INTRODUCTION TO PARASITOLOGY parasites.

Hosts are organisms that

harbor the parasite and provide
PARASITISM nourishment to the parasite.
There are two important elements in
parasitism: TYPES OF HOSTS
 Parasite  Definitive hosts – are hosts that harbor
 Host the adult stage of the parasite or where
 Parasites are organisms that usually the sexual stage of the life cycle of the
depend on the host for survival in several parasite occurs
ways  Intermediate hosts – are those that
harbor larval stage of the parasite or
BASED ON HABITAT where the asexual of the life cycle of the
 Ectoparasites – parasites that live parasite occurs
outside the host’s body. Invasion of the
body by ectoparasites called infestation
 Endoparasites – parasites that live
inside the body of the host. Invasion of
the body by endoparasites is called
infection and is the result of entry and
multiplication of the parasite within the
host
 Reservoir hosts – are vertebrate hosts
BASED ON ABILITY OF
that harbor the parasite and may act as
INDEPENDENTLY OF THE HOST
additional source of infection in man
 Facultative Parasites – parasites that
 Paratenic hosts – are those that serve as
can live independently of the host. The
a means of transport for the parasite so
parasites do not have to live inside a host
that the infective stage of a certain
to complete their life cycle
parasite that may reach its final host
 Obligate parasites – parasites that must
live inside a host (Plasmodium,
Leishmania, hookworms). Majority that
infect humans are obligate parasites.

BASED ON MODE OF LIVING

 Permanent parasites – parasites that
remain in a host from early life to
maturity (ex. plasmodium)
 Intermittent parasites – parasites that SOURCES OF EXPOSURE TO
simply visit the host during feeding time. INFECTION / INFESTATION
(ex. Non-pathologic parasites)  Contaminated soil
 Incidental parasites – parasites that  Food containing the parasite’s infective
occur in unusual host (ex. Dog tapeworm stage
in humans)  A blood sucking insect
 Transitory parasites – parasites whose  A domestic or wild animal harboring the
larva develops in a host while the adult is parasite
free-living (Echinococcus granulosus or  Another person and his clothing,
dog tapeworm) bedding, or intermediate environment
 Erratic parasites – parasites that are that has contaminated
seen in an unusual organ, different from  Auto infection
that which it ordinarily parasitizes (ex.
Ascaris lumbricoides in lungs or kidneys) MODES OF TRANSMISSION
 Ingestion of contaminated food and
HOSTS water (Fecal – oral transmission) – most
 Hosts are essential to the existence of common of most intestinal parasites
  Include the intestinal protozoa (cyst  Transplacental or congenital infection
stage), and the the embryonated (ex. Taxoplasma gondii and occasionally
egg stage of the intestinal plasmodium)
roundworms (ex. Ascaris  Trans mammary infection (ex.
lumbricoides, Trichuris trichiura). Strongyloides, Ancylostoma)
 Trichinella spiralis, taenia solium,  Sexual intercourse (ex. Trichomonas
Taenia saginata, Diphyllobotrium vaginalis)
latum, intestinal flukes and the lung
flukes are transmitted by eating PORTAL OF EXITS
food containing the larval stage of  The most common is through the anus.
the parasites Urine may serve as portal of exit for
Trichomonas vaginalis, Strongyloides
stercoralis, Schistosoma hematobium
 Through the sputum are: Paragonimus
westermani and Ascaris lumbricoides
(larval stage)
 T. vaginalis may also be isolated from
vaginal discharge

