CHAPTER 1 I GENERAL INTRODUCTION: PARASITOLOGY

Chapter Outline:
 Introduction & Terminology  Life cycle of the Parasite
 Parasites  Transmission of the Parasite
 Hosts  Immunology of the Parasitic Disease
 Vector  Pathogenesis of the Parasite
 Host-Parasite Relationship  Laboratory diagnosis of the Parasitic diseases

------------------------------------------------------INTRODUCTION & TERMINOLOGY--------------------------------------------------

Parasitology EXPOSURE & INFECTION

- An area of biology that is concern with the
phenomenon of dependence of one organism
on another.
Medical Parasite
- Deals with the parasites, which cause human
infections and the diseases they produce.
It is broadly divided into two parts:
1. Protozoology
2. Helminthology

EPIDEMIOLOGIC MEASURES
Epidemiology
- Study of patterns, distribution, and occurrence
Reservoir (Host)
of disease.
- A host harbouring pathogen that serves as the
Incidence
source of infective agent that transmits
- Number of new cases of infection appearing in a
infectious substance to human or another
population in a given period of time.
susceptible host without harming to itself. Often
Prevalence
no symptoms (Asymptomatic).
- Number (usually expressed as percentage) of
Carrier
individuals in a population estimated to be
- A person who is infected with parasite without
infected with particular parasite species at a
(any clinical or subclinical disease) manifesting
given time.
any signs and symptoms.
ADDITIONAL INFO: Example: All anthroponotic infections and vertical
Cumulative Prevalence transmission of congenital infections.
- Percentage of individuals in a population Exposure
infected with at least one parasite. - Process of inoculating an infective agent,
Morbidity infection connotes the establishment of the
- Clinical consequences of infection or disease infective agent in the host.
that affect an individual’s well-being. Prepatent Incubation Period (Biological Incubation
Endemic Period)
- Disease maintains a steady, moderate level. - Period between infection and acquisition of
Hyperendemic parasite and evidence demonstration of
- Prevalence of disease is high. infection.
Epidemic Entry of the infective third-stage larvae -> till the first
- Sharp rise in the incidence or an outbreak of appearance of microfilariae in circulation.
considerable intensity. 1. Initial exposure
Sporadic 2. Detection of microfilariae
- Disease appears occasionally in one or at most a Clinical Incubation Period
few members of the community. - Period between infection and evidence of
symptoms.

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NOTE
Entry of the infective larvae -> till the development Superimposition
of the earliest clinical manifestation. - Means high infection, e.g. Ascaris
1. Initial exposure lumbricoides.
2. Detection of microfilariae Scolex
3. Manifestation of clinical signs and - Head of tapeworm
symptoms Carl Lennaeus
Autoinfection (Self Infection) - Father of Taxonomy
- Results when an infected individual becomes his - Famous for creating a system of naming
own direct source of infection. plants and animals – binomial system of
- It is observed in Cryptosporidium parvum, nomenclature.
Taenia solium, Enterobius vermicularis, Species Name
Strongyloides stercoralis and Hymenolepis nana. - Genus + Specific Epithet (naming parasite)
- Finger-to-mouth transmission, e.g. pinworm – if not ITALICIZED then UNDERLINE
Generic Name
SUB CLASSIFICATION
- Single word in Initial Capitalized
Retroinfection (External Autoinfection) e.g. Enterobius Specific Name
vermicularis - Always begins with Small letter.
- From anus to colon, causes heavy parasitic load
in the host (continued infestation). The term "parasite" is usually applied to Protozoa
- Infection which occurs due to third stage larvae (Unicellular organisms) and Helminths (multicellular
organisms)
migrating back into the host.
Internal reinfection (Internal Autoinfection) e.g.
REMEMBER!!!
Strongyloides The names of the Genera and Species are ITALICIZED
- From anus to mouth or UNDERLINED when written.
- Happens by the pathogen already present within
the body.
Superinfection (Hyperinfection)
- Parasitic load is high
- When the already infected individual is further
infected with the same species leading to
massive infection with same parasite.
Co-infection
- Stimulates infection by multiple pathogens
species.
-----------------------------------------------------------------PARASITES-------------------------------------------------------------------

Parasites - A parasite living outside the body of a host.

