INTRODUCTION

IN
PARASITOLOGY
Assoc. Prof. Dr. Carmen-Michaela Cretu
MD, PhD, DTM&H
CTH

Carol Davila University of Medicine and Pharmacy

Bucharest

PARASITES
PARASITIC DISEASES
Parasites are very common all over the world, in
humans, animals and vegetables as well.
Concerning their relationship with the host, in these
associations, there are some kind of interactions, the
benefit being on one side (host), on the other one
(parasite), or, rarely, on both sides.
It is a strong interaction between host and parasite

The importance of parasitic

diseases
The parasitic diseases can have an acute
evolution,
evolution even up to death:
- Malaria represents the third cause of death in the
world, among the infectious diseases.
- African trypanosomiasis or visceral leishmaniasis
are very dangerous, arriving even to death, in the
absence of the specific treatment
Other parasitic diseases, are associated with
chronic evolution, representing an important
source of morbidity (i.e. chronic schistosomiasis)

PARASITIC DISEASES MORBIDITY

Congenital malformations

Toxoplasmosis, Chagas disease

Blood transfusion diseases

Malaria, Chagas disease

Malnourishment, chronic diarrhea

Intestinal helmints / protozoa

Decreasing the intellectual

development

Intestinal parasites (worms)

Iron deficiency anemia

Malaria, hook worms

Gall bladder, or urinary malignances

Opistorchiasis, schistosomiasis
(S. haematobium)

Intestinal occlusion

Ascaridiasis

Cardiac disturbances

Chagas disease, Trichinellosis, VLM

Vision troubles / blindness

Toxoplasmosis, Oncocerchiasis, OLM,

Cysticercosis, Achantamoeba keratitis,

Seizures

Cysticercosis, VLM, Malaria, Schistosoma

Liver cirrhosis

Schistosomiasis, opistorchiasis

Kidney damage

Malaria, schistosomiasis

Secondary sterility

Schistosomiasis

Skin / mucosa sore

Cutaneous leishmaniasis

Temporary inability for working

Dracontiasis

TROPICAL AND DEVELOPING COUNTRIES

- Parasitic diseases represent an important target for international

organisms involved in Public Health surveillance

- It is estimated that about 33% of the human population is under the risk
of parasitic diseases, mainly those living in inter-tropical areas

Parasitic disease

Infected
persons

Morbidity

Mortality /
year

Malaria

300-500 million

39 million

1.5-2.7 million

Chagas disease

16-18 million

600 000

17 000

Leishmaniasis

12 million

1.7 million

42 000

African trypanosomiasis

0.3-0.5 million

1.3 million

40 000

Amoebiasis

1.5 billion

Ascaridiasis

1.5 billiard

1.3 million

60 000

Hook worms infection

1.3 billiard

1.7 million

65 000

Onchocercosis

18 million

1 million

Lymphatic filariasis

120 million

4,7 million

Flukes

40 million

Schistosomiasis

200 million

70 000

1.7 million

7 000

DEVELOPED COUNTRIES
Despite the good hygiene level, water supply, vector control,
some parasitic diseases can appear in these countries, either
as epidemic, or sporadic cases
This situation seems to be linked to:
- Professional field
- Recreation/business voyages in tropical areas,
change of the nutrition style (i.e. eating raw or improperly
cooked meat taeniasis/cysticercosis, trichinellosis or fish
anisakiasis)
- Life in collectivities (giardiasis epidemics in kindergartens)
- Multiple causes of immune suppression (reactivation of an
ancient infection - cerebral toxoplasmosis, visceral
leishmaniasis - in HIV patients, or acquiring a new pathogen
like Cryptosporidium parvum, Encephalitozoon intestinalis,
Enterocytozoon bienusi)

EMERGING PARASITIC DISEASES:

some well known parasitic diseases which can be
easily spread and become frequent:
Due to the climate changes, malaria parasites can be spread
in areas where the disease was initially eradicated:
The climate consequences of El Nio in 1997 was followed
by a malaria epidemic in Kenya
The war and social troubles in Africa can explain the
increasing cases in African trypanosomiasis and the
residual foci of dracunculiasis in Sudan
The field irrigation in tropical areas are facilitating the
occurrence of malaria or schistosomiasis infection in these
regions
The increase of air transport (for persons or commercial
flights) may facilitate the transport of the parasites from a
geographic area to another: airport malaria
Commercialized infected meat with Trichinella spp., the
importation of raspberry contaminated with Cyclospora,
from Guatemala to US

DEFINITIONS
Parasite: organism living together with the host,
depending totally or partially on it, but without
destroying the host: protozoa, metazoan (worms)
Definitive Host: Worms - Harbors Mature Parasite
Protozoa - Harbors Sexually Reproducing Stage
Intermediate Host: Worms - Harbors the Immature Parasite
Protozoa - Harbors Asexually Reproducing Stage
Reservoir Host: Non-Human host which maintains the infection in nature
Vector: Transmits parasite from one host to the next one
Usually a Arthropod - Parasite undergoes compulsory life cycle
development
Transport Host: Direct transmission of the parasite i.e. fecal
contamination by flies

Zoonosis: a common disease to human and domestic or

sylvatic animals as well (trichinellosis, schistosomiasis,
toxoplasmosis)
Parasite specificity - the capacity of a parasite to develop in a
certain host (or a host group)
The specificity is variable:
- poor or inexistent (toxoplasmosis, trichinellosis)
- moderate (fascioliasis)
- high (enterobiasis)
The specificity is variable upon the host:
i.e. malaria parasite is very specific for human, but less specific
for mosquito (there are several anopheles species known as
malarial vectors)
As a rule:
a disease due to a well adapted parasite has a better tolerance
in the host than a disease due to a less adapted parasite

HOST-PARASITE RELATIONSHIP
Saprophyte: organism living in the nature
on any decomposing material
Symbiosis: some organisms living
together, in association, this kind of life
being profitable for both of them
Commensal: organism living in contact
with the host, without causing any
disturbances or benefit in hosts life style
Predator: organism living initially together
with the host, but finally killing the host in
order to nourish himself

PARASITES
Parasite location in the host:
- can live only in a certain, elective organ of the host: digestive
system (intestinal parasites), liver (Fasciola spp.), blood
(Plasmodium spp.), skin (Sarcoptes spp)
- can live in a not habitual organ critique site or, they can
migrate in different organs, when the parasite is not very well
adapted to the host, which serves to him only for the transport paratenic host (larva migrans syndrome due to the dogs Ascaris
migration)

Ectoparasites: are living on the body surface, skin, of the host

- Determining by themselves a skin disease, as S. scabies
- Acting as vectors for some parasitic diseases (mosquitoes, flies)
- Producing a local, temporary reaction (louse)
Endoparasites: are living inside the body host tissues, blood,
intestine, etc

HOST-PARASITE RELATIONSHIP
Compulsory parasitic life - some parasites always
need a host for surviving and living
Optional parasitic life - some parasites use to live
as saprophytes in nature and they become parasites
under certain circumstances
Accidental parasitic life - some parasites are living
as free organisms, rarely becoming parasites

PARASITIC INFECTIONS
PATHOGENESIS
Human can be host to over 100 kinds
of parasites
Parasitology - largely a study of
symbiosis
When the symbiont is harming the
host, it becomes a parasite

FEATURES OF PARASITIC
INFECTIONS

Host immune response

Geographical region
Parasitic burden
First/secondary infection
Associated pathology of the host

TRANSMISSION
Directly, without any intervention - person to person
transmission (giardiasis, enterobiasis)
Indirectly,
Indirectly by the intervention of an external factor:
- Environment (soil ascaridiasis, trichuriasis)
- Passive organism (transport host insects, or vegetables)
- Active transmission (vector mosquito, fly)

TRANSMISSION
Oral contamination
Skin penetration
Vector transmission
Sexual transmission
Blood transfusion / organ transplant
Vertical transmission (mother to child)
Other types of contamination

1. Oral transmission
A. Water, food contaminated by cysts, eggs or larvae:
Protozoa
Metazoa
E. hystolityca
Giardia duodenalis
Balantidium coli
Cryptosporidium spp.
Toxoplasma spp.
Cyclospora spp.
Microspora spp.

Ascaris lumbricoides
Enterobius vermicularis
Trichuris trichura
Hydatid cyst
Cysticercus /coenurus
Hymenolepis spp.
Toxocara spp.
Fasciola hepatica
Dracunculus medinensis

B. Improperly cooked meat / fish containing parasitic larvae:

Meat
- Trichinella spp.
- Taenia spp.
(T. saginata, T. solium)

- Toxoplasma gondii
- Sarcocystis spp.
- Gnathostoma spinigerum

Fish
- Opistorchis / Clonorchis
- Paragonimus spp.
- Capilaria philipinensis
- Anisakiasis
- Angiostrongylus spp.
- Diphilobotrium spp.
- Heterophies heterophies /
Metagonimus yocogaway
- Gnatostoma spinigerum
- Sparganum

2. Skin penetration

direct penetration
of the living larvae from water / soil, following the skin contact

Schistosoma spp.
A. duodenale / N. americanus; S stercoralis
Myasis
Cutaneous Larva Migrans
Sarcoptes Scabiei
Tunga penetrans

3. Vector transmission

skin bite / contamination by a haematophagus vector

Skin bite
Plasmodium spp.
Babesia spp.
T. brucei rhodesiense / gambiense
Leishmania spp.
Wuchereria bancrofty /
Brugia malayi
Onchocerca volvulus, Loa loa

Skin contamination
Trypanosoma cruzi

4. Sexual transmission
Endoparasites
Trichomonas vaginalis
Entamoeba histolytica

Ectoparasites
Phtirius pubis
Sarcoptes scabies

5. Blood transfusion / organ

transplant
Plasmodium spp.
Trypanosoma cruzi
Toxoplasma gondii
(primary / ancient, reactivated infection)

6. Vertical transmission
(mother to child)
Toxoplasma gondii
Trypanosoma cruzi
P. falciparum

7. Other type of contamination

Free living amoeba
Acantamoeba spp.
Naegleria spp.

EFFECTS ON THE HOST

Congenital malformations

Toxoplasmosis, Chagas disease

Blood transfusion diseases

Malaria, Chagas disease

Malnourish, chronic diarrhea

Intestinal helmints / protozoa

Decreasing the intellectual

development

Intestinal parasites (worms)

Iron deficiency anemia

Malaria, hook worms

Gall bladder, or urinary malignances

Opistorchiasis, Schistosomiasis
(S. haematobium)

Intestinal occlusion

Ascaridiasis

Cardiac disturbances

Chagas disease, Trichinellosis, VLM

Vision troubles / blindness

Toxoplasmosis, Oncocerchiasis, OLM,

Cysticercosis, Achantamoeba keratitis

Seizures

Cysticercosis, VLM, Malaria, Schistosomiasis

Liver cirrhosis

Schistosomiasis, Opistorchiasis

Kidney damage

Malaria, Schistosomiasis

Secondary sterility

Schistosomiasis

Skin / mucosa sore

Cutaneous leishmaniasis

Temporary inability for working

Dracontiasis

Parasite
Organ

Protozoa

CNS

Plasmodium spp
Babesia spp
T. b. Gambiense
Naegleria spp.
Acantamoeba spp.
Toxoplasma gondii

T. solium
(cysticercosis)
E. granulosis
Schistosoma spp.
Paragonimus spp.
Multiceps spp.
H. heterophyes

Toxocara spp.
Trichinella spp.
A. cantonensis
Loa loa

Hypoderma spp.

Eye

Acantamoeba spp.
Toxoplasma gondii
T. cruzi

T. solium
(cysticercosis)
Spirometra spp.

Toxocara spp.
Loa loa
O. volvulus
Thelazia spp.
Dirofilaria repens

Hypoderma spp.
Demodex
Foliculorum
Phtyrius pubis

Lung

Toxoplasma gondii
Plasmodium spp.
E. histolytica
P. cariniix
C. parvumx

E. granulosus
Schistosoma spp.
Paragonimus spp.

Toxocara spp.
A. lumbricoides
W. bancrofti
Dirofilaria immitis
S. stercoralis
A. duodenale /
N. Americanus

Heart

Toxoplasma gondii
T. cruzi
T. b. rhodesiense

T. solium
(cysticercosis)

Trichinella spp.
Dirofilaria immitis

E. granulosus
E. multilocularis
S. mansoni
Opistorchis spp.
F. Hepatica
E. Granulosus
S. mansoni

T. canis
A. lumbricoides

P
A
R
A
S
I
T
E
S

L
O
C
A
T
I

Liver /
Bile ducts

Plasmodium spp.
T. gondii
E. histolytica
T. gambiense
Leishmania spp.
Microsporidia
Plasmodium spp.

Lymph nodes
Spleen

T. gondii
T. Gambiense

Bone marrow

T. cruzi
Leishmania spp.
Plasmodium spp.

O
N

Plat-helmints

E. granulosus
H. heterophyes

Nematoda

W. bancrofti
S. stercoralis

Arthropoda

Muscles

T. cruzi
Sarcocystis spp.
T. Gondii
Sarcocystis spp.

T. solium
(cysticercosis)

Trichinella spp.
Toxocara spp.

Kidney
parenchima

Plasmodium spp.
Microsporidia

E. granulosus
S. mansoni

Loa loa

Genital urinary system

T. vaginalis
E. histolytica

S. haematobium

E. vermicularis
W. bancrofti

Intesinal lumen

E. histolytica
Giardia intestinalis
Balantidium coli
Isospora belli
Cryptosporydium
parvum
Cyclospora spp.
Microsporidia
Dientamoeba
fragillis

T. solium
T. saginata
H. nana
D. latum
Fasciolopsis buski
H. heterophyes
S. mansoni
S. japonicum
S. intercalatum

E. vermicularis
A.lumbricoides
A.duodenale
N. americanus
S. stercoralis
Trichuris trichiura
Anisakis
Capilaria
philipinensis
Trichinella spp

Skin

T. gondii
Leishmania spp.

Schistosoma spp.
Spirometra spp.

Loa loa
O. volvulus
D. medinensis
Dirofilaria repens
S. stercoralis
A.brasiliense
A.caninum
Gnathostoma spp
A. costaricensis

Phtirius
pubis
S. scabiei

S. scabiei
S. penetrans
Cordilobia
spp.
Dermatobia
spp.
Pediculus
spp.
Phtirius
pubis
Demodex
foliculorum

PARASITIC INFECTION

Pathogenesis - Mechanisms for host injury

Eliciting an Immune Response: hookworm larvae in the lungs cause
eosinophilic pneumonia
Mechanical injury - trauma:
- hookworm larvae, insect bite, schistosoma eggs during migration
- choledochal occlusion by ascaris, fasciola
- appendicitis due to ascaris, trichiuris, enterobius
- compression on surrounding anatomical structures: hidatid cyst, cysticercus
Nutritional depletion: adult hookworms, ascaris, giardia lamblia
Digestion of host tissues: Entamoeba histolytica
Toxins and toxic metabolites:
- Plasmodium, pruritus due to sarcoptes female migration
- anal pruritus due to E. vermicularis egg deposition
- toxins inoculated by insect bite
Behaviour changes: ascaris, enterobius, teniasis, giardiasis
Combinations of the above are common

How the parasite is

eliminated by the host?
Through feces - all the intestinal parasites:
nematodes, cestodes, protozoa, eliminating: eggs
(infective or not), larvae, cysts
Through the genital-urinary tract: Schistosoma
haematobium, Trichomonas vaginalis
By haematophagus insects, for the blood parasites:
Anopheles spp. for Plasmodium spp., or
Phlebotomus spp. for Leishmaniasis
For the deep tissue parasites sometimes it is
necessary a predator ingestion of pork meat
containing Cysticercus spp., or Trichinella larvae

How the parasite can avoid

the host reaction
Anatomical separation by an antigenic amorphous, but permeable structure for
the nutrients (external host layer of the hydatid cyst, collagen capsule of the
muscle fiber, containing Trichinella larvae)
Thick cuticle of the worms
Resistance to the complement cytotoxic activity
Inhibition of the liposome fusion by the intracellular parasites
T. gondii
Synthesis by the worms of some proteases destroying the antibodies
Host antigens acquisition (blood group substances on Schistosoma spp.
adults surface, filarial worms)
Antigenic variation (in T. brucei, P. carinii etc)
Immune-suppression (lymphocytotoxines secreted by Trichinella spp.)
Surface antigens specific for certain stages of the parasites (lymphatic
filariasis)

Host reaction to the parasite

Encapsulation (Trichinellosis, Cysticercosis)
Calcium depositing (Trichinellosis, Cysticercosis)
Inflamation - granuloma formation (Toxocariasis,
Schistosomiasis)
Included intracellular (Toxoplasma gondii, Leishmania
spp., T. cruzi)
Tissue reaction:
- hypertrophy billiary tree due to Fasciola hepatica
- neoplasia papilloma and bladder cancer in urinary
Schistosomiasis

Parasitic diseases can occur:

Sporadic isolated cases, without any connection
Endemic the continuously persistence of the
disease, with a minimum morbidity and seasonal
appearance
Hyperendemic endemic, with high morbidity
Epidemic - a rapid extension of the disease,
including an important number of population
Endemo-epidemic periodical epidemics in an
endemic area
Pandemic epidemic, with extension at large
areas of the world

PARASITES
PROTOSOA

METASOA

Sporozoa

Nemathelminthes

Sporozoans

Roundworms

Sarcodina

Plathelminthes

Amoebas

Flatworms

Mastigophora
Flagellates
Ciliates

Trematoda

Cestoda

Ciliates

Flukes

Tapeworms

IMPORTANT ENDOPARASITES IN HUMAN PATHOLOGY

PROTOZOA
PHYLUM RHIZOFLAGELATAE

Order Rhizopoda
Entamoeba histolytica
Entamoeba hartmanni
Entamoeba coli
Entamoeba gingivalis
Entamoeba polecki
Iodamoeba butschlii
Dientamoeba fragilis
Endolimax nana
Naegleria fowleri
Acanthamoeba spp.

Order Flagellata
Trypanosoma brucei
gambiense
Trypanosoma brucei
rhodesiense
Trypanosoma cruzi
Leishmania donovani
Leishmania tropica
Leishmania brasiliensis
Leishmania mexicana
Trichomonas vaginalis
Trichomonas intestinalis
Trichomonas tenax
(bucalis)
Chilomastix mesnili
Retortamonas
(Embadomonas) intestinalis
Enteromonas hominis
Giardia duodenalis

IMPORTANT ENDOPARASITES IN HUMAN PATHOLOGY

PHYLUM SPOROZOA

Haematozoa
Plasmodium spp.
Plasmodium falciparum
Plasmodium vivax
Plasmodium malariae
Plasmodium ovale
Babesia spp.
Coccidia
Sarcocystis hominis
Isospora belli
Cryptosporidium parvum
Toxoplasma gondii
Cyclospora spp.

PHYLUM MICROSPORIDIA

Nosema spp.
Encephalitozoon spp.
Enterocytozoon spp.
Pleistophora spp.
Septata spp.
PHYLUM CILIATA

Balantidium spp

UNCERTAIN TAXONOMY
Pneumocystis carinii
Blastocystis hominis

IMPORTANT ENDOPARASITES IN HUMAN PATHOLOGY

PHYLUM PLATHELMINTH

Order Trematoda

Distoma
Fasciola hepatica
Dicrocoelium dendriticum
Clonorchis sinensis
Opisthorchis felineus
Fasciolopsis buski
Echinostoma spp.
Heterophyes heterophyes
Metagonimus yokogawai
Paragonimus westermanni:
Schistosoma
Schistosoma haematobium
Schistosoma mansoni
Schistosoma intercalatum
Schistosoma japonicum
Schistosoma mekongi

Order Cestoda

Taenia saginata
Taenia solium
Diphyllobothrium latum
Spirometra spp
Echinococcus granulosus
Echinococcus multilocularis
Hymenolepis nana
Hymenolepis diminuta
Dipylidium caninum

IMPORTANT ENDOPARASITES IN HUMAN PATHOLOGY

PHYLUM NEMATODA

Order Nematoda

Trichuris trichiura
Enterobius vermicularis
Ascaris lumbricoides
Ancylostoma duodenale
Necator americanus:
Strongyloides stercoralis:
Toxocara spp.
Anisakys spp.
Capillaria hepatica
Angiostrongylus cantonensis
Gnathostoma spp.
Trichostrongylus spp.
Trichinella spiralis
Wuchereria bancrofti
Wuchereria pacifica
Brugia malayi
Loa loa
Onchocerca volvulus
Dracunculus medinensis
Mansonella spp

PHYLUM PARARTHROPODA

Order Pentastoma
Linguatula serrata
Armillifer spp.

IMPORTANT ECTOPARASITES IN HUMAN PATHOLOGY

PHYLUM ARTHROPODA
Order Insect
Diptera (fly, mosquito, phlebotomus)
Anoploura (louse)
Anopheles spp.
Pediculus humanus
Culex spp.
corporis
Mansonia spp.
Pediculus
Aedes spp.
Phthirus pubis
Phlebotomus spp.
Trichodectes canis
Lutzomya spp.
Hemiptera (bugs)
Simulium spp.
Cimex lectularius
Chrysops spp.
Cimex hemipterus
Glossina spp.
Triatoma infestans
Calliphora spp.
Triatoma megista
Lucillia spp.
Rhodnius prolixus
Gastetrophilus spp.
Aphaniptera (flea)
Cordylobia spp.
Pulex irritans
Auchmeromyia spp.
Xenopsylla cheopis
Cochliomyia spp.
Nosophyllus fasciatus
Oestrus spp.
Ctenocephalides canis
Sarcophaga spp.
Tunga penetrans
Hypoderma spp.
Dermatobia spp.
Wolhlfahrtia spp

Order Arachnidae

Acarina
Ixodides
Ixodes ricinus
Ixodes scapularis
Sarcoptidae
Sarcoptes scabiei
Demodicide
Demodex
folliculorum
Order Crustaceea
Cyclops spp
Diaptomus spp.

When a doctor should think

about a parasitic disease?
should have into consideration a parasitic disease, because
there are a lot of clinical situations related to the parasites:
There are a lot of organs (liver, CNS, eye, skin, lung, etc) and
many medical specialties (neurology, ophthalmology,
dermatology, pediatrics, chest diseases, allergology, surgery,
infectious diseases, etc) involved
Travel medicine push the medical doctors to ask their patients
about their travels (duty or holiday), the duration, the
accommodation; the importance of the medical advice before
departure and after return, in order to look for the most
important diseases common in the respective areas
The well knowledge of the geographic area where the patients
had travel, allows the doctor to suspect or to eliminate a parasite

GEOGRAPHICAL DISTRIBUTION OF THE MOST IMPORTANT PARASITES

Cosmopolite

Asia

Africa

South America

E. histolytica

Malaria

Malaria

Malaria

Cryptosporidium spp.

Opistorchis felineus

Leishmania spp
(cutaneous, visceral)

L. mexicana /
L. brasiliense

Cyclospora

S. japonicum

T. brucei

T. cruzi

Microsporidiasis

Capillaria philippinensis

Wuchereria bancrofti

Oncocerca volvulus

Trichomonas spp.

Wuchereria bancrofti
Brugia malayi

Loa loa

S. mansoni

Toxoplasma gondii

Paragonimus
westermanii

Dracunculus
medinensis

Angiostrongylus spp.

Giardia duodenalis

Fasciolopsis buschi

Onchocerca
volvulus

A. duodenale /
N. americanus

Angiostrongylus
cantonensis

S. haematobium
S. mansoni
S. intercalatum

A. lumbricoides

Gnathostoma
spinigerum

Paragonimus
africanus

E. vermicularis
S. stercoralis
Trichuris trichura
Trichinella spp.
Hymenolepis nana
Teniasis
D. latum