INTRODUCTION TO

MEDICAL PARASITOLOGY

03/26/2023 By: Tassew Tefera 1

 OUTLINE
 Introduction to Medical Parasitology

 Definition of terms
 Features of parasites

 Source of infections
 Mode of transmission

 Routes of infection
 Pathogenesis of parasites

 General life cycle of parasites

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 Learning Objectives

At the end of this chapter the student will be

able to:
– Define common terms used in medical
parasitology
– Describe Scope of Human parasitology
– Discuss the geographical distribution, mode of
transmission, source of infection, and portal of
entry of parasites
– Explain the general life cycles of parasites

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 1. Introduction to Medical parasitology
1.1. Definition
 Medical parasitology (GK: para = beside
Sitos = food
– The study of the parasites of man and their medical
consequences . 
• It is a subject that deals about:
– the biological features of human parasites,
– the relationship between the human being and the
parasites,
– the prevention, control and treatment of the parasitic
diseases. 

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 Scope of Medical Parasitology

According to the very broad definition of

parasitology, parasites should include:-
viruses, bacteria, fungi,
protozoa and metazoa (multi-celled organisms)
which infect their host species.
However, for historical reasons the first three have
been incorporated into the discipline of
Microbiology. 
Now, it encompasses protozoology, helminthology
and arthropology.

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 Concepts related to medical parasitology

 Symbiosis
• Symbiosis (Greek symbioun, “to live together”)
• a close association of animals or plants of different
species that is often, but not always .
• with each member a symbionts.
• one partner lives in or on another one’s body.
– 3 types:
• Mutualism
• Commensalism
• Parasitism
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 Mutualism
– Permanent association
– Obligatory ,physiological dependent
– Can not survive with out the other
– The mutuals are metabolically dependent
on one another;
– Example ; coexistence of certain species of algae
and fungi that together compose lichens

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 Commensalism
– Association of two different organisms
– Commensalism may be facultative
– One partner is benefited while the other neither
benefited nor injured
– Eg: Entamoeba dispar and human
 Parasitism
– “Eating at another’s table”
– Antagonestic symbiosis
– Association of two different organisms one
partner is benefited while the other is injured.
such as human and different parasite .
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1.2. Features of Parasite
• Parasite (Para - beside, sitos - site, food or eating) is an
organism which lives in or upon another organism called
the host.
• By this definition all infectious agents; viruses, bacteria,
fungi, protozoa, & helminths are parasites, but
traditionally protozoa, helminths & medical arthropod are
studied in Parasitology.
• The parasites of medical importance may be divided into
three major groups:
– Protozoa (one-celled organisms)
– Helminths (worms)
– Arthropods (insects and their allies)
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1.3. Hosts and types of hosts
Host:-Hosts are organism which harbors the
parasite.
In parasitism, it is the injured partner
Mostly large, complex and better regulated bodies
Types of Hosts: -
Definitive host:-
Intermediate host:-
Reservoir host
Paratenic host

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 Definitive host:-
• harbours the adult or sexually mature stages of
the parasite. (In case of worm)
• Normally the larger of the hosts, usually a
vertebrate.
• Definitive host may be human or non-human
living things.
• e.g. man is DH for Schistosoma haematobium and
female Anopheles mosquito is DH for Plasmodium
species

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 Intermediate host:-
• that harbors larval or sexually immature stages of the
parasite
• then moves on to a different host before reproducing.
– Asexual multiplication takes place
e.g. man is IH of malaria parasites.
• Some parasites: have two intermediate hosts termed
1st and 2nd IH may be needed for completion of a
parasite's life cycle.
e.g., snails are the first intermediate hosts & fresh
water fish are the second intermediate hosts for
Clonorchis sinensis.
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Paratenic or Transport Host
– No development occurs but parasite remains alive
and infective to another host
– bridge gap between IH & DH
– May go dormant
– May cause damage
• e.g., dogs and pigs may carry hookworm eggs
Accidental or Incidental Host
– Parasite is in the “wrong” species.
– Parasite usually wanders around and causes great
damage because it doesn’t know where to go then
dies.

