LEC.1 Parasitology Dr. Maysoon A.

Merdaw
Parasitology is the area of biology concerned with the phenomenon of
dependence of one living organism on another. Medical parasitology
deals with the parasites which infect man, the diseases they produce, the
response generated by him against them, and various methods of
diagnosis, prevention and treatment.
Parasite: is an organism that is entirely dependent on another organism,
referred to as its host, for all or part of its life cycle and metabolic
requirements. Strictly speaking, the term parasite can be applied to any
infectious agent but, by convention, it is generally restricted to infections
caused by protozoa and helminths and excludes the viruses, bacteria and
fungi.
Parasite is of two types:
1-Microparasite: small, unicellular and multiplies within its vertebrate
host, often inside cells. Protozoa are microparasites.
2-Macroparasite: large, multicellular and has not direct reproduction
within its vertebrate host. This category include helminths.
On the basis of their location, parasites may be divided into:
-Ectoparasites: which live on the surface of the body, e.g., the human
louse, Pediculus humanus. The infection by these parasites is known as
infestation. They are important as vectors transmitting pathogenic
microorganisms.
-Endoparasites: which live within the body of the host. All protozoan
and helminthic parasites of man are endoparasites. The invasion by
endoparasites is known as infection. These can be further subdivided into
following types:
-Obligate parasites: organisms cannot exist without a host e.g.
Toxoplasma gondii.
-Facultative parasites: organisms that under unfavorable circumstances
may live either a parasitic or free- living existence e.g. Naegleria fowleri.
-Accidental parasites: organisms that attack an unusual host e.g.
Echinococcus granulosus in man.

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-Aberrant parasites: organisms that attack a host where they cannot live
or develop further e.g. Toxocara canis in man.
-Free- living: the term free-living describes the nonparasitic stages of
existence which are live independently of a host e.g. hookworms have
active free-living stages in the soil.
Host: organism which harbors the parasite and provides the nourishment
and shelter. It is of following types:
-Definitive host: harbors the adult parasite, where the parasite replicates
sexually.
-Intermediate host: the host which alternates with the definitive host and
harbors the larval or asexual stages of a parasite. Some parasites require 2
intermediate hosts for completion of their life cycle.
-Paratenic host: a host in which larval stage of a parasite survives but
does not develop further. It is often not a necessary part of life cycle.
-Reservoir host: can harbor a pathogen indefinitely with no ill effects.
Once discovered, natural reservoirs elucidate the complete life cycle of
infectious diseases, providing effective prevention and control.
-Compromised host: one in whom normal defense mechanisms are
impaired e.g. AIDS. Such hosts are extremely susceptible to a variety of
pathogens.
Host- parasite relationships:
-Symbiosis: an association in which both host and parasite are so
dependent upon each other that one cannot live without the help of the
other. Neither of the partners suffers from any harm from this association.
-Commensalism: an association in which only parasite may benefit
without detectable damage to the host as in case of Entamoeba coli in the
large intestine of man, (One partner benefits but the other is not hurt).
-Parasitism: One partner (the parasite) harms or lives on the expense of
the other (host). The degree of dependence of a parasite on its host varies.
Classification of animal parasite and vectors:
Subphylum Class Order Family Genus
Species
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All of these names must be of Greek or Latin origin or have a classical
termination.
Species: it designates a population, the members of which have
essentially the same genetic characters and are capable of continued
reproduction of their kind, but usually cannot interbreed with individuals
of other species.
Genus: is a group of closely related species.
The scientific designation of a species is a combination of the genus and
species name. This is referred to as binomial nomenclature. Ex.
Entamoeba histolytica.
Vector: an agent, usually an insect that transmits infection from one
human host to another. Vector is only transport, helping the pathogen to
complete its life cycle, while intermediate host existence is essential in
completion of some parts of life cycle (asexual only).
Zoonosis: term describe a disease communicable from animals to
humans (enzootic infection acquired by man) under natural conditions.
Examples include; leishmaniasis, hydatid cyst and fascioliasis.

Section I. Protozoa
Protozoa are single-celled animals; each cell performs all of the necessary
functions of life, majority of which are free-living.

Classification of the protozoa: Human parasites in the kingdom Protista,

subkingdom Protozoa are classified under four phyla:
1- Sarcomastigophora (containing amoeba and flagellates)
2- Apicomplexa (containing Sporozoa)
3- Ciliophora (containing Ciliates)
4- Microspora
1- Sarcomastigophora
This phylum is subdivided into two subphyla:
1- Sarcodina 2- Mastigophora
Sarcodina (Amoebae):
Amoeboid organisms using pseudopodia for both locomotion and
feeding. Only Entamoeba histolytica is of medical importance.

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Entamoeba histolytica

Morphology: the parasite exists in three forms; trophozoite, precyst and

cyst. Trophozoites; 10-60 µm size, unidirectional motility, single
pseudopodium, ingest erythrocytes, granular cytoplasm small, central
karyosome, and beaded chromatin.

