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PARASITOLOGY LECTURE

Symbiosis Host
- living together of unlike/different - harbors the parasite
organisms - may/may not suffer from pathogenic
Symbiont effects of the parasite
- the organism in a symbiotic relationship
 Final Host (Definitive Host)
Types of Symbiotic Relationship - Harbors mature/adult form of parasite
 Commensalism - Sexual reproduction occurs
- one benefits and one unharmed - Usually man
- non pathogenic
- Entamoeba coli  Intermediate Host
 Mutualism - harbors immature/larval stage of a
- both organisms benefit from each parasite
other - undergoes asexual reproduction
- Termites and Flagellates in their - lower animals & vegetation
digestive system (synthesize *humans become intermediate hosts in the
cellulase for the breakdown of following examples:
ingested wood) - Plasmodium – causes malaria
 Parasitism - Taena solium (tapeworm)
- host is harmed while parasite
benefits  Vectors
 Phoresis - responsible for parasite transmission
- Means “to carry” o Biologic Vector
- Phoront – being carried  parasite develops in it
- no physiologic interaction is involved  there’s physiologic
between parasite and host interaction
 ex. Aedes, ticks, fleas,
Parasitology mosquito – Anopheles
- deals with the dependence of one
organism to another o Mechanical/Phoretic Vector
- host (animals/humans) & parasite  no morphologic change
- study of the relationship between  no physiologic interaction
parasites and their host  parasite is outside the
vector
* Majority of people inflicted with parasitic  ex. Cockroaches, flies
infections are from poor, developing countries.
 Accidental Host
Schistosoma (blood-flukes) - harbors parasite that are not infective
- causes enlarged bellies because of fluid - ex. When humans injest Toxocara cati
accumulation (ascarid on cats)

Characteristics of Parasitic Diseases  Paratenic Host (Transfer Host)


- prevalent in developing countries - animals that harbor larval stages but
- low mortality and morbidity no further development will occur
- limited drug-development - ex. boars – Paragonimus westermani
- no current vaccines crustaceans – Anisakis

#28 Patricia Ann C. Jose 2A-MT


PARASITOLOGY LECTURE
 Dead-end Host (Incidental Host) Erratic Parasite
- doesn’t allow the parasite’s life cycle to - not living in its natural habitat
continue - ex. Ascaris
- ex. humans– Trichinella spiralis (in
pigs) Accidental/Incidental Parasite
- does not live in its usual host
 Reservoir Host - ex. Toxocara cati of cats went to humans
- allows life cycle of parasite to continue
- usually animals Spurious Parasite
- ex. pigs- Palatinum coli - passes through the GI tract without
(largest protozoan) infecting the host
field rats- Paragonimus westermani - false infection
cats- Brugia malayi
beavers- Giardia lambia (travelers Permanent Parasite
are commonly infected) - lives a long period of time

Parasites Temporary Parasite


 Obligate Parasite - lives a short period of time
- requires a host for survival
- ex. Ascaris, Hookworm, Trichuris Parasites Based on Egg Laying Capacity
 Oviparous
 Facultative Parasite - immature/unembryonated eggs
- ex. threadworms- Strongyloides - no larva/embryo
stercoralis (smallest) - ex. Ascaris lumbricoides, Trichuris
- has two phases: trichura, Hookworm, Enterobius
 Free living phase – on environment vermicularis
 Parasitic phase – in the host
 Ovoviviparous
*genus of free living pathogenic amoeba: - mature/embryonated/segmented eggs
o Naegleria - Schistosoma, Clonorchis, Opisthorchis,
o Acanthamoeba Haplorchis, Heterophyes
o Balamuthia
 Larviparous
 Commensal Parasite - lays larva
- non-pathogenic - ex. Trichinella spiralis
- ex. Entamoeba coli
Parasites According to Sexes
Parasites According to Habitat  Monoecious
 Ectoparasite - hermaphrodite/ hermaphroditic parasites
- outside the host - testes and ovaries are present
- “infestation” when you have it - ex. cestodes (tapeworms)
- ex. ticks, lice, fleas, dust mites (causes trematodes (fleas)
allergy), Sarcoptes (causes scabies)
 Endoparasite  Dioecious
- inside the host - separate sexes (male or female)
- “infection” when you have it - ex. Schistosoma, nematodes (round worm)