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 Reservoir Host
– It is an organism in which the parasite is harboured with
no ill effect until it is transmitted to the main or primary
host.
– Even if the animal is the normal host of the parasite, it
is the reservoir for the zoonotic infection of
people ． Thus ， the reservoir host shares the same
stage of the parasite with humans.
– The animal serves as an important source of infection
for humans
• e.g., water buffalo is the reservoir host for
schistosomiasis.
– They may be:
• Wild animals ------ sylvatic reservoirs
• Domestics animals By:
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Tassewdomestic
Tefera reservoirs 14
 Carrier host: -
– A person who harbors parasites has no any clinical
symptom. He is an important source of infection in
epidemiology.
– e.g. human beings harboring cyst form of
E.histolytica

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1.4. Parasitic infection

• Although parasitic infections occur globally,

the majority occur in tropical regions.
• Factors required for transmission of parasites

1. Source of infection
2. Mode of transmission
3. Susceptible people

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 parasitic …..
1. Source of infection
1. Humans
• They are the source or reservoir in a
majority of parasitic infections (e.g.,
taeniasis, amoebiasis, etc).
• The condition in which the infection is
transmitted from one infected human to
another human is called anthroponoses.

2. Animal
• In many parasitic diseases, animals act as the
source of infection.
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 parasitic…..

 These sources might be

1. Patient:
• persons who have parasites in their body
& show clinical symptoms.
2. Carrier:
• persons who have parasites in their body
& do not show symptoms.
3. Reservoir host:
• animals that harbors the same species of
parasites as man.
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 parasitic…..

2. Modes of Transmission
– It is ways/means how the parasite invades
human body which is numerous & often
complex.

Types transmission

1. Direct mode of transmission

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 parasitic …..
A. Direct Mode of Transmission
• The parasites do not need vectors and/or
intermediate hosts for the completion of their life
cycle.
• It can be classified as Horizontal & Vertical
a. Horizontal Mode of Transmission: person to person
through
• Feco-oral route
• Sexual route
• Blood transfusion
b. Vertical Mode of Transmission: mother to child
through:
• Transplacental
• Transmammary By: Tassew Tefera
03/26/2023 20
 parasitic…..
B. Indirect Mode of Transmission:-
1. Vehicle: non living materials capable of transmitting
infectious agents
• Fomites: bedding & clothing, e.g. E. vermiculais
• Food & water
2. Vector:
• Arthropods that transmits infectious agents from
one individual to another.

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 parasitic …..
Types of Vectors:
1. Biological vectors:
• Characterized by the reproduction and/or
development of the parasite before its transfer
to another host
• Act as transportation & host as well.
– Example: mosquito
2. Mechanical vectors:
• No parasitic development or reproduction occurs
• Act as transportation only.
– Example: fly

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 parasitic…..
• Route of transmission;
– is the specific entrance through which the parasite
invades the human body
– The infective stage, certain form of the parasite, many
be transmitted from one host to another in the
following ways.
1. Oral route
– It is transmitted orally by ingestion of food, water or
vegetables contaminated by the infective stages of the
parasite.
– This MOT is referred to as faecal-oral route (e.g., cysts
of G. lamblia & E. histolytica ； ova of A.
lumbricoides, T. trichura & E. vermicularis).
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 parasitic …..
• Oral route
– Ingestion of raw or undercooked meat, harboring the
infective stage. e.g., pork containing cysticercus
cellulosae, the larval stage of T. solium.
– Ingestion of raw or uncooked fish & crab containing the
infective stage.
e.g., crab or cray fish containing the metacercariae of P.
westermani, fish harboring the metacercariae of
Clonorchis sinensis).
– Ingestion of raw or under cooked water plants,
harbouring the infective stage.
• e.g., water chest nuts, etc., containing metacercariae
of Fasciolopsis buski and Fasciola hepatica.
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 parasitic …..

