2H-MT (Dr.
Yolo) MEDICAL PARASITOLOGY: concerned primarily
INTRODUCTORY CONCEPTS OF PARASITOLOGY
Symbiosis: living together of unlike organisms.
Different concepts of Parasitism, what we know
is only one benefits.
True but not all the time.
 COMMENSALISM - two species live
together and one species benefits from the
relationship without harming or benefiting
the other. (NO ONE GETS HURT)
Ex: Entamoeba coli in the intestinal lumen
(gut)
 MUTUALISM - a symbiosis in which two
organisms mutually benefit from each
other (I SCRATCH YOUR BACK YOU
SCARTCH MINE)
Ex: Termites and Flagellates in their
digestive system, which aids in breakdown
of ingested wood by synthesizing cellulase
Cellulose is a very hard substance to degrade
but not for a specific specie of flagellate that
has CELLULASE
 PARASITISM: an organism, the parasite,
lives in or on another, depending on the
latter for its survival and usually at the
expense of the host (ONE WAY
RELATIONSHIP)
Ex: Entamoeba histolytica, which derives
nutrition from the human host and causes
amebic dysentery.
Here in the ph we are blessed with parasites
(tropical countries)
PARASITOLOGY
➢ An area of biology that deals with the
dependence of one living organism on
another.
o HOST
o PARASITE
with parasites of humans and their MEDICAL
SIGNIFICANCE, as well as their importance in
human communities
Why? Because of the implication of cause of
disease
Parasites love to thrive where living conditions
are poor and sanitation is poor
TYPES OF PARASITES (accd. to habitat)
➢ ENDOPARASITE – living inside the body of a
host (presence of endoparasite on host =
infection) (focus ng lessons)
➢ ECTOPARASITE – living outside the body of
a host (presence of ectoparasite on host =
infestation)
➢ ERRATIC Parasite – migrates in a unusual
location. Does happen very more so.
Examples:
➢ Erratic Ascariasis to the appendix
(obstruction and inflammation of
appendix occurs causing appendicitis)
*walang backward movement ang parasite
➢ Fleas of dogs can bite you as well
TYPES OF PARASITE (accd. to their mode of
dev’t?)
OBLIGATE (Holoparasite):
- A parasitic organism that cannot
complete its life-cycle without
exploiting a suitable host.
- Most parasites of medical importance
are obligate
- If an obligate parasite cannot obtain a
host, it will fail to reproduce.
FACULTATIVE PARASITE:
 - may exist in a free-living state or may
become parasitic when the NEED arises
- even without the host
ACCIDENTAL/INCIDENTAL PARASITE:
- establishes itself in a host where it does
not ordinarily live.
- Never meant for the human to begin
with
- Free-living parasite may become an
accidental parasite
PERMANENT PARASITE: remains on or in the
body of the host for its entire life
Example: Nematodes, until they are expelled
out.
TEMPORARY PARASITE: lives on the host only for
a short period of time
SPURIOUS PARASITE: a free-living organism that
passes through the digestive tract without
infecting the host. It is not a commensal
relationship because it is still a parasite.
Spurious – like a bypass
TYPES OF HOST
➢ DEFINITIVE or FINAL Host - one in which the
parasite attains sexual maturity. HUMANS
are considered the definitive host. 
usually
➢ INTERMEDIATE Host - harbors the asexual or
larval stage of the parasite. This is to
complete its life cycle.
Ex: Lower Animals (snails), Vegetation
IF there is more than one Intermediate host,
assign primary, secondary and so on.
➢ PARATENIC Host - one in which the
parasite does not develop further to later
stages.
(Parasite remains alive and is able to
infect another susceptible host)
Example: Pigs, Cows, Fish: They have a parasite
and the parasite remains in them but they can
infect humans.
If you ingest for example contaminated
