissemination.
• Sanitary control of drinking water and food.
• Proper waste disposal – through establishing safe sewage
systems, use of screened latrines, and treatment of night soil.
• The use of insecticides and other chemicals used to control the
vector population.
• Protective clothing that would prevent vectors from resting in
the surface of the body and inoculate pathogens during their
blood meal.
• Good personal hygiene.
• Avoidance of unprotected sexual practices.
Classification of Medical Parasitology
Parasites of medical importance come under the kingdom called
Protista and Animalia. Protista includes the microscopic single-celled
eukaryotes known as protozoa. In contrast, helminths are macroscopic,
multicellular worms possessing well differentiated tissues and complex
organs belonging to the kingdom animalia. Medical Parasitology is
generally classified into:
• Medical Protozoology - Deals with the study of medically
important protozoa.
• Medical Helminthology - Deals with the study of helminths
(worms) that affect man.
• Medical Entomology - Deals with the study of arthropods which
cause or transmit disease to man.
Describing animal parasites follow certain rules of zoological
nomenclature and each phylum may be further subdivided as follows:
Phylum
Subphylum
Class
Superclass Subclass
Order
Superfamily Subfamily
Genus
Species
Classification of Medical Important Parasites
i) Protozoa
(1) Sarcodina (Amoebae)
(a) Entamoeba histolytica
(b) Endolimax nana
(c) Iodamoeba butchlii
(d) Dientamoeba fragilis
(2) Mastigophora (Flagellates)
(a) Giardia lamblia
(b) Trichomonas vaginalis
(c) Trypanosoma brucei
(d) Leishmania donovani
(3) Sporozoa
(a) Plasmodium falciparum
(b) Toxoplasma gondii
(c) Cryptosporidium parvum
(d) Isospora belli
(4) Ciliates
(a) Balantidium coli
ii) Metazoa (Helminths)
(1) Platyhelminthes
(a) Trematodea
(i) Schistosoma japonicum
(ii) Fasciola hepatica
(b) Cestoda
(i) Diphylobotrium latum
(ii) Taenia saginata
(iii) Echinococcus granulosus
(iv) Hymenolepis nana
(2) Nemathelminthes
(a) Intestinal nematodes
(i) Ascaris lumbricoides
(b) Somatic nematodes
(i) Wuchereria bancrofti
16.2 Objectives
• To discuss the various parasites and their respective hosts with its
relationship and effects;
• To identify and recognize medically important parasites; and
• To classify the difference between the Cestodes, Nematodes,
Trematodes, Protozoa, and Arthropod-related parasites.
16.3 Material and Reagents
• Ancylostoma caninum slide
• Ascaris lumbricoides slide
• Diphylidium caninum slide
• Hymenolepis diminuta slide
• Schistosoma japonicum slide
• Taenia saginata slide
• Trichinella spiralis slide
• Trichuris trichuria slide
• Planaria slide
• Aedes slide
• Anopheles slide
• Cules slide
• Pediculus humanus capitis slide
• Compound microscopes
16.4 Microscopic Parasite Observation
1. Examine all available prepared slides under the low and high-power
objectives. Do not use oil immersion objectives since these
parasites have a thick slide preparation. These prepared slides
might break if precautions will not properly follow.
2. Photo document and record your observations in your laboratory
report. Identify the distinguishing microscopic characteristic,
classification, laboratory diagnosis, host-parasite relationship, life
cycle, geographic distribution, treatment, prevention and control.
16.5 Results and Observations
Analyze and interpret your results and discussion in this section. Tabulate
and place your data on the tables below. Add more template summary as
necessary.
Table 16.5.1 Medical parasites summary
Prepared slide specimen Name of specimen
Photograph a representative field
Defining characteristics
Classification
Laboratory diagnosis
Host-parasite relationship
Life cycle
Geographic distribution
Treatment
Prevention and control
