PARASITOLOGY

Parasite
Parasite : is an organism that is entirely dependent on
another organism, referred to as its host, for all or part of
its life cycle . It is generally restricted to infections
caused by protozoa and helminths and excludes the
viruses, bacteria and fungi.
Parasite is of two types:
Microparasite: small, unicellular and multiplies within its vertebrate
host, often inside cells. Example: Protozoa .
Macroparasite: large,multicellular and hasnot direct reproduction
within its vertebrate host. Example: helminths.
Host: organism which harbors the parasite and provides the
nourishment and shelter .
Types of hosts:
-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.
-Reservoir host: can harbor a pathogen indefinitely with no ill
effects
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).

Species: it designates a population, the members of which have
essentially the same genetic characters .
Genus: is a group of closely related species.
This is referred to as binomial nomenclature. Ex. Entamoeba
histolytica.
Relationships of the medically important parasites.
SECTION 1

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 Protozoa are classified into:
1- amoeba
2- flagellates
3- Ciliates
4- Sporozoa
 Amoebae
Amoebae:
Amoeboid organisms using pseudopodia for both
locomotion and feeding. Only Entamoeba histolytica is of
medical importance.

Entamoeba histolytica
Morphology: the parasite exists in three forms;
trophozoite, precyst and cyst.
Entamoeba histolytica
1-cyst stage
cysts are present only in the lumen of the
colon and in formed feces
The cyst wall, which is hard and impermeable to small
molecules, protects Entamoeba from lysis by environmental
condition such as osmotic shock ,and stomach acid .
The cyst may contain :
4 nuclei that characteristically have centrally-located
karyosom
Chromatoid bodies
 Entamoeba histolytica
2-Trophozoite stage

Pathogenic Entamoeba trophozoites have a single

nucleus, which have a centrally placed karyosome
The nuclear membrane is lined by fine, regular
granules of chromatin.
May containe ingested RBC
Trophozoites passed in the stool are fragile and
quickly die once outside the host.
Infective stage :cysts

Diagnostic stage: cysts and trophozoite

Habitat: trophozoites reside in mucosa
and submucosa of large intestine of man.

Route of infection: by ingestion of

mature cysts (quadrinucleate)
in faecally contaminated food, water, or hands.
Transmition
1. Through Fecal–oral route; cysts are usually
ingested through contaminated water and food
2. Flies linked to transmission in areas of fecal
pollution.
3. Most infections are asymptomatic, with the
asymptomatic carriers being a source of infection
4. Outbreaks occur where sewage leaks into the
water supply
 Life cycle
Infection by E. histolytica occurs by ingestion of mature cysts
(quadrinucleate) in faecally contaminated food, water, or hands.

Excystation occurs in the small intestine and amoeba becomes active,

rapture the cyst membrane and trophozoites are released, which migrate to
the large intestine.

The trophozoites multiply by binary fission and start colonization inside

digestive tract and produce cysts, and both cysts and trophozoite are
passed in the feces.
 Because of the protection conferred by their walls, the cysts
can survive days to weeks in the external environment and are
responsible for transmission.
 Life cycle
Trophozoites passed in the stool are rapidly destroyed once outside the
body, and if ingested would not survive exposure to the gastric
environment.

 In many cases, the trophozoites remain confined to the intestinal

lumen (noninvasive infection) of individuals who are
asymptomatic carriers, passing cysts in their stool.
 In some patients the trophozoites invade the intestinal mucosa and
cause dysentery(bloody diarrhea)
 In some patients the trophozoites invade the intestinal mucosa and
through the bloodstream can reach extraintestinal sites causing
extraintestinal amebiasis.
Entamoeba histolytica:
Life Cycle
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.
E. histolytica may also cause amoebic appendicitis
Clinical Presentation:
A wide spectrum,
from asymptomatic infection ("luminal
amebiasis"),
to invasive intestinal amebiasis (dysentery, colitis,
appendicitis),
Symptoms:
1. Fever in 10-30% of patient
2. diarrhea, watery or bloody with white mucus
3. Abdominal cramps.

Some people may have only mild abdominal

discomfort or no symptoms at all.
Symptoms can start 2 or more weeks after infection.
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 form big liver
abscesses it may enter into general circulation involving
lungs (pleuropulmonary abscess), brain abscess, spleen,
skin( peritonitis), cutaneous and genital amebic lesions.
Laboratory Diagnosis:
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 .
as trophozoites usually appear only in diarrheic feces
in active cases and survive for only a few hours
 Treatment
Nitroimidazoles

The nitroimidazole class of antibacterials

includes metronidazole and tinidazole.
They are bactericidal,
Act by inhibition DNA synthesis.
They are indicated for the treatment of :
1. Gram-positive and Gram-negative anaerobic bacterial infections
2. protozoal infections
 Treatment
Metronidazole
Metronidazole is currently the standard therapy for treating
adults and children with invasive amoebiasis, but it may not be
sufficient to eliminate amoebic cysts from the intestine.
Metronidazole is given in mutiple doses For 5-10 days .
 Treatment

Tinidazole
Offer a shorter treatment course and fewer
side effects.

