INTRODUCTION TO MEDICAL PARASITOLOGY

By Dr. Eman D. El- Kerdany

Prof. of Medical Parasitology,

INTERRELASHIONSHIPS BETWEEN ORGANISMS

Symbiosis

(living together)

Though you may never have even heard of the word symbiosis, it plays a huge part in the world you live in. The definition of symbiosis is a close and often long term relationship between two different biological species.

THERE ARE THREE DIFFERENT TYPES OF SYMBIOSIS;

1-commensalism, 2-mutualism, 3- and parasitism.

COMMENSALISM
is

the type of symbiosis in which one of the organisms benefits from the relationship, and the other one is not affected. An example of commensalism is clownfish and anemone

THE SECOND TYPE IS MUTUALISM

which both organisms benefit from the close relationship. An example of mutualism is the relation between a butterfly or a bee and flowers or crocodiles and Egyptian teeth cleaning plovers]

, in

PARASITISM- Lastly,

the third type of symbiosis is parasitism, in which one organism benefits, however, the other is harmed. The benefiting partner is called the parasite and the other partner is called the host. The parasite is dependent on the host for food or shelter or both For example, intestinal parasites or ectoparasites

PARASITISM
Ectoparasites,

that which live on the outer surface of the host (E.g: - ticks, mites, leeches)

 Endoparasites,

that which live inside the body of the host (E.g: - tapeworm, liver fluke). Endoparasites are generally disease causing. The disease causing parasites are called pathogenic parasites

PARASITIC

In ancient Greece, the person getting free meals for entertaining others by his amusing conversations was called a parasite - 'para' refers to beside and 'sitos' refers to grains. Thus, parasitism is defined as an association between individuals of two different species in which one is benefited and the other is harmed.

TYPES OF PARASITISM.

1-Superinfection is reinfection with the same species of parasite from external source, while
2- Auto infection is the case when an infected person reinfect himself by his own old infection. This may be external or internal autoinfection. 3- Hyperinfection; in immunosuppressed individules. A type of internal autoinfection

. Overall,

however, symbiosis is vitally important to millions of our world's most fascinating creature's survival.

Evaluation:

1. Define symbiosis, commensalism, mutualism, and parasitism. 2. Give two examples of pairs of organisms that have these symbiotic relationships: commensalism, mutualism, and parasitism and explain the relationship.

PARASITOLOGY

Parasitology is a biological phenomenon concerned with The dependence of one living organism on another . OR the study of the relationship between a parasite and its host. This is the topic in this course

PARASITOLOGY
. This method of existence is the single most successful way of making a living, and it has been estimated that no less than 80% of all species of organisms are parasites. (1992, Sci. Am. 267(4): 42-48; 1998, Int J Parasitol 28(12): 1939-1941). It is likely that this is an under-estimation.

MEDICAL PARASITOLOGY

The subject which deals with

The infect man ( Host ), 5- The diseases produced by the parasite, clinical picture and the immune response of the host . 6- The various methods of the diagnosis, 7- The treatment 8- The prevention and control

The parasites 1- Morphology 2- Habitat 3- Life cycle of the parasite 4- Its mode of transmission

TYPES OF PARASITES:

1. Obligatory parasite that cannot exist without a host. 2. Facultative parasites that are able to exist independently of their host, leading a free living life. 3. Accidental or Incidental parasites that enter accidentally and can live in a host different from their normal definitive host 4. Opportunistic parasites are those of low pathogenicity and become highly pathogenic in patients with a defective immune system.

TYPES OF PARASITES ACCORDING TO THEIR HABITAT

1- Endoparasites which live inside their host causing infection 2-Ectoparasites which are found attached to the skin of their host or its superficial tissue causing infestation ( Insects)

TYPES OF HOSTS:

1. Definitive host in which the adult stage of the parasite lives, or sexual reproduction takes place. 2. Intermediate Host in which the immature or larval stage of parasite is found, or in which the parasite multiple asexually. 3. Reservoir host: An animal which is utilized by a parasite as a temporary refuge till it reaches its appropriate definitive host is referred . It is generally a animal which is normally infected with a parasite that can also infect man. For example, dogs and cats are reservoirs of Leishmania.

