Medical Parasitology

Professor Sudheer Kher

Objectives
List the defining characteristics of protozoa Describe the major characteristics of the six phyla of protozoa and give examples Define intermediate and definitive host Distinguish characteristics of the three groups of parasitic helminthes and give examples

Resource - Chatterjee Ch 1

Why study Parasitology?

Recent estimates of prevalence of parasites in the world are: Ascaris 1.5 billion Hookworms 1.3 billion Whipworms 1 billion Filarial worms 657 million Malaria 500 million Schistosomes 270 million Amebiasis 50 million Taenia tapeworms 50 million Clonorchis 20 million Chagas Disease 15 million These parasites cause untold suffering and death in the world today.

Definitions
Medical parasitology: the study and medical implications of parasites that infect humans A parasite: a living organism that acquires some of its basic nutritional requirements through its intimate contact with another living organism. Parasites may be simple unicellular protozoa or complex multicellular metazoa Eukaryote: a cell with a well-defined chromosome in a membrane-bound nucleus. All parasitic organisms are eukaryotes Protozoa: unicellular organisms, e.g. Plasmodium (malaria) Metazoa: multicellular organisms, e.g. helminths (worms) and arthropods (ticks, lice) An endoparasite: a parasite that lives within another living organism e.g. malaria, Giardia An ectoparasite: a parasite that lives on the external surface of another living organism e.g. lice, ticks

Symbiosis
------The relationship between two living beings (animals). Two living beings live together and involve protection or other advantages to one or both partner. Commensalism Mutualism Parasitism*

Commensalism
------ Both partners are able to lead independent lives, but one may gain advantage from the association when they are together. Dont harm each other.

Fig. A female pea crab in the mantle cavity of its mussel host. The crab does not damage the mussel and uses its shell purely for protection

Mutualism
------ An association which is beneficial to both living things.

Fig. A selection of ciliates from the rumen. The rumen contains enormous numbers of ciliates that break down cellulose in the feed.

Definitions
Host: the organism in, or on, which the parasite lives and causes harm Definitive host: the organism in which the adult or sexually mature stage of the parasite lives Intermediate host: the organism in which the parasite lives during a period of its development only
Reservoir host : Animals harboring the same species of parasites as man. Potential sources of human infection.

Zoonosis: a parasitic disease in which an animal is normally the host - but the parasite also infects man Vector: a living carrier (e.g. an arthropod) that transports a pathogenic organism from an infected to a non-infected host. A typical example is the female Anopheles mosquito that transmits malaria

Important Groups of Human Parasites

Protozoa Amoeba Flagellate Sporozoa Ciliate Helminthes Platyheminthes
Trematodes Cestodes

Nematodes

Arthropoda Mosquito Fly Tick Mite Bug Flea Lice

Taxonomy
Kingdom Animalia Subkingdom Phylum
Subphylum Subphylum

Protozoa Sarcomastigophora
Sarcodina amoeba Mastigophora (Flagellates)

Entamoeba, Nagleria Giardia, Trichomonas, Trypanosoma, Leishmania Plasmodium, Toxoplasma, Cryptosporidium, Isospora Balantidium Microsporidium

Phylum

Apicomplexa (Sporozoa)

Phylum Phylum

Ciliophora (ciliates) Microspora

Terms
Mastigophora movement with flagella e.g. giardia, trichomonas
Sarcodina pseudopodia e.g. entamoeba Apicomplexa apical complex, no locomotor apparatus; sexual reproduction e.g. plasmodium, toxoplasma, cryptosporidium Ciliophora Movement with cilia e.g. Balantidium

General properties of protozoa 1/2

Def Single cell like unit which is morphologically & functionally complete. Morphology Cytoplasm Ectoplasm Hyaline, protective, locomotive & Sensory functions. Ectoplasmic structures Organelles of locomotion Pseudopodia, Flagella, Cilia Contractile vacuoles Rudimentary digestive system cytostome, cytopharynx. Cyst wall

General properties of protozoa 2/2

Endoplasm Granular, nutritive & reproductive functions Nucleus Well defined nuclear membrane, chromatic granules, karyosomes Kinetoplast, Micronucleus & Macronucleus In flagellates. Encystment Inactive, protective and resistant stage

Reproduction Asexual
Binary fission Multiple fissions or schizogony

Sexual
Conjugation in ciliates Syngamy e.g. Plasmodia

Protozoa
Intestinal
Entamoeba histolytica Amoebiasis Giardia intestinalis (lamblia) Giardiasis Balantidium coli Opportunistic infections Isospora belli -doCryptosporidium -doFree living amoeba Acanthamoeba Meningoencephalitis & Keratitis