MODES OF TRANSMISSION
 Penetration of the skin from the soil (ex.
PARASITIC MECHANISMS
Hookworms and Strongyloides) or from  TRAUMATIC DAMAGE
contaminated water (ex. Blood fluke)  The manifestations may be due to
 Bite of blood sucking vectors (ex. the direct physical damage caused
Malaria, leishmaniasis, trypanosomas, by the parasite in the organ it
and filariasis) parasitizes or at the point of entry
 Inhalation of eggs (ex. Pinworms or of the parasite.
Enterobius vermicularis)  LYTIC NECROSIS
 Enzymes and other substances
produced by many parasites that
are necessary for them to digest
food available in the immediate
environment may cause harm to the
host tissues.
 STIMULATION OF HOST TISSUE
REACTION
 These reactions may be in the form
of cellular proliferation and
infiltration at the site of the parasite
entry or may involve systemic
increase in certain types of cells
 TOXIC AND ALLERGIC
PHENOMENA
 Also considered as
Immunopathology. Proteins or
other metabolites produced by the
parasites may lead to
hypersensitivity or allergic reactions
due to stimulation of antibody
production.
 OPENING OF PATHWAYS FOR
ENTRY OF OTHER PATHOGENS
 The presence of the parasites and
MODES OF TRANSMISSION the damage they produce to the
 tissues may favor the entry and
proliferation of other organisms,
especially bacteria. For instance,
infection with pinworm leads to
intense itchiness in the anus.

IMMUNOPATHOLOGIC REACTIONS Phylum Ciliophora

 Ciliates – possess rows or patches of cilia
that serve as their organs of locomotion
Phylum Apicomplexa
 Sporozoa – does not have organ for
motility

GENERAL LIFE CYCLE

COMPONENTS
 source of infection
 MOT
 infective stage – morphologic form that
infects humans Helminths – multicellular metazoan (sub-
 pathogenic stage – form that is kingdom Metazoa)
responsible for the pathology produced  Nemathelminths (roundworms)
leading to clinical manifestation  Platyhelminths (flatworms)
 diagnostic stage – form that can be  Trematoda (flukes)
detected through manifestations  Cestode (tapeworms)

CLASSIFICATION OF PARASITES

 PROTOZOA – single celled DIAGNOSIS OF PARASITIC

Phylum Sarcomastigophora INFECTIONS
 Amoeba – move by means of
pseudopodia
 Flagellates – are equipped with one SPECIMEN COLLECTION AND
or more whip-like flagella that HANDLING
enable them to move.  Daily shedding of the diagnostic forms of
the parasite may not occur. Thus,
multiple specimens may be collected for
adequate detection.
 Timing of specimen collection is
important. To demonstrate motility
characteristic of protozoan parasites,
fresh specimen must be used. The
 diagnostic stage of protozoans is the  To remove debris and other
trophozoite, which is usually found in contaminants that might interfere with
liquid stool (therefore it is recommended the microscopic examination
that liquid stools be examined within 30
minutes after collection) TYPES OF CONCENTRATION
 Formed stools which usually contain the TECHNIQUE
cyst forms may be held for a maximum
of 24 hours after collection. Preservative SEDIMENTATION (FORMALIN-ETHYL
or fixatives may be added if the ACETATE SEDIMENTATION
specimen cannot be examined right PROCEDURE)
away. (Ex. formalin, polyvinyl alcohol,  Principle: This is based on specific gravity
sodium acetate formalin, and modified - parasites are heavier than the solution
polyvinyl alcohol) used and thus settle in the sediment of
the tube while the fecal debris which are
MICROSCOPIC EXAMINATION lighter will rise to the upper layers of the
test tube.
TECHNIQUES  Procedure: Ethyl acetate is added to a
All fresh specimens submitted for saline-washed formalin-fixed sample in a
examination must undergo microscopic test tube and then centrifuged.
examination:
 Direct wet preparations HOW TO DO THE SEDIMENTATION
 Concentration techniques TECHNIQUE
 Permanent stains https://www.youtube.com/watch?
v=EN3oiPxcxQU
DIRECT WET PREPARATIONS
 Purpose: to detect the presence of ZINC SULFATE FLOTATION
motile protozoan trophozoites; other TECHNIQUE
stages detected include cysts, oocysts, Principle:
ova and larvae worms  This is based on the differences on
 Principle: A small portion of unfixed stool specific gravity and the sample debris (in
is mixed with saline or iodine then this case heavier thus sinks to the
studied under the microscope bottom while the parasite is lighter and
 Procedure: floats upward the top of the tube.
 Place small amount of unfixed stool
HOW TO DO THE ZINC SULFATE
on a glass slide.
FLOTATION TECHNIQUE
 Add a drop of 0.85% saline
https://www.youtube.com/watch?
 Mix using a wooden applicator stick.
v=oEKBYyTE2Xg
 Place a cover slip on the slide.
 Examine slide using both low-power
and high-power objectives of the
PERMANENT STAINS
microscope
 Stains that may be used include Wheatly
trichome (most widely used), iron
HOW TO PREPARE WET MOUNTS
hematoxylin (demonstrate morphology
https://www.youtube.com/watch?
of intestinal protozoa), and other
v=r69QmZQc0Qc
specialized stains (modified acid-fast
stain to detect oocysts of
Cryptosporidium)
CONCENTRATION METHODS
Purpose:
OTHER SPECIMENS & LAB
 To aggregate parasites, present into a
PROCEDURE
small volume of the sample that enables
the detection of small numbers of DUODENAL MATERIAL
parasites that might not be detected in Procedure:
direct wet preparations.  In the Entero-test, the patient is made to
 swallow a gelatin capsule that contains a TISSUE AND BIOPSY SPECIMENS
coil of yarn that is weighted. The yarn is  This may be utilized to detect the
released and is carried to the duodenum presence of Leishmania, Toxoplasma
as the capsule dissolves in the stomach. gondii, Trypanosoma, Taenia solium, and
The free end of the yarn is attached to Trichinella spiralis in tissues
the patient's neck or cheek and after an
incubation of 4 hours is pulled back out GENITOURINARY SECRETIONS
of the patient. The bile-stained material  The specimen of choice for detecting the
attached to the string is then examined blood fluke Schistosoma haematobium is
microscopically with wet preparation urine. It may also be used to detect
followed by application of permanent Trichomonas vaginalis, which may also
stains. be isolated from genital secretions.