2) Penetration of the skin and mucous

membrane
– Penetration of the intact skin by filariform
larvae of hookworm, S. stercoralis on
coming in contact with faecally polluted
soil.... Ground itch
– Piercing the skin by cercariae of
Schistosoma japonicum, S. mansoni & S.
haematobium on coming in contact with
infected water...swimmer’s itch
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 parasitic …..
3) Inoculation by an arthropod vector
– The infection also can be transmitted by
A. Inoculation into the blood by Anopheles
(vector for Plasmodium).
B. Inoculation into the skin by mosquitoes
(vectors for Wuchereria bancrofti,
Brugia malayi etc).
4) Sexual contact
– T. vaginalis is transmitted by sexual contact.

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2. Host parasite inter-relationships
2.1. Pathogenesis
• The prefix “path” refers to disease.

• Pathogenesis refers to the series of steps or mechanisms involved

in the development of a disease

• Factors that greatly affect the outcome of parasitic infection or

infestation are:
– The parasite’s size and location of the infection,

– The immune response the organism stimulates, may either result

in physical damage to the host or destruction of the parasite

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Patogenesis….
 Pathogenesis of the parasitic diseases is depends on the
complex interaction of a variety of host and parasitic factors.
A. Host Factors
1. Genetic factors, E.g. Black population who lack Duffy antigen
resist P.vivax
2. Nutritional status of the host, malnutrition or under
nutrition.
3. Immune response to parasitic infection
4. Immune status of the host whether there is immuno-
suppression or not.
5. The presence or absence of the co-existing disease or other
physiological conditions such as pregnancy and HIV.
6. 03/26/2023
The age, sex and level of the immunity at the time of
By: Tassew Tefera 28
infection.
B. Parasite factors
1. Strain of the parasite and adaptation to human host
2. Parasite load ( number of parasite )
3. Site (s) occupied in the body
4. Metabolic processes of the parasite, particularly the
nature of any waste products or toxins produced by
the parasite during its growth and reproduction..

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 2.2. How do Parasites Cause Injury to their
Host?
A. Competition for the host’s nutrients
- Eg. D. latum absorbs vitamin B-12, can cause anemia
- other tapeworms absorb large amounts of proteins and
sugars
-Use of host’s fluids
- hookworm ingests blood, can be up to 250 ml/day
B. Destruction of host tissues
- some injure upon entry, some after established
- eg. Swimmers itch, cercariae penetrate and cause
inflammation
- intestinal worms, after established cause small lesions in
gut, possible secondary infection
- Entamoeba actively digest epithelial cells in large intestine

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C. Tissue changes
- may cause serious consequences to host
- metaplasia, change of tissue cell type to another type. Eg.
Paragonims (lung fluke)
- neoplasia, growth of cell to form a new structure. Eg. Tumors
D. Toxins and secretions
• - some may cause pathogenic response, some may inhibit
immune function
- eg. Mosquito saliva
E. Mechanical interference
• - Elephantiasis (filarial worms) blocks lymphatic system
- Tapeworms in large numbers can block intestine
- Plasmodium can cause RBC’s to stick together and clog
capillaries

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F. Introduction of Pathogenic Microorganisms
– Bacterial infection of lesions produced initially by a
parasite may occur and in some cases may prove
lethal, e.g. tetanus is a well-known complication of
Dracunculus medinensis infection.
– This is the result of the spores of Clostridium tetani
contaminating the ulcers of the foot, produced by D.
medinensis.
– Similarly, the very high urinary carrier rate of
Salmonella typhi in parts of Egypt is due to equally
high incidence of urinary Schistosomiasis caused by
human blood flukes, S. hematobium
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G. Immuno-pathological lesion:
– The immune response the organism stimulates, may either
result in physical damage to the host or destruction of the
parasite
– Inflammatory reaction: many of the parasite induce
inflammatory reactions in the host leading to the formation of
various pathological lesions;
– Allergic manifestation: metabolic & excretory products of the
parasites absorbed in the circulation, produce a variety of
immunological & allergic manifestations in the sensitized
hosts.
e.g. schistosoma liver cirrhosis; when hydatid fluid is released
from the rupture of a hydatid cyst anaphylaxis (allergic
reaction).

