PARASITES OF PUBLIC

HEALTH IMPORTANCE
THEIR NATURE, CLASSIFICATION,AND
BIONOMICS
BY
DR. H. O. DADA-ADEGBOLA
M.B.B.S, FMCPATH.
 TAXONOMY AND
CLASSIFICATION
The parasites of medical importance fall
into two kingdoms: Protista (eukaryote;
unicellular) and Animalia (eukaryote;
multicellular).
The microscopic, single-celled, eukaryotic
(having a true nuclear membrane)
macroscopic, multicellular worms
possessing well differentiated tissues and
complex organ systems.
 PROTOZOA
Protozoa are unicellular organisms which are
widely distributed in nature. Each consist of a
true membrane bound nucleus and cytoplasm.
Each protozoan cell is able to perform all the
vital functions of life, and unlike the metazoan
cells, it is capable of an independent existence.
Most activities such as nutrition, respiration and
excretion occurs through osmosis.
Locomotion is an important characteristic of
protozoa and this takes place by means of three
basic types of organelles: flagella, cilia, and
pseudopodia.
 Nature of Protozoa
All medically important protozoa are microscopic
and their basic structure consists of the
protoplasm which is differentiated into the
cytoplasm and the nucleus. The cytoplasm is
made up of the transparent external portion
called ectoplasm. Functions of ectoplasm
include locomotion and sensation. The inner
granular portion of the cell is called as
endoplasm and it contains food vacuoles which
help in digestion of food. The functions of
endoplasm include nutrition, excretion and
reproduction.
 Nature of protozoa 2
The nucleus consists of a network of a
network of fine reticulum enclosed by a
nuclear membrane. The nucleus acts as
governing centre for vital activities of cell,
seat of dynamic activity, essential for cell
division, growth and replication,
responsible for hereditary characters and
also takes part in fertilization of cell.
 Protozoa reproduction
Reproduction could be by asexual and sexual mode.
Asexual reproduction occurs by:
Binary fission (transverse as in ciliates or
longitudinal as in flagellates) into two daughter
cells.
Multiple fission (Schizogony) the nucleus of
the parent cell undergoes multiple divisions,
resulting in the formation of daughter cells (e.g.
plasmodium).
Endodyogeny- In this the cell undergoes a single
internal budding resulting in the formation of two
daughter cells (e.g. Toxoplasma).
 Protozoa reproduction 2
Sexual Reproduction occurs by either of the
following two methods:
Conjugation- in this process two cells become
temporarily attached to each other during which
time there is exchange of nuclear material. On
completion of conjugation the cells separate and
there is no increase in the number of cells. It is
seen in ciliates.
Syngamy (Gametogony) It is a permanent
fusion of male and female gametes. This is seen
in sporozoa. The male and female gametes fuse
to form the zygote.
 Encystation

Protozoa (e.g. Entamoeba histolytica,

Giardia intestinalis and Balantidium coli)
may show a resting phase when they
enclose themselves within a resistant
membranous wall and are then designated
as cysts. Cysts are non-motile structures
and resist unfavourable conditions better
than trophozoites (the active or vegetative
stage). These, hence, serve double
purpose of protection and reproduction.
 PROTOZOA

The shape, size, mode of reproduction and

type of locomotive organelle have been
used to divided these into four major
classes.-
i. Sarcodina- (Rhizopods)/Amoebae;
ii. Ciliophora/Ciliates;
iii. Mastigophora (Flagellates) and
iv. Coccidia (Sporozoa).
 HELMINTHS
The helminths are worms that are
elongated, bilaterally symmetrical, covered
with thick cuticle and vary in length. The
common helminthic parasites of human
beings can be placed in one of the three
classes on the basis of body and
alimentary tract configuration, nature of the
reproductive system and need for more
than a single host species for the
completion of life cycle.
General features of helminthes
They do not possess organs of locomotion,
therefore locomotion is generally by
muscular contraction and relaxation
The outer covering, known as cuticle or
integument is tough and may be armed with
spines or hooks. It is resistant to intestinal
digestion.
Digestive system is absent or rudimentary
Nervous system is primitive
General features of helminthes2
Reproductive system is very well developed
These may be monoecious (hermaphroditic) or
diecious (separate sex)
Both self fertilization and cross-fertilisation may take
place.
Eggs are produced in enormous numbers, but only
a few of them survive and manage to infect a
suitable host.
Helminths, by and large, do not multiply in the
human body, so that single infection does not lead
to disease.
The adult worm or their eggs/larvae can be widely
distributed in various organs and tissues of the body.
 HELMINTHS
i. Platyhelminthes
(Flat worms)
a. Trematoda (Flukes)
b. Cestoda (Tape worms)
ii. Nemathelminthes (Round
worms)
c. Nematodes.
 PLATYHELMINTHES
The body is flattened dorsoventrally, they
have no body cavity, the alimentary canal
is either totally absent or rudimentary and
they are mostly hermaphroditic (both
sexes present in same organism). Suckers
are present. Further division to
Trematodea
Cestodea
 TREMATODEA (Flukes)
These are ecto- or endoparasites without
epidermis or external cilia; they are leaf-like
worms with no body cavity and incomplete
alimentary canal consisting of a mouth, pharynx
and a bifurcated intestine. They are covered with
a cuticle and are provided with one or more
suckers. The body is not segmented. They are
hermaphrodites with paired testes, but a single
ovary, except the Schistosomes in which the
testes vary in number from four to eight.
 CESTODEA (Tapeworms)
These are tape-like, segmented worms
often with hooks and suckers. They have
no body cavity (coelom); the internal
organs are embedded in a loosely
connected parenchyma. They have no
circulatory or respiratory systems, no
alimentary canal, no exoskeleton and no
definitive anus and are hermaphrodite. The
excretory system is comprised of flame
cells and ducts (protonephridia).
 NEMATHELMINTHES
NEMATODEA (roundworms)- the only
class of nemathelminthes. They are
cylindrical, unsegmented and have body
cavity with complete alimentary canal.
They have no hooks or suckers but have a
well developed buccal capsule. They are
sexually differentiated.
Nematodes could be found in the intestine
or tissue
 CLASSIFICATION OF
PARASITES
1. Location in the host,
Ectoparasites: such as ticks, lice, fleas,
and Sarcopties scabi which live on the
surface of other organism.
Endoparasites: such as some protozoa
and worms which live within the bodies of
other organisms.
 CLASSIFICATION OF
PARASITES 2
2. Level of dependence on the host
Obligate parasites: MUST spend at least some of their life
cycle in or on a host e.g. malaria parasite.
Accidental parasites: when parasites attack an unusual
host.e.g. Toxocara canis and Toxocara catis (Visceral
and cutaneous larva migrans)
Aberrant parasites: a parasite is aberrant if it reaches a
site in a host, during its migration, where it cannot live or
develop further.
Facultative parasites: they normally are free living but
they can obtain their nutrients from the hosts also e. g.
Naegleria and Acanthamoeba.
 CLASSES OF HOST
Definitive hosts- they harbor a parasite while it
reproduces sexually.
Intermediate hosts- they harbor the parasite during
some developmental
Paratenic hosts- they harbor a parasite without showing
any development of parasite.
Natural hosts - are naturally infected with certain
species of parasite.
Accidental host - a host which is usually not infected
with a particular parasite.
Reservoir host are infected animals that make parasites
available for transmission to other hosts.
 Types of relationship
Symbiosis- parasites that does no harm to
the host
Commensalism-one organism is benefited and
the other remains unaffected. and
Parasitism- an organism benefits at the cost of
the host.
Mutualism is another kind of symbiosis in which
both the partners are benefited
Opportunism
 MECHANISM OF DISEASE
PRODUCTION BY PARASITES
1. By mechanical injury e.g. rupture of red
blood cell by malarial parasite, intestinal
obstruction by Ascaris lumbricoides, lysis of
cells by Entamoeba histolytica; pressure
following the growth e.g. Hydatid cysts;
Blockage of ducts such as blood vessels or
lymphatics e.g. Strongyloides stercoralis;
Filarial worms (Oedema and elephantiasis
e.t.c).
 DISEASE MECHANISM contd
2. By the deleterious action of toxic substances
e.g. malarial parasite pigments (rigors, chills
e.t.c).
-Histolytic enzymes of Entamoeba
histolytica.
 DISEASE MECHANISM contd
(3) Deprivation of nutrients, fluids and
metabolites, by competing with the host for food
e.g.
-Diphyllobothrium latum (fish tapeworm)
Vit.B12 deficiency (Megaloblastic Anaemia).
-Blood sucking activities of hookworm - Necator
americanus & Ancylostoma duodenale Iron
deficiency Anaemia
- Competing for other micronutrients = Protein
energy malnutrition as in Ascaris, Strongyloides
etc.
 DISEASE MECHANISM Contd
(4)Introduction of pathogenic
microorganisms e.g. Tetanus
complicating Guinea worm infection.
- High urinary carrier rate of
Salmonella typhi has been linked to
the equally high incidence of urinary
schistosomiasis caused by
Schistosoma haematobium.
Pathological processes of parasites
Such parasites may cause damage or disease
through;
Trauma (hookworm, roundworms, taeniasis)
Lytic necrosis (Amoebiasis)
Inflammation (trichinellosis, Leishmaniasis)
Toxins (Amoebiasis)
Allergic manifestation (Visceral larval migrans,
roundworm infections)
 METHOD OF ACQUISITION
Ingestions through contaminated food & drinks e.g.
Ascaris, Entamoeba histolytica, Taenia spp.,
Diphylobothrum latum, Dracunculus medinensis.
Skin penetration e.g. Hookworm, Strongyloides
stercoralis, Schistosoma spp. (Schistosoma
haematobum)
Insect bite Wuchereria bancrofti and Brugia
(mosquito); Loa loa (chrysops fly);Onchocerca volvulus
(Simulium damnosum); Plasmodium spp. (Anopheles
mosquito); T. b. gambiense (Glossina spp.); T. b.
rhodesiense (Glossina spp.); Leshmania spp.
(Phlebotomus spp. (sand flies).
Sexual contact e.g. Trichomonas vaginalis.
Rubbing infected insect faeces into the site of the
insect bite e.g. Bug & Trypanosoma cruzi.
 LIFE CYCLE OF PARASITES
No intermediate host (Direct life cycle) e.g.
Ascaris Lumbricoides, Enterobius
vermiculaus; Balantidium coli, Entamoeba
histolytica. E.t.c
One intermediate host: - e.g Taeniasis ( pig or
cow), Echinococcus granulosus (dog);
Trypanosoma cruzi (bug); Plasmodium spp
( man) e.t.c
Two intermediate hosts e.g Paragonimus
westermani ( snail and crustacean);
Diphyllobothrium latum (cyclop and fish);
Clonorchis sinensis ( snail and fish)
 MAJOR PARASITIC INFECTION
OF MEDICAL IMPORTANCE
Malaria
Filaraisis (Elephantiasis)
Onchocerciasis (River blindness)
Trypanosomiasis
Guinea worm
Leishmaniasis
Schistosomiasis
Intestinal helminthiasis.
Amoebiasis
 MALARIA-
caused by P.falciparum, P. malariae, P. ovale, and P.
vivax.
Insect vector is the female anopheles mosquito.
Over a billion people in the world live in malarious area
300-500million clinical cases are reported each year (90% in
Africa)
0.5-3million deaths occur yearly (majority in children < 5yrs)
Plasmodium falciparum (malignant tertian) has developed
resistance to almost all categories of antimalarial drugs currently
in use.
Resurgence has been reported in areas where malaria has
initially being eradicated.
Very few new therapies have been developed in the last century.
The people at risk of severe malaria are:-non-immune
travelers/migrant workers, children< 5yrs, and pregnant women.
Economic importance of malaria
Loss of man hour
Cost of treatment and
investigations
In pregnant women - premature
delivery, still birth/ abortion.
Attendant problem of acute and
complicated cases including
death.
 AMOEBIASIS
Entamoeba histolytica.
Acquired feaco-orally
On a global scale it infects about 480million people, and
some 48million suffer from invasive amoebiasis.
It affects about 50% of inhabitants of some developing
countries, 10% of the world population and even 1% of
the population of America are infected with E. histolytica.
Invasive Amoebiasis produces an estimated 40million
disabling infections and 40,000 deaths annually.
Amoebiasis has been ranked among parasitic causes of
death.
 TRYPANOSOMIASIS
AMERICAN TRYPANOSOMIASIS
In Latin America, Tyrpanosoma cruzi infects an
estimated10million individual annually,
The infection is acquired when the faeces of infected bug is
rubbed on the conjunctiva or skin abrasions.
The acute phase begins with facial swelling and
pronounced oedema of the eyelids of one eye
(Romanas sign) (this happens in 50% of the cases).
If parasite enters through abrasion on the skin it gives rise
to circumscribed area of erythema and swelling, which is
called chagoma.
Chagoma are most commonly seen on the face,
AFRICAN TRYPANOSOMIASIS
In Africa, Trypanosoma brucei rhodensiense or T. b.
gambiense causes sleeping sickness (one of the most
lethal human infections). In African trypanosomiasis,
infective trypanosomes of T. b. gambiense and T. b.
rhodesiense are introduced through the bite of the tsetse
fly and multiply at the site of inoculation to cause variable
induration and swelling (the primary lesion), which may
progress to form a trypanosomal chancre. They spread
to lymph nodes, bloodstream and, in terminal stages, to
the central nervous system where they produce the
typical sleeping sickness syndrome: Lassitude, inability
to eat, tissue wasting, unconsciousness, and death.
 LEISHMANIASIS
Epidemiology: parts of Europe, Asia and Latin
America and also prevalent in India.
SPECIES-
Leishmania donovani causes visceral
leishmaniasis (Kala-azar)
L. tropica cause of cutaneous
leishmaniasis or oriental sore; Baghdad boil
or other local names.
L. braziliensis cause of American
leishmaniasis which predominantly affects
mucous membranes.
 FILARIASIS
Onchocerca volvulus river blindness
Wuchereria bancrofti elephantiasis
Loa loa (eye worm) calabar swelling.
Other filarial are:
Brugia malayi causes elephantiasis
(Lymphatic filariasis)
Brugia timori
 ONCHOCERCIASIS
Transmitted by Simulium damnosum
The resulting nodules are called
onchocercomas.
Sowda- allergic rxn resulting in skin
darkening.
Hanging skin (elephant skin)- from loss of
elasticity
Leopard skin- depigmentation in chronic
cases.
 OCULAR ONCHOCERCIASIS
The most serious complication of onchocerciasis
- microfilariae in the skin of the face migrate into
the eye.
microfilariae can be found in the cornea and in
the anterior chamber, causing iridocylitis,
choroiditis in early cases. Characterized by
redness and irritation of the eye.
Progressive changes caused by inflammatory
reaction around damaged and dead microfilariae
can cause sclerosing keratitis which can lead to
blindness. Cataract and glaucoma can also
result.
 SCHISTOSOMIASIS
The five principal species that infect man are:

Schistosoma haematobium Terminal spine

Schistosoma mansoni - Lateral spine
Schistosoma japonicum - Minutely spined
Schistosoma intercalatun - Terminal spine
Schistosoma mekongi - Minutely spined.
The intermediate hosts are Bulinus spp for S.
haematobium, Omphalaria spp for S. mansoni
and for S. japonicum is Oncomelania.
 GUINEA WORM
It is caused by Dracunculus medinensis
and acquired by drinking water that
contains infected Cyclops (a micro-
crustacean).
The female worms cause severe pain and
allergic reactions including Urticaria, fever,
nausea and vomiting. Damage to the
worms in the skin can produce severe
inflammation.
 INTESTINAL HELMINTHES
it is estimated that there are more worms
than the people, especially in the
developing countries. These worms are
acquired faeco-orally e.g. Ascaris
lumbricoides (affects 1billion), Trichuris
trichiura, Enterobious vermicularis, or
through skin penetration: - hookworm
(Ancylostoma duoderale, Necator
americanus) affects about 900million
individuals and Strongyloides stercoralis.
 PARASITIC INFECTIONS IN
COMPROMISED HOST
Parasitic opportunistic infection occur with
protozoan such as; Toxoplasma gondii
(CNS involvement), Cryptosporidium
parvum, Microsporidium and Isospora belli
(Enteritis>1month duration), and helminth
e.g. Strongyloides stercoralis
(disseminated infection).
 METHODS OF DIAGNOSIS OF
PARASITIC INFECTIONS
Direct demonstration of adult parasites
(Ascaris)/segments (Taenia).
Microscopic examination of body fluids and tissues for
early stages e.g. ova, trophozoites, larva and cyst.
Cultural methods
Xenodiagnosis
Animal inoculation
Histopathology
Immunodiagnosis-serology
-skin reaction
Radiological & scanning techniques.
CONTROL AND PREVENTION OF
PARASITIC INFECTIONS
Environmental sanitation (mosquitoes,
helminths),
Reduction of mans contact with the vectors
Use of prophylactic drugs and mass treatment of
susceptible population in endemic zones.
Active treatment of infected individuals.
Control of the different stages of the parasites.
Vector control (for those parasites with
intermediate hosts e.g. mosquitoes, Cyclops,
e.t.c.
Provision of safe drinking water e.g. Dracunculus
medinensis.
 REFERENCES for further reading

Medical Parasitology Ichpujani RL and Bhatia R. 2nd Edition. 1998.

Jaypee, New Delhi.
Medical Parasitology Muller R and Baker JR 1990 Gower, London.
Falade C.O, Salako L.A., et al 1997). Comparative efficacy of halofantrine,
chloroquine and sulfadoxine pyrimethamine for treatment of acute
uncomplicated falciparum malaria in Nigerian children Transaction of the
Royal Society of Tropical Medicine and Hygiene 91, 58-62
Kremsner P.G., Luty A.FJ.F. and Graninger W. (1997). Combination
chemotherapy for Plasmodium falciparum malaria. Parasitology today 13:(5)
167-168.
Certa, V: Malaria vaccine. Experientia 47; 157, 1991.
Muller R: Guinea worm disease: Epidemiology, control and treatment. Bull
WHO 57; 683 1979.
Hawkurg F: The distribution of human filariasis throughout the World. Part
III, Africa Trop. Dis Bull. 74: 650, 1977.
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