2 g/day PO for 3 days

 Treatment
Diloxanide furoate is a dichloroacetamide derivative
that is a luminally active agent used to:
1. Eradicate cysts of E. histolytica in asymptomatic
carriers
2. After treatment with metronidazole in those who have
invasive amebiasis
B-Non-Pathogenic Amebae

Several species of amebae are capable of colonizing the

human gastrointestinal tract but, in contrast
to Entamoeba histolytica, are not considered pathogenic.
The nonpathogenic intestinal amebae
include Entamoeba coli ,Entamoeba hartmanni
and Endolimax nana
B-Non-Pathogenic Amebae

Entamoeba gingivalis is a non-pathogenic ameba that

inhabits the human oral cavity and occasionally other
sites.
Clinical Presentation

None of these amebae cause symptomatic disease

in humans; colonization is noninvasive.
 Ciliates
Balantidium coli
Balantidium is the only ciliated protozoan known to
infect humans.
Balantidiasis is a zoonotic disease and is acquired
by humans via the feco-oral route from the
reservoir host, the pig (or rodents), where it is
asymptomatic.
Contaminated water is the most common
mechanism of transmission.
 Life cycle
Infection occurs when a host ingests a cyst, which usually happens
during the consumption of contaminated water or food.

Once the cyst is ingested, it passes through the host’s digestive system
reaches the small intestine, trophozoites are produced.

The trophozoites then colonize the large intestine (habitat), where they
live in the lumen and feed on the intestinal flora.
Some trophozoites invade the wall of the colon using proteolytic
enzymes (hyaluronidase) and multiply, and some of them return to the
lumen.
 Life cycle

Encystation of the trophozoite occurs . In this process, the

organism partially rounds up, then, it secretes a tough cyst
wall.
 In the infected person the parasite may be passed in the
faeces as a trophozoite or a cyst. The trophozoite does not
encyst outside the body and disintegrates.
 The passed cyst survives and may contaminate food and
water and, as a result, may then be passed to other
humans or animals.
 Pathogenesis And Clinical Symptoms

1- Chronic recurrent diarrhea, alternating with constipation, is

the most common clinical manifestation,
2-There may be bloody mucoid stool
3- anorexia, nausea.
Extraintestinal involvement such as liver, peritonea and lung may
occur.
In a majority of patients, recovery occurs in 3–4 days even
without treatment but extreme cases may mimic severe intestinal
amoebiasis
 Diagnosis

Balantidiasis is diagnosed by microscopic examination of a

patient’s feces. Trophozoites can also be detected in tissue.
Treatment

Tetracycline
metronidazole
Mastigophora (flagellates)
 Intestinal flagellates
Giardia lamblia
also called Giardia duodenalis, is one of the most common intestinal parasites in
the world.
First observed by Anton Van Leuwenhoek in 1681 in a sample of his own
diarrheal stool
 Life Cycle and Structure

This one-celled flagellated protozoan has a simple life cycle

consisting of two stages: trophozoite and cyst.

Trophozoites :have two nuclei and each nucleus contains a

prominent karyosome, giving the parasite its characteristic
face-like appearance.
In addition it has four pairs of flagella, an axostyle (an
organelle to which the flagella attach), and a ventral disk (use
in attachment to mucosal surface).
Cysts: are the transmission (infective)stage which are
slightly smaller than trophozoites, have a carbohydrate-
rich cell wall which likely protects them from the
environment and two to four nuclei.
Transmission
The cysts are responsible for transmission of Giardiasis,
They are immediately infectious when released into the
environment via feces and can remain infectious for up
to almost 3 months.
Cysts can spread from person to person or through
contaminated water, food, surfaces, or objects.
 Life Cycle
-Cysts are the transmission stage and are excreted in the feces of infected
individuals into the environment can survive for weeks in the enviroment.

When ingested exposure to the low pH of the stomach and pancreatic enzymes
induces excystation, with two trophozoite development from each cyst.
Troph. attach to epithelial cells of the upper intestine.

Attachment is mediated by the ventral disk of the trophozoite .

Encystation occurs commonly in transit down the colon.

 Pathogenesis:
Giardia lamblia generally does not penetrate the intestinal
wall, but may cause inflammation and shortening of the villi
in the small intestine.
Extremely large numbers of troph. may be present and may
lead to a direct, physical blockage of nutrient uptake,
especially in fat soluble substances such as vitamin A.
 Symptoms

1-severe diarrhea of steatorrhoea type

2- epigastric pain and flatulence.

3-When the parasite localizes in the biliary tract, it may

lead to chronic cholecystitis and jaundice.
Laboratory diagnosis:
-General Stool Examination GSE

Diagnostic stage: cysts and trophozoite

we can identified the cysts in formed stool and the trophozoites
in diarrhoeal stool by direct smear under the light microscope.

- The enzyme-linked immunosorbent assay (ELISA) to detect

anti-Giardia antibodies in patients’ serum.
 Treatment

Metronidazole has been the first-line treatment for

Giardiasis
Metronidazole is given in mutiple doses for 5-7 days
 Treatment
Tinidazole may offer a shorter treatment course
and fewer side effects.
Tinidazole 2g is given in 1 dose