PARASITOLOGY

05/18/08

Definition of Terms
MEDICAL PARASITOLOGY - Parasites that infect man and diseases produced PARASITE - An organism dependent on another organism for its survival - Obtains nourishment & shelter from the organism on which it thrives

HOST
- an organism which harbors the parasite & is usually larger than the parasite COMMENSAL - does not damage the host - capable of independent life SYMBIOSIS - parasitic relationship which results in great advantage to each other as compared to disadvantages

OBLIGATE PARASITE - completely dependent on the host

INTERMEDIATE HOST - a host in which the intermediate stage of the parasite develops DEFINITIVE HOST - a host in which sexual reproduction takes place or the adult form of the parasite resides

PARATENIC HOST - a host which acts as transporting agent for the parasite; parasite does not undergo any development INFESTATION - presence of arthropods on the skin of the host ZOONOSIS - diseases transmissible between man & animals

Definition of Terms
Parasitology - The study of parasites and parasitism. Parasite - a plant or animal that lives upon or within another living organism at whose expense it obtains some advantage; include multicelled and singlecelled animals, fungi, and bacteria, and viruses. Those that feed upon human hosts can cause diseases ranging from the mildly annoying to the severe or even fatal. Parasitism - 1. symbiosis in which one population (or individual) adversely affects another, but cannot live without it. 2. infection or infestation with

PARASITES
ECTOPARASITE - on the surface of the host (e.g. fleas) ENDOPARASITE - within the host (e.g. intestinal worms) may be OBLIGATE (entirely dependent on the host) or FACULTATIVE (free- living or associated with the host)

HOSTS
DEFINITIVE - a host in which a parasite attains sexual maturity INTERMEDIATE - a host in which a parasite passes one or more of its asexual stages; designated 1st and 2nd, if there is more than one (e.g. larval & intermediate stages develop) RESERVOIR - an alternate or passive host or carrier that harbors pathogenic organisms or parasites without injury to itself and serves as a source from which other individuals can be infected.

VECTOR
Vector - a carrier, esp. an animal such as an arthropod that transfers an infective agent from one host to another. (E.g. mosquito, tsetse fly, dogs, bats, and other animals) MECHANICAL - an animal vector not essential to the life cycle of the parasite. BIOLOGICAL - an animal vector in whose body the pathogenic organism develops and multiplies

TRANSMISSION
Fecal-oral Vector Direct penetration Favored by: Poor sanitation Abundance of vectors and reservoirs

Subkingdom PROTOZOA
I. Phylum SARCOMASTIGOPHORA RHIZOPODA (AMOEBAE) - both freeliving and parasitic, characterized by the ability to produce pseudopodia during most of the life cycle single-celled pseudopods 2 Forms:
Trophozoites motile stage Cysts resting stage

Entamoeba histolytica
Amoebiasis fecal-oral, contaminated vegetables and H20, sexual contact Trophozoite feeding form; has one locomotor pseudopodium, prominent nucleus, food vacuoles cyst - infective stage; resistant form; 4 nuclei, reduced or absent chromatoidal bars, glycogen deposits Site of excystation: small intestine Site of encystation: Cecum or colon

Entamoeba histolytica
Virulence is related to secretion of cysteine proteinase invasion of intestinal wall Noninvasive normal immune system Invasive immunocompromised
Granulomatous ulcers (amebomas) in the mucous membranes and submucosa. Extraintestinal amoebiasis LIVER (single abscess in the upper right lobe, anchovy sauce); LUNG, BRAIN.

Entamoeba histolytica
Amoebic dysentery fever, profuse diarrhea w/ blood and mucus, severe abdominal pain. Dx:
Trophozoites (in fresh stools) & cysts in stool Flask-shaped ulcers in the intestinal submucosa

Entamoeba histolytica
Amebas multiply by simple binary fission. Survival outside the host depends on the desiccation-resistant cyst form. Encystation occurs in response to desiccation as the ameba is carried through the colon. After encystation, the nucleus divides twice to produce a quadrinucleate mature cyst. Excystation occurs after ingestion and is followed by rapid cell division to produce four amebas which undergo a second division. Each cyst thus yields eight tiny amebas

Entamoeba histolytica

Entamoeba histolytica

Entamoeba histolytica

Entamoeba histolytica

Entamoeba histolytica

Entamoeba histolytica

Entamoeba histolytica

Subkingdom PROTOZOA
I. Phylum SARCOMASTIGOPHORA ZOOMASTIGOPHOREA (flagellates) include all those that have one or more flagella throughout most of their life cycle, simple, centrally located nucleus; many are parasitic in both invertebrates and vertebrates, including humans.

Giardia lamblia
Giardiasis Steatorrhea 2 Forms:
Trophozoite bilaterally symmetrical with 2 prominent nucleoli and 4 pairs of flagella. Flattened w/ a concave ventral adhesive disc (for attachment) Cyst

Transmission: fecal-oral route, contaminated H20, sexual contact

Giardia lamblia
Pathogenesis: coating of the distal villi w/ many trophozoites malabsorption (lipids and lipidsoluble vitamins) Stools are foul-smelling but w/o pus or blood. Dx:
Trophozoites & Cysts in stool Enterotest or String Test

Tx: Metronidazole

Giardia lamblia
Reproduction is by asexual longitudinal division. Trophozoites begin to encyst as the feces dehydrate during passage through the large intestine. Cysts are excreted in formed stool. Ingestion of cysts results in infection.

Giardia lamblia Trophozoites

Giardia lamblia Trophozoites

Giardia lamblia Trophozoites

Giardia lamblia CYST

Giardia lamblia CYST

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Giardia lamblia CYST

05/18/08

Trichomonas vaginalis
Trichomoniasis (Ping-pong infection) Found in the GUT (vulva and vagina), infection is frequently symptomatic Exists only as trophozoite form (single nucleus, axostyle and 5 flagella, undulating membrane) Strictly human, sexually transmitted flagellate Asymptomatic males (reservoirs) Pathogenesis: feeds on host cells and

Trichomonas vaginalis
Symptoms: tenderness, hyperemia, itching, profuse, frothy, malodorous discharge Dx:
Direct wet mount (vaginal secretions, urethral discharge, prostatic secretions, urine sediment). Trophozoites in specimens with jerky tumbling motility

Tx: Metronidazole

Trichomonas vaginalis

05/18/08

Trichomonas vaginalis

Trypanosoma cruzi
Chagas dse. (American trypanosomiasis) Acute dse. - inflammation at the bite site (chagoma), near the eyes (Romana's sign) Chronic stage: megaesophagus, megacolon Reservoirs: armadillo, opossum, rodents, cats, dogs

Trypanosoma cruzi
MOT: Triatomine or Reduvid bug bite, feces at site of bite (metacyclic trypomastigote); blood transfusion, sexual contact Infective stage to man: metacyclic trypomastigote Infective stage to bug: trypomastigotes Tx: Allopurinol, Nifurtimox

TRYPANOSOMA CRUZI
Pathogenisis Intracellular amastigotes divide to form pseudocysts, which release nondividing trypomastigotes into the blood. Trypomastigotes ingested by a vector bug transform in the insect intestine into epimastigotes, which reproduce to form infective metacyclic trypomastigotes, which are expelled in feces and enter a new host through skin abrasions

TRYPANOSOMA CRUZI

TRYPANOSOMA CRUZI

TRYPANOSOMA CRUZI

TRYPANOSOMA CRUZI

TRYPANOSOMA CRUZI

TRYPANOSOMA CRUZI

TRYPANOSOMA CRUZI

TRYPANOSOMA CRUZI

Trypanosoma gambiense/rhodesiense
African trypanosomiasis (Sleeping sickness) Vector: male and female tsetse fly (saliva) Reservoirs: wild game animals Infective stage to man: metacyclic trypomastigotes Infective stage to tsetse fly trypomastigotes Variant surface glycoprotein (VSG) antigenic variation

TRYPANOSOMA GAMBIENSE/RHODESIENSE
Trypanosoma brucei unlike those of T. cruzi, multiply while in the blood or cerebrospinal fluid. Trypanosomes ingested by a feeding fly must reach the salivary glands within a few days, where they reproduce actively as epimastigotes attached to the microvilli of the gland until they transform into metacyclic trypomastigotes, which are found free in the lumen. Around 15 to 35 days after

Trypanosoma gambiense

Trypanosoma gambiense

Trypanosoma gambiense

Trypanosoma gambiense

Leishmania donovani
Intracellular parasite of monocytes and macrophages in humans Cutaneous leishmaniasis skin ulcers Mucocutaneous leishmaniasis (espundia) Visceral leishmaniasis (Kala-azar)Leishmannia.donovani Vector: female Phlebotomus sandfly Reservoirs: dogs, rodents Infective stage to man promastigotes Infective stage to sandfly - amastigotes

Leishmania donovani
Dx: Microscopic examination aspiration of bone marrow, liver or spleen Tx: Sodium stibogluconate, meglumine antimonate

Leishmania donovani

Leishmania donovani

Leishmania donovani

Leishmania donovani

Leishmania donovani

Subkingdom PROTOZOA
II. Phylum CILIOPHORA (CILIATES) - members possess cilia throughout the life cycle; a few species are parasitic. BALANTIDUM COLI (common parasite of pigs) Balantidiasis Largest Human Protozoan Parasite, feed on starch dysentery and colitis Dx: Trophozoites and Cysts in stool Fecal-Oral, cyst-contaminated food Tx: Metronidazole, Doxycycline

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BALANTIDUM COLI

BALANTIDUM COLI

BALANTIDUM COLI

BALANTIDUM COLI

Leishmania donovani

Subkingdom PROTOZOA
III. Phylum APICOMPLEXA (includes SPOROZOA) strictly parasitic protozoans that pass through a complicated life cycle usually involving alternation of a sexual with an asexual generation often require two or more dissimilar hosts to complete their life cycle typically immobile and usually intracellular parasites include many serious pathogens (as the

SPOROZOA
Malaria Plasmodium species P. vivax P. ovale P. malariae P. falciparum Vector: female Anopheles mosquito Sporozoites along w/ saliva are injected in the host (infective stage to man) Gametocytes infective stage to mosquito

SPOROZOA
2 hosts: VERTEBRATE - humans; intermediate hosts (asexual phase - schizogony) in liver and RBC ARTHROPOD - sexual phase (sporogony) Onset of symptoms (10-14 days after erythrocytic cycle) Fever, chills, diarrhea, headache Anemia, hepatosplenomegaly (destruction of erythrocytes)

MALARIA (Life Cycle)

In nature, uninucleate sporozoites in the salivary glands of infected mosquitoes are injected into a human host when the mosquito feeds. sporozoites rapidly invade liver parenchymal cells, where they mature into liver-stage schizonts, which burst to release 2,000 to 40,000 uninucleate merozoites. In P. vivax and P. ovale infections, maturation of the schizont may be delayed for 1 to 2 years (hypnozoites).

MALARIA (Life Cycle)

Within the red cell, the merozoite matures either into a uninucleate gametocyte--the sexual stage, infectious for Anopheles mosquitoes--or, over 48 to 72 hours, into an erythrocyticstage schizont containing 10 to 36 merozoites. Rupture of the schizont releases these merozoites, which infect other red cells. If a vector mosquito ingests gametocytes, the gametocytes develop in the mosquito gut to gametes, which undergo fertilization and mature in 2 to 3

Plasmodium vivax
Tertian malaria (paroxysms recur every 3rd day). Oval-shaped host cells - enlarged Schuffners granules Signet-ring Preferentially invade reticulocytes (young RBC's) Relapse Tx: Chloroquine phosphate then Primaquine (eradicate hypnozoites)

Plasmodium vivax

Plasmodium vivax

Plasmodium vivax

Plasmodium ovale
Benign Tertian same as P. vivax both cause relapses [dormant organisms in the liver (hypnozoites)]

Plasmodium ovale

Plasmodium ovale

Plasmodium ovale

Plasmodium ovale

Plasmodium ovale

Plasmodium ovale

Plasmodium ovale

Plasmodium ovale

Plasmodium malariae
Quartan malaria has Bar and Band forms with Rosette schizonts parasitizes old RBC: normal size Recrudescence TX: Chloroquine

Plasmodium malariae

Plasmodium malariae

Plasmodium malariae

Plasmodium malariae

Plasmodium malariae

PLASMODIUM FALCIPARUM
Malignant tertian malaria multiple ring forms and crescents (gametocytes), schizonts are rare in PBS Massive hemoglobinuria (blackwater fever); cerebral malaria TX: for chloroquine-resistant strains, give Quinine with doxycycline

PLASMODIUM FALCIPARUM

PLASMODIUM FALCIPARUM

PLASMODIUM FALCIPARUM

PLASMODIUM FALCIPARUM

PLASMODIUM FALCIPARUM

PLASMODIUM FALCIPARUM

The end
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