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 2.3. Treatment
• Treatment of parasitic diseases is primarily based on
chemotherapy and in some cases surgery & adequate
nutrition.
1. Chemotherapy
– It is employed for the treatment & prophylaxis of the
parasitic infections.
– Many parasitic diseases can be treated by
chemotherapy.
• Albendazole, mebendazole & pyrantal pamoate are
some of the commonly used anthelmintics.
• Praziquantel is used against many cestode (tape
worm) and trematode (fluke infections).
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Treatment.....
• An ideal agent for use in chemotherapy against parasitic
infection should be:
1. Of high therapeutic index
2. Administered orally, preferably in a single dose or
divided doses on the same day
3. Stable over a long period
4. Inexpensive, and
5. Also the parasite should not develop drug resistance.
2. Surgical management
– It is indicated in the parasitic diseases for which anti-
parasitic drugs are not yet available or if not
completely effective.
– It is recommended especially for the hydatid disease,
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 2.4. Prevention and Control
• Prevention of parasitic disease refers to its
interruption.
• Control refers to:
– check the possibilities of dissemination of
infection & epidemics,
– reduce and maintain a low level of parasitic
infections prevalent in human population.
• The understanding of parasite lifecycle is key to
assure control of the diseases
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 Prevention and Control …..
 Control focuses on:
1. Controlling the source of the infection.
• Treatment of the patients, carriers & reservoir
hosts.
2. Intervention at the routes of transmission
• Managing feces & water resource,
• Controlling or eliminating vectors & intermediate
hosts.
3. Protecting the susceptible hosts
• Paying attention to personal hygiene, changing
bad eating habit, taking medicine.

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37
2.5. General Life Cycles of parasites
• Describes the cycle of development of the parasite,
• This may involve
• Passing through a number of developmental stages
& environment.
• Parasitic and non-parasitic stages.
• The life of a parasite can be divided into a number of
phases:
– Growth and maturation,
– Reproductive (sexual and asexual) and
– Transmission phases.
– All vitally important for the successful survival of the
parasite.
• Can be simple or complex
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 Life cycle of parasites
• Definition: It is the route followed by a parasite
from the time of entry to the host -to- exit from
the host.
• Knowledge of the life cycle for the parasite is
necessary for
• interrupting the life cycle & thereby minimizing
the number of infections,
• knowing the correct specimen type required for
identifying the particular parasite

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 Life cycle ….
a. Types of life cycle
1. Monoxenous (simple or direct), when only
one host is involved
• In a simple life cycle all the developmental
stage of the parasite are completed in a
single host.
• --- geo-helminth

2. Heteroxenous (complex or Indirect),

involving one or more intermediate hosts
• Here, many parasites require two different
hosts, one definitive & the other is
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 b. Phases of Life Cycle: two phases

1. Phase I:
– Involves the route a parasite follows inside the body.

– This provides information about symptomatology, pathology &

diagnostic methods of the parasite & selection of appropriate
medication.

2. Phase II:
– The route a parasite follows outside of the body.

– It provides crucial information pertinent to epidemiology,

prevention, & control

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 Parasite Life - generalized mode

Invading Human residing Pathogenesis

Oral stage
Skin Sit
Vector
contac e
t
No
Infective Stage to discharge
.
stage Via:
feces
Urine
(soil, water, animal host, Sputu
m
insect) Vecto
r
Extra-Human development blood
Epidemiolog Diagnosis
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 Why study life cycles?
 Control.
 Treatment.
 Epidemiology.
 For research.

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