4. PARATENIC HOST OR TRANSPORT HOST

Sometimes the parasite ( larval stage) enters a host in which it does not undergo any development but remains alive till it gains entry in the definitive host or intermediate host. Such a host is termed as paratenic or transport host or a carrier host. These hosts are important for the completion of the life cycle of certain parasites as they are believed to bridge the ecological gap between the intermediate and the definitive host.

TYPES OF HOSTS

5. Vector (usually arthropod) that transmits parasites from one host to another.

LIFE CYCLE

The life cycle :From the definitive host back to the same or another definitive host. When a parasite requires only one host to completes its life cycle then it is said to have a direct life cycle. When two or more hosts are required to complete the life cycle this is called indirect life cycle.

FROM THE LIFE CYCLE YOU HAVE TO KNOW:

Def. host Habitat Portal of exit of eggs Diagnostic stage Intermediate host (s) Infective stage Mode of infection:

to where ???

Portal of entry Infective stage

SOURCES OF PARASITIC INFECTION OR INFESTATION

1. Soil: Contaminated soil with human excreta containing eggs of the parasite. 2. Water: Contaminated water may carry protozoal cysts and cercaria of schistosomes 3. Food: Fresh water fish, infected meat or raw vegetables

SOURCES OF PARASITIC INFECTION

4. Animals: .Domestic animals such as dogs and cats can be a source of parasitic infection to man

Zoonosis is the term given to the diseases of

animals which are transmissible to man.

Contact with dogs may transmit parasitic infection ( Zoonosis)

SOURCES OF PARASITIC INFECTION OR INFESTATION

5. Infected persons: can be direct sources of infection to himself ( ? ) or to others. 6. Arthropods: Blood sucking arthropods transmit blood and tissue parasites.

SOURCES

7. Iatrogenic: through contaminated syringes as in transfusion malaria, or amongst drug addicts. 8. Nosocomial: is a parasitic infection acquired in hospital and was not present at the time of admission. 9. Placenta: Congenital infection 10. Milk: Transmammary

PORTAL OF ENTRY INTO THE BODY

Parasites ( infective stage) enter the human body through different routes 1. Mouth is the most important portal of entry for cysts of intestinal protozoa, and eggs of helminths 2. Skin: Active skin penetration occurs from the soil, water or introduced through blood sucking arthropods 3. Respiratory tract: Airborn infection occurs. 4. Placenta 5. Genital tract by sexual intercourse.

DEVELOPMENT OF INFECTION

Once the parasite entered the body of its host , it migrates to its final habitat where it matures to the adult stage. The time taken from its entry until the appearance of the first signs and symptoms of the disease is known the clinical incubation period.

 The

prepatent or parasitological incubation period refers to the interval between exposure to infection and the earliest demonstration of the parasites or their products in faeces, blood, urine etc

PORTAL OF EXIT
For the continuation of the life cycle , the parasite ( Diagnostic stage) must have a portal of exit from the host and this can occur via faeces as eggs of most helminths and cysts of intestinal protozoa urine, sputum, blood or genital tract.

PATHOGENESIS OF PARASITIC INFECTION

The ways in which damage may be produced in parasitic infections can occur through different etiologies: 1. Mechanical : The parasite may obstruct a normal passage causing intestinal obstruction or bile duct obstruction or appendicitis.

Mechanical obstruction by Fasciola worm in the bile duct

Hydatid cyst in liver

2. Traumatic: External damage occurs when the parasite invades the skin as in scabies or myiasis. Internal damage occurs when the parasites attach themselves by their buccal capsule to the intestinal mucosa producing ulcers.

3. Toxic: Circulation of certain toxic byproducts of parasites produces generalized manifestations. 4. Necrosis: Enzymes elaborated by the parasite produce necrosis of tissues.

5- Allergic Manifestations: Allergic reactions occur with i nsect bites.

PATHOGENESIS OF PARASITIC INFECTION

6. Stimulation of the host immune response: Parasitic antigens stimulate both a humoral and cellular immune response provoking tissue reactions consisting of cellular proliferation and infiltration at the site of parasites antigens, or deposition of circulating immune complexes in the tissues or fibrous capsulation 7. Cellular destruction: Destruction of red blood corpuscles , reticuloendothelial cells and other tissue cells . 8. Neoplastic Formation: Parasitic infections may contribute to tumour formation.

Cellular infiltration with macropghges in Leishmania infection

a) Multiple mucosal polyps in the descending and sigmoid colon

b) Severe sigmoid polyposis coalescing into a mass

A large malignant tumour in the bladder,. The bladder walls are calcified,

DIAGNOSIS OF PARASITIC INFECTIONS

Clinical diagnosis depends on the characteristic signs and symptoms related to the parasitic infection. Laboratory diagnosis can be achieved by : A)Direct methods microscopical examination of the excreta, blood, tissues or smears. Culture and animal inoculations.

DIAGNOSIS OF PARASITIC INFECTIONS

B) Indirect methods ( Serology) These methods depend on the detection of antigens or antibodies in the patients serum .They are mainly resorted to when parasites are present in tissues, or in cases of closed chronic infection These methods depend on the detection of specific antigens or antibodies in patients serum. C) Molecular biological methods Recently molecular biology techniques were introduced as a means of diagnosing parasitic infections. i) DNA Probes: The DNA hybridization probe technique is based on the assumption that each organism possesses a unique nucleic acid sequence. ii) Polymerase Chain Reaction (PCR): The principle of this technique depends on the ability of replicating a single target piece of DNA of the parasite in the presence of polymerase enzyme.

MEDICAL HELMINTHOLOGY (WORMS)

Helminths or parasitic worms are multi-cellular, bilaterally, symmetrical elongated, flat or rounded animals. Helminths which occur as parasites in man belong to two phyla: I. Phylum Platyhelminths (Flat Worms)
II. Phylum Nematoda (Round Worms)

TYPES OF HELMINTHS

Trematods

Cestodes

Nematodes

I. PHYLUM PLATYHELMINTHS
The platyhelminths or flat worms are dorsoventrally flattened, leaf -like or ribbonlike. Their alimentary tract is rudimentary or completely absent and they have no body cavity. Most of them are hermaphrodites

This

phylum is divided into four classes of which only Trematoda and Cestoidea include human parasites and of medical importance.

CLASS TREMATODA

Trematodes are commonly known as flukes. General Morphology Adults are leaf-like, pear-shaped or elongate worms, covered externally by a cuticle which may be smooth, spiny or tuberculated. All trematodes possess at least two suckers as organs of attachment on their cuticle. Beneath the cuticle are three layers of muscle fibers and the bulk of the body consists of a spongy tissue in which the internal organs are embedded. The digestive system of a trematode starts by the mouth opening, found at the bottom of the oral sucker. The mouth leads to a pharynx, then a short oesophagus which bifurcates into two long blind intestinal caeca.

Morphology of trematodes

MORPHOLOGY

Fasciola spp. &Heterophes hetrophes

CLASS TREMATODA: MORPHOLOGY

The excretory system starts by a definite number of excretory cells ( flam cells) . Waste products pass from the cell to the excretory tubules, excretory duct then into an excretory bladder which discharges its contents through a pore at the posterior end of the fluke.

The nervous system is simple. It consists of a ring of nerve ganglia, around the pharynx, from which nerve fibres ramify. The reproductive system, in almost all the parasitic trematodes are hermaphrodites except bilharzia worms.

Nutrition and Respiration Trematodes are essentially anaerobic they feed on blood, intestinal contents, biliary secretions and tissue juices depending on their habitat.

LIFE CYCLE OF TREMATODES

Flukes are called digenetic trematodes because they undergo two different modes of reproduction: Sexual in the definitive host and Asexual in the intermediate host which is a snail.( Imp.)

IMPORTANT POINTS IN THE LIFE CYCLE

Parasitic trematodes utilize snails as intermediate hosts. With the exception of bilharzia worms, all trematodes lay operculated eggs which may pass out of the definitive host as mature egg i.e with a fully developed embryo (miracidium ) or pass as immature eggs.

Egg of all trematode are all operculated Except Schistosoma eggs

Miracidium

LIFE CYCLE OF TREMATODES

In water ( V. imp), eggs hatch liberating the miracidia which are attracted to their specific snail. After snail penetration, the miracidia transform into sporocysts. They give a second generation of sporocysts or rediae and cercariae

LIFE CYCLE OF TREMATODES

CERCARIA ( INFECTIVE STAGE)

Cercariae leave the snail in batches of hundreds at a time, they are highly developed larval forms. A typical cercaria has a body and a tail. The body resembles in its organization the adult fluke . The tail of the cercariae may be simple (leptocercous) . It may be forked at its end (furcocercous) or provided with a fin or membrane (pleuro-lopho-cercous). .

CERCARIA

CERCARIA ( INFECTIVE STAGE)

Cercariae do not feed in water, they swim freely for few days after which they either 1-Penetrate the skin of the definitive host or 2- Encyst in a second intermediate host or on water vegetations ( Encysted metacercaria )

AS EXAMPLES OF PARASITIC TREMATODES, THE FOLLOWING FLUKES WILL BE STUDIED:

Liver flukes

Fasciola hepatica and F. gigantica

Intestinal flukes

Heterophyes heterophyes
Blood flukes

Schistosoma mansoni Schistosoma haematobium

CESTODES

CLASS CESTOIDEA CESTODES OR TAPEWORMS

General morphology Adults are flat, ribbon like and segmented. Their length varies from few millimeters to several meters The body is divided into head or scolex, neck and several proglottids or segments. The chain of proglottids is called strobila. The scolex is provided with bothria (i.e. grooves) or suckers as organs for attachment, with or without rostellum and hooks. The neck is the region of growth.

Platyhelminthes:
Cestodes

Trematodes

Flat, Ribbon like, segmented

Class:CESTOIDEA

Major features

They are Platyhelminthes. The body is divided into segments.

The body is differentiated into scolex , neck and proglottids (segments). Each group of segments is called strobila

No body cavity. No gut Each segment has both male & female R O.(hermaphrodites ) Adults are all endoparasites The embryo is called a hexacanth. They are divided into two orders: Pseudophyllidea and Cyclophyllidea

CLASS CESTOIDEA

Nutrients are absorbed through their cuticle or tegument which has also a protective function by secreting substances that inactivate the host digestive enzymes. ( imp) Reproduction is by self fertilization in the same segment or by cross fertilization between different segments. The Excretory System consists of flame cells and collecting ventral and dorsal tubules running laterally, emptying through a bladder in the terminal proglottid. The Nervous System in the scolex,

CESTODES
PSEUDOPHYLLIDEA
1- Scolex

CYCLOPHYLLIDEA

e.g Diphyllobothrium latum

e.g. Taenia spp

Hymenolepis nana

SCOLEX

Top view to the rostellum showing the raw of hooks

PSEUDOPHYLLIDEA - CYCLOPHYLLIDEA
3- Gravid segment: shape, uterus, disintegrated or detached

PSEUDOPHYLLIDEA CYCLOPHYLLIDEA
4- egg

5- Embryo

Coracidium

Hexacanthus embryo

PSEUDOPHYLLIDEA
6- Life cycle

CYCLOPHYLLIDEA

* Habitat of Adult worms: Small intestine of the D. H( man or animal) * Eggs ( or gravid segment) are passed in the faeces Immature Mature Operculated Rounded, small Resemble those of trematode Hexacanthus embryo ( oncosphere)
They must reach

water

LIFE CYCLE OF CESTODES

Adults are parasites of the small intestine of man or animals . They require one or two intermediate hosts with the exception of Hymenolepis nana which has one host only acting both as intermediate and definitive host . Gravid segments or eggs of cestodes are passed in the faeces of their definitive hosts. Cestodes that infect man belong to two orders Pseudophyllidea and Cyclophyllidea

LIFE CYCLE

In the Pseudophyllidea, the eggs are immature and operculated resembling those of trematodes. They must reach fresh water to become embryonated, and then hatch liberating the coracidium. These are ingested by Cyclops, which is the first intermediate host and develop into first stage larvae, the procercoid larvae. When the cyclops is ingested by fish (the second intermediate host) they develop into plerocercoid larvae. Man and fish-eating mammals become infected by eating imperfectly cooked fish containing the plerocercoid larva i.e. second larval stage.

LIFE CYCLE

In the Cyclophyllidea, the eggs are mature when passed in the stools. After their ingestion by the intermediate host, the hexacanth embryos or oncospheres are liberated from the egg shell, penetrate the intestinal wall by aid of the hooks and develop in various organs into cystic larval stages e.g. cysticercus - cysticercoid hydatid or coenurus cysts. When these larval stages are ingested by the definitive hosts they develop into adults in their small intestines.

TAPEWORMS TO BE STUDIED ARE:

Pseudophyllidean Tapeworms

Diphyllobothrium latum Spirometra mansoni.

Cyclophyllidean Tapeworms

Taenia solium Taenia saginata Echinococcus granulosus Hymenolepis nana Dipylidium caninum

PHYLUM NEMATODA ARE

unsegmented, bilaterally symmetrical, elongate, cylindrical worms with a body cavity a patent digestive tract. The sexes are separate. Most nematodes are free living and some of them represent the commonest human parasites.

II. PHYLUM NEMATODA

General Morphology The nematodes are cylindrical worms, tapering at both ends. The body is covered by a cuticle made of scleroprotein designed to resist the digestive juices and enzymes of the host. The cuticle may be smooth or marked with various thickenings or expansions. Within the body cavity lie the digestive, reproductive and parts of the excretory and nervous systems of the nematode. The digestive system is a patent tube starting with the mouth opening anteriorly and ending posteriorly by an anus in females and a cloacal opening in males. The mouth leads to the oesophagus which has a chitnized lumen. Its shape and size are useful for the identification of the nematode. The shape of the oesophagus may be cylindrical or filariform, club shaped, double bulbed, rhabditiform and stichosome or cellular.

A cuticle made of scleroprotein designed to resist the digestive juices and enzymes of the host. The cuticle may be smooth or marked with various thickenings or expansions. It is secreted by the hypodermis which is a protoplasmic syncitial layer, thickened into four longitudinal chords. Between the chords and below the hypodermis is a single layer of longitudinal muscle cells which line the body cavity

GENERAL MORPHOLOGY

The nervous system consists of a nerve ring surrounding the oesophagus from which nerve trunks extend anteriorly, posteriorly and laterally. Some nematodes posses a pair of chemoreceptors situated on minute papillae behind the anus called phasmids, others lack such chemoreceptors. The excretory system is composed of two lateral longitudinal canals connected by a transverse tube which opens in the cervical region. The reproductive system in both sexes consists of a series of long tubules coiled around the intestine. Female worms may lay eggs (oviparous) or may give birth to larvae (larviparous or viviparous).

pinworm

Strongyloides

Trichuris

Trichinella hookworm

NEMATODES

Nematodes can be classified according to their habitat into 1- intestinal and tissue nematodes or 2- by the presence or absence of Phasmids.

LIFE CYCLE OF NEMATODES

Adult worm may lay Eggs Larvae Infection by: Ingestion of larvated eggs Or Penetration of the skin by infective larvae

LIFE CYCLE

CLASS ADENOPHOREA (APHASMIDEA)

Nematodes in this subclass are devoid of phasmids and caudal papillae. The anterior part of the body is usually very thin and contains the oesophagus which is of the stichosome type. Females possess a single set of genitalia. Eggs when laid are usually with polar plugs. The following are important members of this subclass:

Trichuris trichiura Trichinella spiralis.

Capillaria philippinensis

CLASS SECERNENTEA ( PHASMIDEA)

These nematodes are provided with phasmids and caudal papillae. Females have a double set of genitalia and the eggs laid are devoid of polar plugs. This subclass includes the majority of parasitic nematodes. The important members include :

- Ascaris lumbricoides Toxocara spp. Enterobius vemicularis Dracunculus medinensis Ancylostoma duodenale Strongyloides stercolaris

Filarial worms