sashimi, you will be infected with the parasite.
Sashimi – 4 days frozen?
Salad
Beef and Pork tapeworm.
At the end of the course, you’ll be paranoid or
vigilant about the food you eat.
➢ RESERVOIR Hosts - allow the parasite’s life
cycle to continue and become
additional sources of human infection.
Continuous source!
Ex: Infected dogs
VECTORS - responsible for transmitting the
parasite from one host to another (MEDIUM
FOR TRANSFERING PARASITES)
➢ BIOLOGIC Vector – morphologic change or
transformation of the parasite before
transmission to another host
Ex: Aedes, Flies and mosquitos
➢ MECHANICAL/PHORETIC Vector – no
morphologic change occurs on the
parasite
Ex: Cockroaches & Flies
MODE OF TRANSMISSION:
ORAL
➢ Most common route, contaminated
food and water (most common)
KISSING – E. gingivalis (habitat: tartar)
Example:
- Taenia solium, Taenia saginata, and
Diphyllobothrium latum
- Entamoeba histolytica and Giardia
lamblia
 - Clonorchis, Opstorchis and Haplorchis
Night Soil – human feces (popular in Bagiuo)
Human feces are great fertilizer
SKIN PENETRATION (especially foot)
- Hookworms, Strongyloides
- Schistisoma sp. enter skin via water
(wading to contaminated H2O)
ARTHOPOD BITES
➢ Malaria, Filariasis, Leishmaniasis,
Trypanosomiasis and Babesiosis
CONGENITAL TRANSMISSION
➢ Toxoplasma gondii
Vertical route
TRANSMAMMARY INFECTION
➢ Ancylostoma and Strongyloides, the
parasites may be transmitted through
mother’s milk.
INHALATION
➢ airborne eggs of Enterobius vermicularis
Floats in the air.
SEXUAL INTERCOURSE
➢ as in the case of Trichomonas vaginalis.
TERMS RELATED TO PARASITOLOGY
EPIDIDEMIOLOGY
- study of patterns, distribution and occurrence
of disease (studying disease per se)
➢ Prevalence – HOW COMMON
➢ Cumulative Prevalence - % of individuals
in a population with at least 1 parasite
➢ Incidence – QUANTITATIVE, how many of
the population is affected.
Prevalent – sobrang common ng isang sakit
ganun
INTENSITY OF INFECTION/WORM BURDEN - refers
to burden/severity of infection which is related
to the number of worms per infected person.
The more worms, the more intense, the sicker
you become
MORBIDITY - clinical consequences of
infections or diseases that affect an individual’s
well-being.
MORTALITY - death
DEWORMING: the use of anthelminthic drugs in
an individual or a public health program
Eradication versus Elimination
ERADICATION is defined as a permanent
reduction to zero of the worldwide incidence
of infection caused by a specific agent, as a
result of deliberate efforts. ONCE THIS IS
ACHIEVED, continued measures are no longer
needed.
They were successful in eradicating yellow
fever and small pox.
ELIMINATION is a reduction to zero of the
incidence of a specified disease in a defined
geographic area as a result of deliberate
efforts. CONTINUED INTERVENTION or
SURVEILLANCE MEASURES are still required.
Schistomiasis prevalent in Samar and Leyte. So
there are gov’t programs that aim to ELIMINATE
the parasite
Filiariasis, Elephantiasis – bicol region
prevalent.
SPORADIC: a disease that occurs infrequently
and irregularly (Spurious)
ENDEMIC: refers to constant presence and or
prevalence of a disease or an infectious agent
in the population within a geographic area
EPIDEMIC: refers to an increase, often sudden,
in the number of cases of a disease often
above what is normally expected in that
population in that area
PANDEMIC: refers to an epidemic that has
spread over several countries or continents
Which is which?
EFFECTS OF PARASITE ON HOSTS
Mechanisms by which parasites cause injury:
➢ Creation of enzymes
➢ Invasion and destruction of host tissue
➢ Depriving the host of essential nutrients
and substances