Vaginal
Trichomonas vaginalis Viginal infections

Naeglaria - Primary Meningoencephalitis

Blood
Plasmodium Malaria Leishmania Kala Azar Trypanosoma Sleeping sickness

Tissue
Toxoplasma gondii - Toxoplasmosis

General properties of Cestodes

Long segmented, tape like, flattened. Variable size, few mm to several meters Adult in GI tract of man / animal Head provided with suckers Hermaphrodites No body cavity No alimentary canal Excretory & nervous systems present Highly developed reproductive system

General properties of Trematodes

Leaf shaped unsegmented, flat. Called Flukes. Size 1 mm to few cms. Presence of suckers. Hermaphrodites, except Schistosomes Incomplete alimentary system. Excretory & Nervous system present. Reproductive system highly developed. Oviparous Eggs operculated except Schistosomes.

Platyhelminths
Cestodes
Taenea saginata -Beef tape worm Taenea solium - Pork tape worm Echinococcus granulosus -Dog tape worm Diphylobothrium latum Fish tape worm Hymenolepis nana Dwarf tape worm

Trematodes
Schistosoma Blood flukes Fasciola hepatica - Liver fluke Parogonymus westermanii -Lung fluke

General properties of Nematodes

Unsegmented worms Variable size 5 mm to 1 meter Complete alimentary canal. Sexes separate Oviparous / Viviparous / Ovoviviparous Generally one host. Occasionally two.

Nematodes
The intestinal nematodes Ascaris lumbricoides Round worm Ancylostoma duodenale Hook worm Trichuris trichura Whip worm Enterobius vermicularis Thread worm / Pinworm Strongyloides stercoralis Dwarf Thread worm The blood- and tissue dwelling nematodes Wuchereria - Filariasis Trichinella spiralis Dracunculus medinensis Guinea worm Oncocerca volvulus River blindness Loa Loa

Life cycle and type of life cycle

Life cycle : The whole process of parasite growing and developing. The direct life-cycle : Only one host (no intermediate host). The indirect life cycle : Life cycle with more than one host (intermediate host and definitive host).

Hookworm life cycle Direct life cycle

Indirect Life Cycle Tape worms

Relationship (Effect) between parasite and host

injury to

Parasites harbour in Host (animal or human)

Produces Immune Response

Effects of the parasites on the host Effects of the host on the parasites

Effects of parasites on the host

Depriving the host of essential substance Hookworm Suck blood Anemia Mechanical effects of parasites on the host Ascaris Perforate/Obstruction Toxic and allergy effect E.h Proteolytic enzyme Necrosis

Parasite antigen Immune system e.g Anaphylaxix

Immune response
Allergy/ Hypersensitivity

The basic factor of transmission of parasitic diseases

Parasitic diseases Infectious diseases Transmission The source of the infection The routes of transmission The susceptible host ----The combined effect of those factors determine the diversity and the prevalence of the parasites at a given time & place and regulate the incidence of the parasitic diseases in local population.

The source of the infection

Patient : Persons who have parasites in their body and show clinical symptoms. Carrier : Persons who have parasites in their body, not show symptoms. Reservoir host : Animals that harbors the same species of parasites as man. Sometimes, the parasites in animals can transmit into human.

The routes of transmission I

Congenital transmission : From mother to infant. Toxoplasmosis Contact transmission : Direct contact--Trichomonas vaginalis; Indirect contact--Ascaris lumbricodes Food transmission : The infectious stage of parasites -->contaminated food / The meat of the intermediate hosts containing infectious stage of parasites.

The routes of transmission II

Water transmission : Drink or contact the water contaminated the infectious stage of parasites. Soil transmission : Contamintion of the soil by feces containing the certain stage of parasites and this stage can develop into stage. Arthropod transmission : Vectors of certain parasitic diseases.

The susceptible host

----In general, most people are susceptible hosts. The parasite reaching a susceptible host must gain entrance and set up a favorable residence in order to complete its life cycle and cause the transmission of parasitic diseases.

The avenues of invasion

Digestive tract : Most common avenue of entrance. (Food/ Water transmission) Skin : Infective larvae perforate skin and reach to body and establish infection. (soil/ water transmission) Blood : Bloodsucking insects containing infective parasites bite the skin and inject parasites into human blood. (Arthropod transmission---malaria).