- Living organisms, which depend on a living host Infection
for their nourishment and survival. - The presence of an ectoparasite on a host.
- They multiply or undergo development in the Free-living Parasite (e.g. cystic stage of Naegleriafowleri)
host. - Nonparasitic stages of active existence, which
BINOMIAL NOMENCLATURE live independent of the host.
Endoparasite (infestation) e.g. Anthropods, Leishmania
According to HABITAT
- A parasite living inside the body of a host.
Parasites can also be classified as:
- Protozoan and helminthic parasites causing
Ectoparasite (infection) e.g. Lice, ticks, mites
human disease are Endoparasite.
- Inhabit only the body surface of the host
Infestation
without penetrating the tissue.
- Presence of an endoparasite in a host.

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Endoparasite can further be classified as: Aberrant Parasites/Wandering Parasites (e.g., Toxocara in
humans)
Obligate Parasite (e.g. Tapeworms, Toxoplasma gondii,
- They infect a host where they cannot live or
Plasmodium)
develop further. (Toxocara canis (dog
- The parasite, which cannot exist without a host.
roundworm) infecting humans.)
(They need a host at some stage of their life
Permanent Parasite
cycle to complete their development and to
- Remains on or in the body of the host for its
propagate their species.)
entire life.
Facultative Parasite (e.g. Naegleriafowleri,
Temporary Parasite
Acanthamoeba)
- Lives on the host only for a short period of time.
- They can live a parasitic life or free-living life,
Spurious Parasite
when the opportunity arises.
- Free-living organism that passes through the
Accidental/Incidental Parasite
digestive tract without infecting the host.
- Parasites, which infect an unusual host where it
Erratic Parasite (e.g. E. histolytica)
does not ordinarily live. (Echinococcus
- Invade body organs that they do not normally
granulosus infects man accidentally, giving rise
invade
to hydatid cysts.)
----------------------------------------------------------------------------------HOST---------------------------------------------------------------------------

Host
NOTES
- Defined as an organism, which harbors the
parasite and provides nourishment and shelter.
- In some parasites, two different intermediate
hosts may be required to complete different
The host may be of the following types: larval stages. These are known as first and
second intermediate hosts, respectively.
The host may be of the following types: Paratenic Host
Definitive/Final Host (e.g., filaria, roundworm, - It functions as a transport or carrier host
hookworm, anopheles species)
- Widen the parasite distribution and bridge
- One in which the parasite attains sexual the ecological gap between the definitive
maturity. (In taeniasis, for example, humans are and intermediate hosts.
considered the definitive host.) Obligate Host – Permanent
Intermediate Host Facultative Host – Temporary (CAN BE)
- harbors the asexual or larval stage of the Accidental Host– Unusual
parasite. (Pigs or cattle serve as intermediate Aberrant Host – Wandering
hosts of Taenia spp., while snails are hosts of Erratic Host – Unpredictable
Definitive – Adult (sexual)
Schistosoma spp.)
Paratenic – Larvae (asexual)
- (e.g., Amphibian snails are the first intermediate
Reservoir – mostly lower animals
host and aquatic plants are the second inter Carrier – Humans
mediate host for Fasciola hepatica) Accidental – Toxocana canis
Paratenic Host (e.g. fish for plerocercoid larva of D. lalum)
- The parasite does not develop further to later cantonensis, big suitable fish for plerocercoid
stages. (However, the parasite remains alive and larva of Diphyllobothrium latum and freshwater
is able to infect another susceptible host.) fishes for Gnathostoma spinigerum)
- (For example, Paragonimus metacercaria in raw Reservoir host
wild boar meat can pass through the intestinal - Allow the parasite’s life cycle to continue,
wall of humans and complete its development, harbors parasite and acts as an important source
fresh water prawn for Angiostrongylus of infection to other susceptible hosts and

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become additional sources of human infection. Accidental Host

(e.g. dog is the reservoir host of hydatid disease, - They infect an unusual host (e.g., Echinococcus
Pigs are reservoirs of Balantidium coli, field rats granulosus infect humans accidentally)
of Paragonimus westermani, and cats of Brugia Amplifier Host
malayi. - The host, in which the parasite lives and
multiplies exponentially.