#28 Patricia Ann C. Jose 2A-MT


PARASITOLOGY LECTURE
*nematodes – big babae with pointed Protozoans
posterior; small lalaki with curved posterior
Trophozoite Cyst
 Parthenogenetic
- female parasites capable of fertilization
- ex. Strongyloides stercolaris

Parasite Stages
 Helminthes (adult)

- motile - non-motile
- vegetative/feeding - infective
stage stage
- on watery stool - oval
Parasite in the photos: Giardia lamblia

female ascaris Modes of Transmission


 Soil Transmitted Helminthes (STH)
 Larva - source of infection : soil contact
• Hookworms
• Ascaris lumbricoides
• Trichuris trichiura
• Strongyloides stercoralis
*all given examples have immature eggs;
Ascaris and Trichuris – ingestion of
embryonated eggs
Hookworm (L3 larva) & Strongyloides– skin
penetration

 Egg/Ovum - Ascaris- giant intestinal worm


- Trichuris- whipworm
- Strongyloides- threadworm (common in HIV
patients)

*Types of Hookworm
- Necator americanus
common name: New world hookworm
(common in America)

- Ancylostoma duodenole
ascaris egg common name: Old world hookworm
(common in Europe)

“Unholy Three” (hookworm, ascaris, trichuris)


- found in stool samples
#28 Patricia Ann C. Jose 2A-MT
PARASITOLOGY LECTURE
Vector Borne Exposure & Infection
- bite of vectors
- ex. Plasmodium, Hemoflagellates, Filarial  Pathogen – organisms that cause injury to
Worms host
 Infection – establishment of parasite in the
Food Borne host
- injestion of raw and undercooked food *infection is without signs, disease is with
- ex. Fasciola (water plants) manifestation
Opisthorchis, Clonorchis, Heterophyes,  Carrier – has parasite but no symptom
Haplorchis (fish)  Incubation Period – period between time of
Echinostoma (snails) infection and appearance of signs and
Taenia (either undercooked pork or beef) symptoms
Paragonimus (raw/undercooked crab)  Pre-patent period – period between time of
infection and evidence/demonstration of
Water Borne infection
- associated with diarrhea  Autoinfection – infection from self
- ex. Giardia, Cryptosporidium (cause of – ex. Capillaria, Strongyloides,
severe diarrhea in HIV patients but also Cryptosporidium, Hymenolepis nana,
infects healthy people) Taenia solium,
Enteriobius vermicularis (doesn’t
Vertical Transmission undergo internal multiplication)
- parasite crosses the placenta  Superinfection/Hyperinfection – infected
- usually in the first trimester of pregnancy individual is further infected with the same
- targets the baby that will lead to congenital parasite (lalong lumalala)
defects – ex. Strongyloides
- Toxoplasma gondii (a parasite of cats)
Epidemiology
Transmammary - study of patterns, distribution and
- through breastmilk occurrence of disease
- Ancylostoma, Strongyloides
• Prevalence - # of infected at a specific time
Inhalation • Cumulative Prevalence -% of individuals in
- Enterobius (most common parasite that can a population with at least 1 parasite
be inhaled or injested) • Incidence- on infectious diseases, # of new
cases in a span of time
Intimate Contact
- Trichomonas vaginalis *more incidence = more risk

Life Cycle • Sporadic- occurs infrequently and


 Direct life cycle – doesn’t need irregularly.
intermediate host • Endemic- constant prevalence of a disease
 Indirect life cycle – needs within a geographic area.
intermediate host -long ongoing transmission
• Epidemic: sudden increase; outbreak
• Pandemic: epidemic over several countries
or continents

#28 Patricia Ann C. Jose 2A-MT


PARASITOLOGY LECTURE
Effects of Host on Parasite
• Genetic Makeup of host
-ex. Duffy Blood Group Fy(a- b-) which are
resistant to malaria (Plasmodium vivax and
Plasmodium knowlesi)
*Africans are usually resistant to malaria
since majority have sickle cell anemia
• Nutrition and Diet (ex. High protein diet)
• Immunity and Immune Response