SIGMOIDOSCOPY MATERIAL OTHERS

 Sigmoidoscopy is used to collect and Sputum - Paragonimus westermani,
examine material from the colon. This is Strongyloides stercoralis (with hyperinfection)
helpful for the diagnosis of infection with E. histolytica, Ascaris lumbricoides larva, and
Entamoeba histolytica. Biopsy of colon the larvae of hookworms
material may be done. Eye specimens - Acanthamoeba keratitis,
Toxoplasma gondii, and Loa loa
CELLOPHANE TAPE OR SCOTCH  Mouth scrapings and nasal discharge -
TAPE PREPARATION E. gingivalis, Trichomonas tenax,
 This procedure is done to detect eggs of Naegleria fowleri
the pinworm Enterobius vermicularis.  Skin snips - skin fluid without bleeding
The female parasite migrates to the anus obtained by making a small cut into the
at night where it lays its eggs. skin with razor blade; to detect motile
microfilariae
 Xenodiagnoses - special method for
diagnosis of Chagas disease where an
uninfected reduviid bug ( the vector) is
BLOOD allowed to take a -blood meal from an
 Examination of blood can detect the infected patient and the feces of the bug
presence of blood-borne parasites such is then examined for the presence of
as Leishmania, Trypanosoma, Trypanosoma cruzi
Plasmodium and the filarial worms.
Blood from the fingertips or earlobes
may be used (without anticoagulant), or PARASTOLOGIC INFECTIONS
form standard venipuncture (with
anticoagulant).  Parasitism is a symbiotic relationship
that is of benefit to one party or
CEREBROSPINAL FLUID (CSF) symbiont (the parasite) at the expense of
 CSF may be used to diagnose certain the other party (the host).
amebic infections. It may also be used in  Parasites are defined as organisms that
patients with African sleeping sickness. live on or in other living organisms
Similar to blood, the CSF must be (hosts), at whose expense they gain
immediately examined if detection of some advantage.
parasite motility is desired. Wet  Parasites that live outside the host’s
preparations can be done to detect body are referred to as
characteristic morphologic forms of ectoparasites, whereas those living
Naegleria, Acanthamoeba, and inside the host are called
Trypanosoma as well as Toxoplasma endoparasites.
gondii, Taenia solium (cysticercosis), and  If more than one host is involved, the
Echinococcus. definitive host is the one that harbors
the adult or sexual stage of the parasite
 or the sexual phase of the life cycle. The  The trophozoite is the motile, feeding,
intermediate host harbors the larval or dividing stage in the protozoal life cycle,
asexual stage of the parasite or the and the cyst, oocyst, and spore are
asexual phase of the life cycle. dormant stages.
 An accidental host is a living organism
that can serve as a host in a particular PROTOZOAL INFECTIONS OF
parasite’s life cycle, but is not a usual HUMANS
host in that life cycle. Some accidental
hosts are dead-end hosts, from which  PROTOZOAL INFECTIONS OF THE
the parasite cannot continue its life SKIN
cycle. Leishmaniasis
 Facultative parasites are organisms that  There are three forms of leishmaniasis:
can be parasitic but are also capable of a cutaneous, mucocutaneous (or mucosal),
free-living existence. Obligate parasites and visceral.
have no choice; to survive, they must be  The cutaneous form starts with a papule
parasitic. that enlarges into a craterlike ulcer.
Individual ulcers may coalesce, causing
HOW PARASITES CAUSE DISEASE severe tissue destruction and
 For helminths, the number that are disfigurement.
present is often referred to as the “worm
burden.” Some parasites produce toxins,
some produce harmful enzymes, some
invasive and migratory parasites cause
physical damage to tissues and organs,
some cause the destruction of individual
cells, and some cause occlusion of blood
vessels and other tubular structures.