-------------------------------------------------------------------------VECTORS-----------------------------------------------------------------------------

Vectors e.g. female Anopheles is the vector of malarial

parasite.
- Responsible for transmitting the parasite from NOTES
one host to another. (usually an arthropod) Biological vectors – True Vectors
Vectors can be: Examples:
Biological vectors • Mosquito: Malaria, filariasis
- A vector, which not only assists in the transfer of • Sandflies: Kala-azar
parasites but the parasites undergo • Tsetse flies: Sleeping sickness
development or multiplication in their body as • Reduviicl bugs: Chagas disease
well. • Ticks: Babesiosis
Mechanical vectors Mechanical vectors - Phoretic vectors
- Only transports the parasite; assists in the Examples:
transfer of parasitic form between hosts but is • Housefly: Amebiasis
not essential in the life cycle of the parasite. • Cocockroaches
Fomite
- Non-living things carriers’ infection, innate
objects that can innate and cause infection.
-------------------------------------------------------------------HOST-PARASITIC RELATIONSHIP------------------------------------------------------
Mutualism
- a symbiosis in which two organisms mutually benefit from each other. (Like termites and the flagellates in their
digestive system, which synthesize cellulase to aid in the breakdown of ingested wood.)

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-------------------------------------------------------------- LIFE CYCLE OF PARASITES---------------------------------------------------------------

Direct life cycle (Simple) - Free-living parasites in water may directly enter
- A parasite requires only single host to complete through vulnerable sites (Naegleria may enter
its development. (e.g. Entamoeba histolytica through nasopharynx).
requires only a human host to complete its life Food
cycle.) - Ingestion of contaminated food or vegetables
Indirect life cycle (Complex) containing infeclive stage of parasite (amebic
- A parasite requires two or more species of host cysts, Toxoplasma oocysts, Echinococcus eggs).
to complete its development (e.g. malarial - Ingestion of raw or undercooked meat harboring
parasite requires both human host and infeclive larvae (measly pork containing
mosquito to complete its life cycle) cysticercus cellulosae, the larval stage of Taenia
SOURCES OF INFECTION solium).
Contaminated soil and water Vectors
- Soil polluted with embryonated eggs - A vector is an agent, usually an arthropod that
(roundworm, whipworm) may be ingested or transmits an infection from man to man or from
infected larvae in soil, may penetrate exposed other animals to man ( e.g. female Anopheles is
skin (hookworm). the vector of malarial parasite.)
- Infective forms of parasites present in water Carrier
may be ingested (cyst of amoeba and Giardia). - A person who is infected with parasite without
- Water containing the intermediate host may be any clinical or subclinical disease. (He can
swallowed (Cyclops containing guinea worm transmit parasite to others. For example, all
larva). anthroponotic infections, vertical
- Infected larvae in water may enter by transmission of congenital infections.
penetrating exposed skin (cercariae of Self (autoinfection)
schisotosomes). - Finger-to-mouth transmission, e.g. pinworm
internal reinfection, e.g. Strongyloides.

-----------------------------------------------------------------TRANSMISSION OF PARASITE-----------------------------------------------------------

Oral or feco-oral route Anthropods

- The most common mode of transmission of the - Serve as vectors and transmit parasites through
parasites. Infection is transmitted orally by their bites.
ingestion of food, water or vegetables Examples:
contaminated with feces containing the infective Agents of malaria, filariasis, leishmaniasis,
stages of the parasite. trypanosomiasis, and babesiosis.
Skin transmission
Congenital Transmission
- Infection is transmitted by the penetration of the
- Toxoplasma gondii trophozoites can cross the
larval forms of the parasite through unbroken
placental barrier during pregnancy. In trans
skin.
mammary infection with Ancylostoma and
Examples:
Strongyloides, the parasites may be transmitted
Hookworm infection is acquired, when the larvae
through mother’s milk
enter the skin of persons walking barefooted on
Direct transmission
contaminated soil. Schistosomiasis is acquired when
- Parasitic infection may be transmitted by person-
the cercarial larvae in water penetrate the skin.
to-person contact in some cases, e.g. by kissing

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in the case of gingiva amebae and by sexual

intercourse in trichomoniasis.
Iatrogenic transmission
- It is seen in case of transfusion malaria and NOTES
toxoplasmosis after organ transplantation. Everywhere – Ubiquitous

----------IMMUNOLOGY OF THE PARASITIC DISEASE------

The immune response against the parasitic infections ---------------------Pathogenesis of the Parasite-------------
depends on two factors:
Host factors
- Immune status, age, underlying disease, NOTES
nutritional status, genetic constitution and Acute – sudden & severe
various defence mechanisms of the host Chronic – existing; long duration; e.g. cancer &
Parasitic factors diabetes
- Size, route of entry, frequency of infection, Sub-acute – neither acute/chronic
parasitic load and various immune evasion Latent – waiting to wake up
mechanisms of the parasites. Reinfection – much severe compare to intinial
Broadly, the host immunity against the parasitic diseases
may be of two types:
Clinical infection produced by parasite may take
1. Protective immune response
many forms:
i. Innate immunity ii. Adaptive/acquired immunity
o Acute
2. Unwanted or harmful immune response
(hypersensitive reactions). o Subacute
o Chronic
Infection Immunity Or Premunition Or Concomitant o Latent
Immunity Or Incomplete Immunity o Recurrent
- Immunity lasts till the original infection remains The parasites can cause damage to humans in
active and prevents further infection. (Observed various ways
in malaria, schistosomiasis,trichinellosis, Mechanical trauma:
toxoplasmosis and Chagas’ disease.) Eggs: Trematode eggs being large in size, can be
Innate immunity deposited inside the intestinal mucosa
- resistance which an individual possesses by (Schistosoma mansoni), bladder (Schistosoma
birth, due to genetic and constitutional make-up haematobium), lungs (Paragonimus), liver (Fasciola
Acquired/Adaptive Immunity hepatica) and can cause mecha nical irritation.
- Resistance acquired by an individual during life Larvae: Migration of several helminthic larvae
following exposure to an agent. (Mediated by (hookworms, Strongyloides or Ascaris) in the lungs
antibody produced by B lymphocytes (humoral produce traumatic damage of the pulmonary
immune response) or by T cells (cell mediated capillaries leading to pneumonitis.
immune response) Adult worms: Adult worms of hookworm,
Unwanted or Harmful Immune Responses Strongyloides, Ascaris or Taenia get adhere to the
- Immune responses may be exaggerated or intestinal wall and cause mechanical trauma
inappropriate in the sensitized individuals on re- Space occupying lesions:
exposure to the same antigen; may be harmful - Certain parasites produce characteristic cystic
to the hosts causing tissue damage. lesion that may compress the surrounding

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tissues or organs, e.g., hydatid cysts and Secondary bacterial infections:

neurocysticercosis - Seen in some helminthic diseases
Inflammatory reactions: (schistosomiasis and strongyloidiasis).
- Most of the parasites induce cellular
proliferation and infiltration at the site of their
NOTES
multiplication, e.g., E. histolytica provokes
Things to remember if Inflammation occurs:
inflammation of the large intestine leading to
o Induration – hardening of
the formation of amoebic granuloma. Adult
o Erythema – Reddening
worm of W. bancrofti causes mechanical
o Hotness
blockage and chronic inflammation of the
2 types of sensitivity:
lymphatic’s and lymph vessels. Trematode eggs
1. Immediate Hypersensitivity (wheal and
can induce inflammatory changes (granuloma
flare response)
formation) surrounding the area of egg
- Occurs after 30 minutes
deposition.
2. Delayed Hypersensitivity (erythema and
Enzyme production and lytic necrosis:
induration)
- Obligate intracellular parasites of man
- Seen after 48 hrs
(Plasmodium, Leishmania and Trypanosoma),
produce several enzymes, which cause digestion
and necrosis of host cells. E. histolytica produces
various enzymes like cysteine proteinases, -----------------LABORATORY DIAGNOSIS -----------------
hydrolytic enzymes and amoebic pore forming Most of the parasitic infection cannot be conclusively
protein that lead to destruction of the target diagnosed.
tissue. On the basis of clinical features and physical examination
Toxins: laboratory diagnosis depends upon:
- Some of the parasites produce toxins, which o Microscopy
may be responsible for pathogenesis of the o Culture
disease, e.g., E. histolytica. However, in contrast o Serological test
to bacterial toxin, parasitic toxins have minimal o Skin test
role in pathogenesis. o Molecular method
Allergic manifestations: o Animal inocuJation
- Many metabolic and excretory products of the o Xenodiagnosis
parasites get absorbed in the circulation and o Imaging
produce a variety of allergic manifestations in o Hematology
the sensitized hosts.
Examples: Microscopy
Schistosomes causing cercarial dermatitis, rupture of - An appropriate clinical specimen should be
hydatid cyst producing anaphylactic reactions and occult collected for definitive diagnosis of parasitic
fi lariasis (tropical pulmonary eosinophilia) infections.
Neoplasia: • Following specimens are usually examined to establish
- Some of the parasitic infections can contribute a diagnosis:
to the development of neoplasia (e.g., S.  Stool
haematobium causes bladder carcinoma,  Blood
Clonorchis and Opisthorchis cause  Urine
cholangiocarcinoma)  Sputum
 Cerebrospinal fluid (CSF)
 Tissue and aspirates