Host Immune Response

Eradication – extinct; no more cases and - Innate immune response (non-specific)


transmission o innate immunity, without
- ex. small pox memory, phagocytosis
- Acquired immune response
Elimination – no more cases but there is o t- cells (produces cytokines,
ongoing transmission target intracellular organisms,
- has reservoir host cell mediated)
o b- cells (produces antibodies,
Morbidity (sick) Mortality (death) humoral)

Intensity of Infection/Worm Burden Parasite Evasion Mechanism


- number of eggs • Resistance to Infection
– Permits survival of parasites upon
Deworming- the use of anthelminthic drugs entering blood and tissues
– Cuticle and integument > resist
Harmful Effects of Parasites to Human Hosts macrophage
– Some organisms may infect humans but do • Immune Suppression
not cause disease – Parasites can reduce immune
– Parasites can cause injury by release of function of macrophages > lower action
metabolites/enzymes (hyaluronidase for P. of macrophages and defective
coli) processing of antigen
– Parasites can cause invasion and tissue • Antigenic Variation
destruction – Trypanosoma brucei infection:
– Parasite can deprive certain nutrients from possesses variant surface glycoproteins
hosts (Diphyllobothrium latum [fish (VSG) *parang nagpapalit ng damit para
tapeworm] causes vitamin B-12 deficiency hindi makilala ng immune system
which also leads to anemia) – Plasmodium: antigenic diversity
– Tissue Damage (Fatty Degeneration, • Host Mimicry
Albuminous Degeneration, Necrosis – certain parasites have similar
– Tissue Changes (Hyperplasia- # of cells, appearance or structure to certain
Hypertrophy- increase in size, antigens of the body
Metaplasia- change in cell type, – Echinococcus granulosus larval
Neoplasia-formation of tumors) stages carry P blood group antigens

#28 Patricia Ann C. Jose 2A-MT


PARASITOLOGY LECTURE
– Schistosoma sp. Can acquire
antigenic molecules from host • Phylum Apicomplexa
– Body could not differentiate self from – Suborder Haemosporina
non-self - malarial parasite
- intestinal coxidian ex. cryptosporidium
• Intracellular Sequestration
– Intracellular parasites: Leishmania
(on macrophage), Plasmodium (inside
RBC & liver cells)

Medically Important Parasites

PROTOZOANS (KINGDOM PROTISTA)


Phylum Sarcomastigophora

• Subphylum Sarcodina – Amoeba

• Phylum Microsporidia
– Intracellular parasites
– Now classified as fungi
• Subphylum Mastigophora – Flagellates – Spore forming
– Possess Polar tube
ex. Enterocytozoon and Encephalitozoon

• Phylum Ciliophora – Ciliates • Phylum Aschelminthes (Class Nematoda)

#28 Patricia Ann C. Jose 2A-MT


PARASITOLOGY LECTURE
Phylum Platyhelminthes • Amount of Stool Specimens
– 2-5 grams of formed stool (thumb,
• Class Trematoda – Order Digenea walnut size)
– 5-6 tablespoons for loose or diarrheic stool

1st collection – normal


2nd collection – cathartic
ex. Fleet’s phosphate soda
In amoebiasis, 6 specimens in 14 days

*contaminants include:
- urine
- toilet bowl water
o may destroy trophozoite

• Class Cestoda *if taking antibiotics, forego the collection

• Specimens can be received in fresh or


preserved

• Preservatives (ref, don’t freeze/heat)


– Fixative Ratio: 3:1 (^fixative)
• Formalin
(5% for protozoan cyst, 10% for
helminth eggs/larva)
• MIF (Methiolate Iodine Formalin)
- stain & preservative