PARASITIC PROTOZOA  Visceral leishmaniasis, also known as

 Amoebas (amebae) move by means of kala-azar, is characterized by fever,
pseudopodia (literally,“false feet”). enlarged liver and spleen,
Flagellates move by means of whip-like lymphadenopathy, anemia, leukopenia,
flagella. Ciliates move by means of hair- and progressive emaciation and
like cilia. weakness.
 Protozoa classified as Sporozoa
(sporozoans) have no pseudopodia,
flagella, or cilia, and therefore exhibit no
motility.
 Although most protozoal parasites of
humans are obligate parasites, some are
facultative parasites—capable of a free-
living, nonparasitic existence, but also
able to become parasites when they
accidentally gain entrance to the body.
Acanthamoeba spp. and Naegleria
fowleri are examples of facultative
 Reservoirs include infected humans,
parasites.
domestic dogs, and various wild animals.
 Because protozoa are tiny, protozoal
 Transmission by blood transfusion and
infections are most often diagnosed by
person-to-person contact have been
microscopic examination of body fluids,
reported.
tissue specimens, or feces.
 An intradermal test, called the
 Most parasitic protozoal infections are
Montenegro test, and immunodiagnostic
diagnosed by observing trophozoites,
and molecular diagnostic procedures are
cysts, oocysts, or spores in the specimen.
also available. In the Montenegro test,
 an antigen derived from promastigotes is
injected into the skin

 PROTOZOAL INFECTIONS OF THE

EYES

 Protozoal infections of the eyes include

conjunctivitis and keratoconjunctivitis
(inflammation of the cornea and
conjunctiva), caused by amoebas in the
genus Acanthamoeba, and
toxoplasmosis, caused by the sporozoan,
Toxoplasma gondii.
 Ocular manifestations of toxoplasmosis
occur primarily in immunosuppressed
patients, in whom the infection can lead
to removal of the infected eyeball
(enucleation).

 PROTOZOAL INFECTIONS OF THE  PROTOZOAL INFECTIONS OF THE

GI TRACT GU TRACT
Trichomoniasis
 The largest waterborne outbreak ever to  is a sexually transmitted protozoal
occur in the United States was caused by disease affecting both men and women.
Cryptosporidium parvum, a protozoan The disease is usually symptomatic in
parasite. women, causing vaginitis with a profuse,
thin, foamy, malodorous, greenish-
yellowish discharge.
 Although rarely symptomatic in men,
trichomoniasis may lead to prostatitis,
urethritis, or infection of the seminal
vesicles.
 Infected humans serve as reservoirs.
Transmission occurs by direct contact
with vaginal and urethral discharges of
infected people during sexual
intercourse. Because this organism exists
only in the fragile trophozoite stage
 (there is no cyst stage), it cannot survive
very long out- side the human body.

 T. vaginalis trophozoites are sometimes

seen in urine and Papanicolaou (Pap)
smears. Diagnosis of trichomoniasis in
men can be accomplished by performing
a saline wet mount of urethral discharge
material or prostatic secretions.

 PROTOZOAL INFECTIONS OF THE

CIRCULATORY SYSTEM

 Malaria is one of the most important

infectious diseases in the world. Humans
become infected following the injection
of male and female gametocytes into the
bloodstream by a female Anopheles
mosquito.
 PROTOZOAL INFECTIONS OF THE
CNS

Primary Amoebic Meningoencephalitis

 PAM is an amebic disease causing
inflammation of the brain and meninges,
sore throat, severe frontal headache,
hallucinations, nausea, vomiting, high
fever, and stiff neck. Unless diagnosed
and treated promptly, death occurs
within 10 days, usually on the fifth or
 sixth day.
HOSTS
 Water and soil serve as reservoirs. The
amoebas usually enter the nasal  The fish tapeworm, for example, is what
passages of a person diving and/or is known as a three-host parasite, having
swimming in ameba-contaminated one definitive host (human) and two
water, such as ponds, lakes, “the old intermediate hosts (a freshwater
swimming hole,” thermal springs, hot crustacean called a Cyclops and a
tubs, spas, and public swimming pools. freshwater fish) in its life cycle
After the amoebas colonize the nasal  Fleas serve as intermediate hosts in the
tissues, they invade the brain and life cycle of the dog tapeworm, whereas
meninges by traveling along the olfactory dogs, cats, or humans can serve as
nerves. definitive hosts.

 Phase-contrast microscopy is helpful.

Smears of CSF sediment can be stained
with Wright, Wright-Giemsa, Giemsa, or
trichrome stain. Leukocytes and
amoebas are similar in appearance.
Unfortunately, most cases of PAM are
diagnosed after the patient’s death
through observation of amoebas in
stained sections of brain tissue.

HELMINTHS

 Helminths are multicellular, eukaryotic

organisms in the Kingdom Animalia. The
two major divisions of helminths are
roundworms (nematodes) and
flatworms. The flatworms are further
divided into tapeworms (cestodes) and
flukes (trematodes).

CHARACTERISTICS
HELMINTH INFECTIONS OF HUMANS
 Adults produce eggs, from which larvae
emerge, and the larvae mature into adult
worms.
 Adult nematodes are either male or
female. Cestodes and many trematodes
are hermaphroditic, meaning that adult
worms contain both male and female
reproductive organs. Thus, it only takes
one worm to produce fertile eggs
MEDICALLY IMPORTANT
ARTHROPODS
There are only three classes of arthropods
studied in parasitology:
 Insects (class insect)
 The insects studied include lice, fleas,
flies, mosquitoes, and reduviid bugs.
 Arachnids (class arachnida)
 Arachnids include mites and ticks.
 Crustaceans (class crustacea)
 Crustaceans include crabs, crayfish, and
certain Cyclops species.

VECTORS

 Arthropods may serve as mechanical or

biologic vectors in the transmission of
certain infectious diseases. 
 Mechanical vectors merely pick up the
parasite at point A and drop it off at
point B, similar to an overnight delivery
service.
 A biologic vector, on the other hand, is
an arthropod in whose body the
pathogen multiplies or matures (or
both). Several arthropods that serve as
vectors of human diseases are shown: