Amity Institute of Virology and Immunology

Topics : (Module I)
• Introduction
• Parasite classification

Course Title: Medical Parasitology and Mycology

Course Code: TBIO110
Faculty Name: Dr. Neha Sharma, Asst Prof II
 Parasites can be classified based on
various factors, including
a. duration on the host
Classification of b. Habitat
Parasites: c. host specificity
Overview d. degree of dependency. Major parasitic
groups include Protozoa, Helminths
(flatworms and nematodes), and
Arthropods
 Temporary parasites: Lead a free life during part of the
life cycle or visit the host time to time (e.g.,
Gastrophilus, Fleas, Flies).

Classification by Permanent parasites: Live as parasites for their whole

Duration life, remaining with the host all the time (e.g., Lice,
Helminths).

Periodic/Sporadic parasites: Make short visits to

obtain nourishment (e.g., Mosquitoes).
 Definition: Parasites found on the surface of the
host body, typically attached to the skin, feathers,
hairs, or gills.

Ectoparasites include organisms that spend their

Classification by
whole life on the host (e.g., human body louse,
Habitat:
Pediculus humanus).
Ectoparasites
Examples: Lice (Phthiraptera - Mallophaga/biting
lice and Anoplura/sucking lice), Fleas, Ticks.
Mites (e.g., Psoroptes ovis causing sheep scab, or
Demodex)
 Definition: Parasites found inside the body
(body cavity, lungs, or other tissues).

Classification They nearly always live a completely parasitic

existence. Endoparasites must overcome host
by Habitat:
immune defenses and adapt to the internal
Endoparasites physiological environment.
(Detail)
Examples: Helminths (e.g., tapeworms,
trematodes, nematodes) and Protozoans (e.g.,
Plasmodium, Entamoeba)
 Intracellular parasites: Found inside the cells of the host (e.g.,
Plasmodium and Babesia, which are found inside RBCs).

a. Intercellular parasites: Found in between the cells, or in the

cavities or lumen of different organs (e.g., Trypanosoma,
Fasciola, Toxocara).
Endoparasite
Subtypes b. Erratic or aberrant parasites: Endoparasites found in organs
other than their normal habitat (e.g., Fasciola found in the lung
or kidney).

c. Incidental parasites: Endoparasites found in a host where

they do not usually live or are not normally found (e.g., Ascaris
lumbricoides in sheep)
 Host-Specific parasites: Host range is confined or limited to
one species or closely related species (e.g., Plasmodium vivax
specific to humans, Babesia bigemina specific to cattle).

Classification by Specificity Non-Host Specific/Euryxenous parasites: Host range is

and Range broad and can develop in a large number of unrelated animals
(e.g., Fasciola gigantica, Toxoplasma gondii).

Stenoxenous parasites: Have a narrow host range (e.g.,

Coccidia, human malaria, hookworms)
 Obligatory parasites: Completely adopted to a
parasitic mode of life and cannot exist without it (e.g.,
Filarid worms, Cestode/Tape worm).

Facultative parasites: Do not absolutely depend on

parasitic life, retaining the power of free-living
existence, depending on circumstances (e.g., maggots
Classification by Degree and
of flies, Toxoplasma gondii).
Pathogenicity
Pathogenic parasites: Have the potential to cause
harm, tissue damage, and clinical disease in a host
(e.g., Fasciola hepatica).

Non-Pathogenic parasites: Do not cause much harm,

damage, or clinical disease (e.g., Entamoeba coli)
 Proliferous parasite: Enters as one individual, grows,
multiplies, and produces numerous daughter individuals
that also grow and multiply in the same host (e.g., Theileria,
Babesia).

Non-Proliferous parasite: Enters as one, grows, but

progeny do not multiply in the host where they are born; they
Classification by
must get into another host before multiplying (e.g.,
Development and
Helminths).
Size
Macroparasites: Can be seen by the naked eye; cannot
replicate within the host; level of infection determined by
infection events (e.g., trematodes, cestodes, nematodes).

Microparasites: Cannot be seen by the naked eye; replicate

rapidly within the host
 • Understanding the life cycle is crucial
for understanding transmission,
disease mechanisms, and developing
effective treatment and control
programs.
Parasite Life Cycles:
• Parasite life cycles are often complex,
General Concepts
involving transformation, replication,
and movement between different host
environments.

• The complexity often reflects the

parasite's success.
 Definitive (or Final) Host: The host in or on which the parasite
reaches maturity and undergoes sexual reproduction.

Intermediate Host: The host in which the parasite undergoes its

Classes developmental stage(s); asexual reproduction may occur, but
of Hosts sexual reproduction does not.

Paratenic Host: A host that a parasite invades and survives

within but cannot undergo further development; it is not usually
essential but can provide a useful bridge for transmission
 Contaminative Transmission: A passive process where
the parasite is acquired through the consumption of
food or water contaminated with the infective stage (e.g.,
cysts, eggs). E.g., Entamoeba histolytica.

Active Transmission: A free-living infective stage

Transmission actively searches for and invades its host. E.g.,
Strategies Schistosome miracidia invading snails or cercariae
invading humans.

Vector-Assisted Transmission: An animal (vector)

physically transmits the parasite between hosts. The
vector often acts as both transmission agent and
intermediate host (e.g., mosquito vectoring malaria)
 Hookworms (Ancylostoma, Necator) are
examples of homogenous parasites living
primarily in one host. Eggs are released in host
faeces. Larvae hatch and develop in warm,
Example: Direct Life Cycle
moist environments. Infectious filariform
(Hookworms)
larvae penetrate the host skin (e.g., human
foot). Larvae migrate via circulation to the
lungs, are swallowed, and mature into adults
in the small intestine
Intestinal helminths are parasitic worms that inhabit the gastrointestinal tract. They are broadly classified into three major
groups: Nematodes (roundworms), Cestodes (tapeworms), and Trematodes (flukes).
General strategies for the treatment of intestinal helminth infections

• Intestinal worms that infest humans include nematodes (pinworm, whipworm, hookworm), trematodes (flukes), and

cestodes (tapeworm).

• Determining treatment can be challenging due to variability in preferred drug of choice and dose for specific worm

infestations, as well as formulation and acquisition concerns.

• Mebendazole, once a mainstay in the treatment of helminth infections, has been discontinued in the United States

without explanation by the sole manufacturer of the product.

• The remaining treatment options include albendazole, ivermectin, nitazoxanide, praziquantel, and pyrantel pamoate

(Table in next slide).

• These less commonly used agents may be unfamiliar to providers treating patients with helminth infestations, and

consideration should be given to consultation with an infectious diseases expert when treating less common helminths.
 Parasite/Disease Drug First line or Alternative
Intestinal nematodes

Albendazole First line

Hookworm
Pyrantel pamoate Alternative
Ascaris lumbricoides Albendazole First line
Ivermectin Alternative
Nitazoxanide Alternative
Pyrantel pamoate Alternative
Pinworm Albendazole First line
Pyrantel pamoate Alternative
Whipworm Albendazole First line
Ivermectin and albendazole Alternative for high worm burden
Ivermectin Alternative
Nitazoxanide Alternative
Fasciolopsis buski; Heterophyes heterophyes; Metagonimus yokogawai; Nanophyteus
salmincola Praziquantel First line

Intestinal Tremtatodes

Taenia saginata (beef), Taenia solium (pork), Diphyllobothrium Praziquantel First line
latum (fish), Dipylidium canium (dog) Nitazoxanide Alternative
Hymenolepis nana (dwarf tapeworm) Praziquantel First line
Nitazoxanide Alternative
Intestinal Helminths: Prevention & Community Control (Population/Public Health Focus)

• Preventive (Prophylactic) Chemotherapy (Deworming)

• WASH - Water, Sanitation & Hygiene

• Health Education
 Aspect Prevention & Community Control (Population/Public Health Focus)

To reduce the prevalence and intensity of infection in the entire community, break
Primary Goal
transmission cycles, and prevent morbidity at the population level.

Multi-Component Interventions: A combination of prophylactic chemotherapy

Core Strategy
(PC), sanitation (WASH), health education, and sometimes vector/snail control.

Entire at-risk populations or specific risk groups (e.g., school-age children, pregnant women),
Target
regardless of individual infection status.
Intestinal
Helminths: Epidemiological data (prevalence, intensity maps), cost-effectiveness, public health
Key Drivers
Prevention & infrastructure, and political will.
Community
Control Approach to Drugs
Drugs are often administered strategically and pre-emptively as Preventive Chemotherapy
(Population/Publi (PC) - treating whole groups periodically to suppress worm burdens.
c Health Focus)
Often bypassed at the individual level. Decisions are based on community-level prevalence
Role of Diagnosis
surveys. "Test and treat" is replaced by "group-based deworming."

Sanitation (Improved toilets, safe excreta disposal), access to clean water, hygiene
Supporting Measures education (handwashing, footwear), and environmental sanitation are foundational for
sustainable control.

Achieving high, sustained coverage in PC programs; long-term funding; behavioral change

Challenges
for WASH; environmental and socio-economic complexities.

Reduction in community prevalence/intensity, disability-adjusted life years (DALYs) averted,

Success Metric
sustained interruption of transmission.
The term generally used in public health for treating intestinal helminths is "preventive chemotherapy" (PC), not
"prophylactic chemotherapy". Preventive chemotherapy is the large-scale, regular administration of anthelminthic
drugs to populations at risk of infection, regardless of individual diagnosis.

Concept of Preventive Chemotherapy

• Preventive chemotherapy (PC) is a core strategy recommended by the World Health Organization (WHO) for

controlling morbidity and transmission of soil-transmitted helminthiasis (STH) (e.g., roundworm, hookworm,

whipworm) and schistosomiasis in endemic areas.

• The strategy is highly cost-effective because the drugs are safe, inexpensive (often donated by pharmaceutical

companies), and easy to administer by non-medical personnel (such as teachers or community volunteers).
Definition and characteristics of preventive chemotherapy

PC is ‘the use of anthelminthic drugs, either alone or in combination, as a public health tool against helminth

infections’ and is the key public health strategy recommended by the WHO to reduce morbidity and

transmission of lymphatic filariasis (LF), onchocerciasis, schistosomiasis and soil-transmitted helminthiasis

(STH).

Three key characteristics define PC as a public health intervention:

1population-based diagnosis;

2population-based treatment; and

3implementation at regular intervals.

Criteria of eligibility for preventive chemotherapy

The following four characteristics strongly suggest considering a helminth infection eligible for PC; they are

linked to biological features of the target diseases as well as to operational aspects of the interventions directed

against them:

• late or unclear onset of the clinical symptomatology;

• slow increase in the likelihood of an infected host to develop morbidity and to transmit infection;

• high efficacy, safety and easiness of treatment procedures; and

• low cost of the PC intervention (diagnostics, drugs, operational costs).