• PVA with Scahudinn’s (polyvinyl


alcohol with mercury fixative)
Laboratory Diagnosis
- stool adhesive sa slide
- permanent stain smear but
Stool
toxic because of mercury
• Most Common Specimen Submitted
- can be replaced by zinc
• Different parasite stages can be detected in
stool specimens
• SAF (sodium acetate formalin)
• Container Used:
- less toxic than shaudinn’s
– Wide Mouth Water Tight Plastic
- softer fixative
Container with Lid (has a scooper)
– Waxed Lined Cardboard
• Universal Fixatives (UniFix)
• Number of Stool Collections:
- one vial system
– Usually 3 specimens in a span of 10
days (to increase chances of detecting
*formalin is for concentration techniques and
parasite
wet mount, not for permanent stained smear
– Up to 6 specimens collected in 14
days for detection of amebiasis

#28 Patricia Ann C. Jose 2A-MT


PARASITOLOGY LECTURE
• Examination
– O and P Examination (ova & parasite) • Microscopic Examination
– Detection of helminth eggs and larva;
• Macroscopic Examination (1st phase) protozoan cysts and trophozoites
- Stool Consistency – Other elements that can be seen
- Color include
o brown stool pigment – » WBC; RBCs; Macrophages; Charcot-
stercobilin/urobilin, a Leyden Crystals; Epithelial cells; Plant
product of bile nemaotdes; eggs of arthropods; Fungal
o black, tarry stool – upper spores; other fecal structures
GI tract bleeding
o red – lower GI tract
bleeding
o gray/pale- bile duct
obstruction (barado)
o green- vegetables

- Gross Abnormalities
o mucus
o pus
o larva
o worms
o proglottids
o tapeworm segments Direct Wet Mount (less sensitive) » NSS Mount
*indole and skatole – for stool odor » Iodine Mount
- for protozoan cyst
- stains: Lugol’s, D Antoni’s
- trophozoites are killed

» NSS Mount
- for trophozoite
- stain: Nair’s methylene blue or
Quensell’s stain

• Concentration Technique
- needs more amount of stool
- recovers cyst, larva, eggs

» Sedimentation- recovers more parasite


• FECT
• AECT
» Flotation – for light eggs (cyst)
 Brine Flotation- salt solution
 Zinc Sulfate Flotation- 33% zinc
sulfate
 spigrarity
 1.18- fresh stool
#28 Patricia Ann C. Jose 2A-MT
PARASITOLOGY LECTURE
 1.20- formalinized

 Sheather’s Sugar Flotation


 -recovery of cryptosporidium

Permanent Stains
– Final Procedure
– Use:Confirmation of the Presence of
Protozoan Cyst and/or Trophozoites
– Preservative of Choice:PVA with
Schaudinn’’s

 Common Stains
– Trichrome (Wheatley Modification)
» widely used; easy to prepare;
long shelf life
– Iron Hematoxylin – Other Examinations Done using Stool
» time consuming » Kato-Katz (quantitative technique for
helminth eggs)
» excellent morphology of
» Kato-Thick (qualitative
intestinal protozoans
» Recovery of Hookworm and Strongyloides
 Specialized Stains
larva
» Modified Acid Fast Stain • BaermannTechnique
• HaradaMoriTechnique
• AgarPlate
» Use of Culture Medium

#28 Patricia Ann C. Jose 2A-MT


PARASITOLOGY LECTURE
Other Specimens
• Duodenal Material - for Giardia,
threadworm, Cryptosporidium
• Sigmoidoscopy – for E. histolytica
• Cellophane Tape Preparation – pinworm and
Taenia eggs
• CSF – Toxoplasma
• Tissue Specimen
• Sputum – P. westermani, Ascaris
• Urine – S. haematobium, T. vaginalis;
W. bancrofti
• Eye Specimens – Acanthamoeba, Loa loa
• Mouth Scrapings – E. gingivalis, T. tenax
• Nasal Discharge - Naegleria
• Skin Snips – O. volvulus

Blood
• Collected for diagnosis of systemic or blood
borne parasites
– Examinations Done
• Thick and Thin Smears
• Knott’s Concentration
(Philarial worms)
Technique (1ml blood + 10ml 2%
formalin)
• Buffy Coat Slides
(hemoflagellate detection)

#28 Patricia Ann C. Jose 2A-MT