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 Genital specimens Culture

Stool Examination - Some p a rasites like Leishmania, Entamoeba a
- Examination of stool is very important fo r the nd Trypanosoma can be cultured in Lhe
detection of intestinal infections like Giardia, laboratory in various axenic and polyxenic
Enlamoeba, Ascaris, Ancylostoma, etc. media.
- Cysts and lrophozoites of E. histolytica, C. Serological Tests
lamblia can be demonstrated in feces. Eggs of - Are helpful for the detection and surveillance of
roundworm and tapeworm are also found in many protozoa and helminthic infections.
stool. The larvae are found in the feces in S. These tests are basically of two types:
slercoralis infection. 1. Tests for antigen detection
Blood Examination 2.Tests for antibody detection.
- Examination of blood is of vital importance for
demonstrating parasites which circuJate in blood Antigen Detection
vessels. - Malaria antigen like P. f alciparum lactate
- Malarial parasite is confirmed by demonstration dehydrogenase (pLDI I) and histidine-rich protein
of its morphological stages in the blood. 2 (HRP-2) are detected by rapid immunochroma
Urine Examination tographic test. Filarial antigens are de tected in
- The characteristic lateral-spined eggs of S. curre nt infection by e nzyme-linke d
haematobium and trophozoites of T. vagina/is immunosorbcnt assay (ELISA).
can be detected in urin e. Microfilaria of W Antibody Detection
bancrofti are often demonstrated in the chylous The following antibody detection procedures are
urine. useful in detecting various parasitic infections like
Sputum Examination amebiasis, echinococcosis and leishmaniasis in man:
- The eggs of P. westermani are commonly • Complement fixation test ( CFT)
demonstrated in the sputum specimen. • Indirect hemagglutination (IHA)
Occasionally, larvaJ stages of S. s/ercoralis and A. • Indirect immunofluoresccnt antibody (IFA) test
lumbricoides may also be found in sputum. • Rapid immunochromatographic test (ICT)
Cerebrospinal Fluid Examination • Enzyme-linked immunosorbent assay test (ELISA).
- Some protozoa like T. brucei, Naegleria, Skin Test
Acanthamoeba, Balamulhia and Angiostrongylus Skin tests are performed by injecting parasitic
can be demonslrated in the CSF. antigen intradermal and observing the reaction.
Tissue and Aspirates Examination Molecular Diagnosis
- The larvae of Trichinella and eggs of Schistosoma - Most frequently used to diagnose human
can be demonstrated in the muscle biopsy parasitic infection are deoxyribonucleic acid
specimens. By histopathological examination of (ONA) probes, polymerase chain reaction (PCR)
brain, Naegleria and Acanthamoeba can be and microarray technique. These tests are very
detected. In ka la-azar, Leishman Donovan (LO) sensitive and specific.
bodies can be demonstrated in spleen and bone Animal Inoculation
marrow aspirate. Trophozoites of Giardia can be - It is useful for the detection of Toxoplasma,
demonstrated in intestinal aspira tes. Trypanosoma and Babesia from the blood and
Trophozoites of E. histolytica can be detected in other specimens.
liver pus in cases of amebic liver abscess. Xenodiagnosis
Genital Specimen Examination - Some parasitic infection like Chagas disease
- Trophozoites of T. vagina.Lis are found in the caused by T. cruzi can be diagnosed by feeding
vaginal and urethral discharge. Eggs of E. the larvae of reduviid bugs with patient's blood
vermicularis are found in anal swabs.

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and then detection of amastigotes of T. cruzi in

their feces.
Imaging
- Imaging procedures like X-ray, ulcrason ography
(USG), computed tomography (CT) scan and
magnetic resonance imaging (MRI) are now
being extensively used for diagnosing variou s
parasitic infections like n eurocysticercosis and
hydatid cyst disease.
Hematology
- Anemia is frequently seen in hookworm
infection and malaria.
 Eosinophilia is frequently present in helminthic
infections.
 HypergammaglobuJinemia occurs in visceral
leishmaniasis.
 Leukocytosis is seen in amebic liver abscess.

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