EFFECTS OF HOST ON PARASITES (You can read
on that)
Several Factors that affect outcome of
Infection in the host:
o Genetic make-up of the host
o Nutritional Status of the host
o Immunity of the host
IMMUNOLOGY OF PARASITIC INFECTIONS (Read
on that)
Possible outcomes of parasite to host
interactions:
1. Parasite fails to become established in
the host.
2. Parasite becomes established and the
host eliminates the infection.
3. Parasite becomes established, and the
host begins to overcome the infection
but is not totally successful.
4. Parasite becomes established and the
host, in trying to eliminate the organism,
becomes damaged itself.
5. Parasite becomes established and kills
the host.
HOST PARASITE INTERACTIONS
o Physical barriers (1st line of defense
against pathogens)
o Skin
o Mucous membranes
o Components of body fluids
o Physiologic functions of the body
HOST IMMUNE RESPONSE
INNATE IMMUNE RESPONSE
➢ body detects and eliminates pathogens
through non-specific mechanisms
Ex. Phagocytosis by macrophage and
dendritic cells
ACQUIRED IMMUNE RESPONSE
➢ host exposed to the parasite antigens →
stimulate an immune response
➢ T and B Cells
PARASITE EVASION MECHANISM
RESISTANCE TO INFECTION
- Permits survival of parasites upon entering
blood and tissues
- Cuticle and integument → resist
macrophage
IMMUNE SUPPRESSION
- Parasites can reduce immune fxn of
macrophages → lower action of
macrophages and defective processing
of antigen
ANTIGENIC VARIATION
- Trypanosoma brucei infection:
o variant surface glycoproteins (VSG)
- Plasmodium: antigenic diversity
HOST MIMICRY
- Echinococcus granulosus larval stages
carry P blood group antigens
- Schistosoma sp. Can acquire antigenic
molecules from host
- Body could not differentiate self from
non-self
INTRACELLULAR SEQUESTRATION
- Intracellular parasites: Leishmania,
Plasmodium
ADVERSE EFFECTS OF IMMUNE RESPONSE ON
THE HOST
- Dysfunction of any of the host defense
systems can result in damage to host
tissue and produce clinical disease:
- Types of Reaction:
o Type 1 (Immediate type
hypersensitivity)
o Type 2 (Immune complex formation)
o Type 3 (Cytotoxic reactions of
antibody)
o Type 4 (Delayed-type
hypersensitivity).
TAXONOMY OF MEDICALLY IMPORTANT
PARASITES (Review din daw HAHAHA)
➢ Protozoans – unicellular eukaryotic
organisms
o Phylum Sarcomastigophora
▪ Ameba, Atrial Flagellates and
Hemoflagellates
o Phylum Ciliophora
▪ Ciliates
o Phylum Apicomplexa
▪ Plasmodium, Babesia, Intestinal
Coccidians, Tissue Coccidians
o Microspora – now under Fungi
➢ Helminthes – “worms”; metazoan
parasites
o Nematodes (Roundworms)
o Cestodes (Tapeworms)
o Trematodes (Flukes)
Overview of Diagnostic Parasitology and
Specimen Collection
➢ Diagnosis of parasitic infections through
demonstration of parasite or parasite
components (adults, egg, larvae, cysts,
trophozoite)
SX used:
❖ Stool – most common
❖ Aspirates (Duodenal, Liver)
❖ Blood, Buffy Coat and Lymphatic Fluid
❖ Urine
❖ Eye Scrapings. Skin Scrapings
❖ Biopsy Specimens
❖ Other body fluids (i.e. CSF, Vaginal Fluid,
Amniotic Fluid)
STOOL
➢ Most common method
➢ Demonstration of eggs, larvae, adults,
trophozoites, cysts, or oocysts in the stool
➢ Preferably morning sample!
Best collected in:
➢ clean, wide-mouthed containers made
of waxed cardboard
or
➢ plastic with a tight-fitting lid to ensure
retention of moisture and to prevent
accidental spillage
Properly Labeled; submitted together with a
lab request
Important Factors to be considered:
➢ Intake of drugs/ medicinal substances
1. Antacids - hyperacidity
2. Anti-diarrheal
3. Barium: x-ray of GIT
4. Bismuth
5. Laxatives
Uminom po ba kayo ng pang-deworming?
Syempre negative lalabas
Stool Examination should be deferred STOOL PRESERVATIVES