Habitat: trophozoites reside in mucosa and submucosa of large intestine

of man.

Life cycle: It passes its life cycle in only one host. Cysts are passed in
faeces. Man acquires the infection by ingestion of mature quadrinucleate
cysts in faecally contaminated food or water. Trophozoites can also be
passed in diarrhoeal stools, but are rapidly destroyed once outside the
body, and if ingested would not survive exposure to the gastric
environment. In contrast, cysts may remain viable in a humid
environment and stay infective for several days. Flies and cockroaches
can also serve as vectors for the transmission of E. histolytica cysts.

In the small intestine the cyst wall is lysed by trypsin and a single
tetranucleate amoeba (metacyst) is liberated. Each nucleus divides by
binary fission giving rise to eight nuclei, thus from each mature cyst eight
small metacystic trophozoites are produced. This process is known as
excystation. Metacystic trophozoites are carried in the faecal stream into
the caecum. They invade the mucosa and ultimately lodge in the
submucous tissue of large intestine. Here they grow and multiply by
binary fission. During growth, E. histolytica secretes a proteolytic
enzyme which brings about destruction and necrosis of tissue and
produces flask- shaped ulcers. Encystation: occurs in the intestinal lumen
in which chromatin materials are concentrated into bars (chromatoidal
bodies) in the cytoplasm of the cyst. The nucleus of cyst divides into two,
then each of the two daughter nuclei divided once again so mature cyst
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has four nuclei. The amoebae are mostly present at the periphery of the
lesion. A large number of trophozoites are excreted along with blood and
mucus in the stool leading to amoebic dysentery. In a few cases, erosion
of the large intestine may be so extensive that trophozoites gain entrance
into the radicles of portal vein and are carried away to the liver where
they multiply leading to amoebic hepatitis and amoebic liver abscess.

It has been established that the invasive and noninvasive forms represent
two separate species, respectively E. histolytica and E. dispar. These two
species are morphologically indistinguishable unless E. histolytica is
observed with ingested red blood cells (erythrophagocystosis).

Pathogenesis:

Intestinal amoebiasis: After an incubation period of 1-4 weeks, the

amoeba invade colonic mucosa. During growth, E. histolytica secretes a
proteolytic enzymes, producing flask- shaped ulcers and profuse bloody
diarrhea (amoebic dysentery). Ulcers may be deep or superficial.

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E. histolytica may also cause amoebic appendicitis and amoebomas
(pseudotumoral lesions associated with necrosis, inflammation and
oedema).

Extraintestinal amoebiasis: About 5-10% individuals with intestinal

amoebiasis, 1-3 months after disappearance of dysentery, develop hepatic
amoebiasis. Tophozoites are carried from the ulcer in the large intestine
and multiply in the liver, lead to cytolytic action then small abscesses
merge to form big liver abscesses. The abscesses may grow in various
directions; it may enter into general circulation involving lungs, brain,
spleen, skin, etc.

Pathogenicity depends on:

1. Virulence of strain

2. Resistance of the host (depends on the innate immunity).

3. State of nutrition of the host.

4. Infection with other agents (free of other infections mean less

susceptible to infection).

5. Some drugs may irritate the intestinal wall so irritated intestine is more
susceptible to infection.

6. Bacterial flora (metabolic processes can enhance the invasiveness).

Symptoms:

Fever, chills, and diarrhea, sometimes bloody or white mucus and often
with cramps. Some people may have only mild abdominal discomfort or
no symptoms at all. Symptoms can start 2 or more weeks after infection.

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Laboratory Diagnosis:

Entamoeba histolytica must be differentiated from other intestinal

nonpathogenic amebae. The nonpathogenic Entamoeba dispar is
morphologically identical to E. histolytica, and differentiation must be
based on isoenzymatic or immunologic analysis. Molecular methods are
also useful in distinguishing between E. histolytica and E. dispar.

-Microscopic identification of cysts and trophozoites in the stool is the

common method for diagnosing E. histolytica. This can be accomplished
using wet mount and permanently stained preparations as Iodine or
trichrome or by Flotation or Sedimentation method for stool samples.

-Blood examination: shows moderate leukocytosis.

-Serological tests: in later stages of invasive amoebiasis, antibodies

appear. Tests include ELISA, IHA and IFA.

-Histology: trophozoites can be identified in aspirates or biopsy samples

obtained during colonoscopy or surgery.

- Molecular methods: DNA probe and PCR.

Treatment:

For asymptomatic infections, paromomycin or iodoquinol are the drugs of

choice. For symptomatic intestinal or extraintestinal infections, the drugs
of choice are metronidazole or tinidazole, immediately followed by
treatment with paromomycin or iodoquinol. Failure of metronidazole
therapy may be an indication for surgical intervention.

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Nonpathogenic amoebae:

Entamoeba Morphologically identical to E. histolytica. It must be separated by

dispar isoenzymatic, immunologic or molecular analyses.
Entamoeba Some consider this a separate species. It differs from E. histolytica by
hartmanni being smaller in size.
Distinguished from E. histolytica by having an eccentric endosome, and
Entamoeba
mature cysts with 8 nuclei. If chromatoidal bodies are present, they have
coli
splintered ends, rather than rounded as in E. histolytica.
Endolimax This is a very small amoeba (6-15um) with a large, eccentric endosome
nana and thin nuclear envelope. Mature cysts contain 4 nuclei.
Both the trophozoite and cyst have one nucleus with a large
Iodamoeba
endosome. The cyst contains a large glycogen vacuole that stains darkly
butschlii
with iodine.

Opportunistic amoebae

Naegleria fowleri:
It is a free-living amoeba that can be pathogenic, causing a fulminant
brain infection called naegleriasis.
Found in warm freshwater and in the soil near warm-water discharges of
industrial plants, and in unchlorinated or minimally-chlorinated
swimming pools.
It can be seen in either an amoeboid or temporary flagellate stage. N.
fowleri is inhaled through the nose, where it then enters the nasal and
olfactory nerve tissue, travelling to the brain.
N. fowleri normally eat bacteria, but when it enters humans, it uses the
brain as a food source.
It does not form a cyst in human tissue, where only the amoeboid
trophozoite stage exists. Cysts and flagellate forms of N. fowleri have
never been found in tissues or CSF.

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Life cycle and pathogenicity

The amoeboid form of N. fowleri is the invasive stage of the parasite.

Man acquires infection by nasal contamination during swimming in
freshwater lakes, ponds or swimming pools. Infection may also be
acquired by inhalation of dust containing infective forms. It is likely that
flagellate forms or cysts of N. fowleri could enter the nose. However,
since the amoeboid form is the invasive stage of the parasite, therefore, it
appears that flagellate forms revert to amoeboid forms and the amoeboid
forms escape from the cysts in the nose.

The amoeboid forms invade the nasal mucosa, and travel along the
olfactory nerves to brain leading to a rapidly fatal infection known as
primary amoebic meningoencephalitis (PAM).

Patient develops severe frontal headache, fever (39°–40°C), anorexia,

nausea, vomiting and signs of meningeal irritation. Involvement of the
olfactory lobes may lead to disturbances in smell or taste. Patient may
also develop visual disturbances, confusion, irritability, seizures and
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coma. The disease usually results in death within 72 hours of the onset of
symptoms.

The period between contact with the organism and onset of clinical
symptoms vary from 2–3 days to as long as 7–15 days. PAM may
resemble acute purulent bacterial meningitis, and these conditions may be
difficult to differentiate particularly in the early stage.

Laboratory diagnosis

Microscopy of CSF: Motile amoebae with characteristic morphology can

be readily demonstrated in simple wet-mount preparation of fresh CSF
specimen.

Culture: N. fowleri may be cultivated by placing some of the CSF on non-

nutrient agar (1.5%) spread with a lawn of washed Escherichia coli or
Enterobacter aerogenes and incubated at 37°C. The amoebae will grow
on the moist agar surface and will use the bacteria as food, producing
plaques as they clear the bacteria. As colonies grow and expand, cysts
that survive moderate desiccation are formed; thus, strains can be
maintained by transfer of either trophic or cystic forms.

-Almost all cases are diagnosed during autopsies due to the rapid
progression of the disease.

Treatment

At present there is no satisfactory treatment for PAM. Antibacterial

antibiotics and antiamoebic drugs are ineffective. Amphotericin B, a drug
of considerable toxicity, is the antinaeglerial agent for which there is
evidence of clinical effectiveness.

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Notes:

Vector:- an agent, usually an insect that transmits infection from one

human host to another.
Vector is only transport, helping the pathogen to complete its life cycle,
while intermediate host existence is essential in completion of some
parts of life cycle (asexual only).
A vector is any organism acting as an intermediary host for a parasite. ...
Good examples of vectors are the mosquito in transmitting malaria and
ticks in transferring Lyme disease, Vector: Any living creature that can
pass an infection to another living creature. Humans are technically
vectors, but the term is more commonly applied to nonhuman organisms.
There are two types of vectors -:
1-Mechanical vector term used to describe a vector which assists in
transfer parasitic forms between hosts but is not essential in the life cycle
of the parasite, e.g. a housefly and Cockroaches in the case of Entamoeba,
that transfers amoebic cysts from infected faeces to food that is eaten by
humans.
2-Biological vector in whose body the pathogenic organism develops and
multiplies before being transmitted to the next host, then it is essential in
the life cycle of the parasite..

While the (reservoir host):-

can harbor a pathogen indefinitely with no ill effects. Once discovered,
natural reservoirs elucidate the complete life cycle of infectious diseases,
providing effective prevention and control.
Or The reservoir is a host which allows the pathogen to live, and possibly
grow, and multiply. Humans, animals and the environment can all be
reservoirs for microorganisms. Sometimes a person may have a disease
but is not symptomatic or ill.
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