AMOUNT OF STOOL SUBMITTED: *Proper concentration: 1 part stool : 3 parts

preservative
A routine stool examination usually requires:
1. Formalin
• a thumb-sized specimen of formed stool 2. Schaudinn’s solution
• about 5 to 6 tablespoons of watery 3. Polyvinyl alcohol
stool. 4. Merthiolate Iodine Formalin
5. Sodium Acetate Formalin
Contamination with toilet water, urine, or soil
must be prevented since these can destroy OVA & PARASITE EXAMINATION
protozoan trophozoites. 1. Macroscopic Examination
Collect it directly!! 2. Microscopic Examination
In addition, soil and water may contain free- ➢ Techniques
living organisms that would complicate
o Direct Fecal Smear
diagnosis of infections o Concentration Techniques
STOOL PROCESSING AND HANDLING o Kato-Katz Technique
o Kato-Thick Smear
➢ Watery/Diarrheic Stool: examine within o Stoll Dilution Technique
30 minutes from time of passage ➢ Preparation of Permanent Stained Smears
➢ Formed stool: up to 24 hours – confirmation of intestinal protozoan
o Use of Iron Hematoxylin or Trichrome
Temporary storage of fecal samples in a
refrigerator (3-5°C) is acceptable OTHER TECHNIQUES FOR STOOL

Trophozoites are KILLED BY REFRIGERATION, Larval Culture – for hookworm and

although helminth eggs and protozoan cysts
are usually not damaged.
NEVER FREEZE STOOL SAMPLES. NEVER KEEP
THEM IN INCUBATORS
threadworm larva
Ex: Harada Mori; Baermann Technique
Perianal Swab – for Enterobius and Taenia

BLOOD

➢ Thick and Thin Smears - for malaria

➢ Knott’s Concentration technique – for
microfilaria
➢ Buffy Coat Smear: for hemoflagellates

SPUTUM

➢ Parasites that may be recovered on

sputum:
o Migrating larvae of Ascaris
lumbricoides, Strongyloides
stercoralis, and hookworms
o Paragonimus ova
 o Echinococcus granulosus hooklets
from
o pulmonary hydatid cysts
o Protozoa such as:
▪ Entamoeba histolytica
trophozoites from pulmonary
amebic abscess
▪ Cryptosporidium parvum oocysts,
although very rare
▪ Non-pathogenic Entamoeba
gingivalis and Trichomonas tenax
o Trypomastigotes of Trypanosoma cruzi,
Trypanosoma brucei rhodesiense, and
Trypanosoma brucei gambiense
o trophozoites of Naegleria
o Parastrongyliasis
o Specimen examined within 20 minutes
Tissue biopsy
o For Trichinella spiralis
Rectal biopsy

*First morning specimen best o Presence of deposited eggs of

Schistosoma japonicum
Patient cannot expectorate > use inductants
(10% sodium chloride or hydrogen peroxide)

URINE

➢ First morning specimen best since there

could have been concentration of
parasites overnight
➢ Best for Trichomonas vaginalis
➢ May also detect Wuchereria bancrofti
and Schistosoma haematobium

TISSUE ASPIRATES:

Sample aspirated from the ff organs:

o Liver
o Duodenum
o Bronchial
o Lymph node
o Skin

Liver aspirate: MOST COMMON in the

Philippines:

o To rule out hepatic amoebic abscess

o For diagnosis of Echinococcus granulosus
in endemic areas

Duodenal aspirate: uses String test

Cutaneous or Skin aspirates

o For cutaneous Leishmaniasis (Oriental

sore)

Cerebrospinal Fluid: