MC 03
FINAL
Topic 1: Introduction
to Parasitology
A relationship where unlike organisms exist together is called
symbiosis. There are three types of symbiotic relationships.
Commensalism is a form of symbiotic relationship in which two
species live together and one species benefits from the other
without harming or benefitting the other. The relationship between
the human body and most of the normal flora in the body
exemplifies this type of relationship. Mutualism, on the other hand,
is a symbiotic relationship in which two organisms mutually benefit
from each other. The normal intestinal flora for instance produces
vitamin K which is needed for the activity of some of the body's
clotting factors. These flora benefit from humans by obtaining
nutrients from the body which they need for their metabolism while
humans also benefit from them because of the vitamin K that they
produce. Finally, parasitism is the form of symbiotic relationship
where one party or symbiont (i.e., the parasite) benefits to the
detriment of the other (the host). In almost all cases of parasitic
relationships, the parasite deprives the host of essential nutrients
There are two important elements in parasitism--the
parasite and the host. Parasites are organisms that
usually depend on the host for survival and are
classified in several ways, namely:
1. Based on habitat
a. Ectoparasites - parasites that live outside the host's
body (e.g., fleas, lice). Invasion of the body by
ectoparasites is called infestation.
b. Endoparasites - parasites that live inside the body
of the host (e.g, helminthes or worms). Invasion of
the body by endoparasites is called infection and is
the result of entry and multiplication of the parasite
within the host.
2. Based on ability to live independently of the
host
a. Facultative parasites - parasites that can live
independently of the host (iLe., free- living).
These parasites do not have to live inside a host
to complete their life cycle.
b. Obligate parasites - parasites that must live
inside a host (e.g., Plasmodium, Leishmania,
hookworms). Majority of the parasites that infect
humans obligate parasites.
3. Based on mode of living
a. Permanent parasites - parasites that remain in a host
from early life to maturity (e.g., Plasmodium)
b. Intermittent parasites- parasites that simply visit the
host during feeding (e.g., non-pathogenic parasites)
c. Incidental parasites - parasites that occur in an
unusual host (e.g., dog tapeworm - in humans)
d. Transitory parasites - parasites whose larva develops
in a the adult is in a host while free-living (e.g.,
Echinococcus granulosus or dog tapeworm).
e. Erratic parasites - parasites that are seen in an
unusual organ, from that ,different which it ordinarily
parasitizes (e.g., Ascaris lumbricoides in the lungs or
Hosts are essential to the existence of parasites. Hosts are
organisms that harbor the parasite and provide nourishment to the
parasite. There are four types of hosts. Definitive hosts are hosts
that harbor the adult stage of the parasite (e.g., humans for the
intestinal round worm Ascaris), or where the sexual stage or sexual
phase of the life cycle of the parasite occurs (e.g., mosquito for the
malaria parasite Plasmodium). Intermediate hosts are those that
harbor the larval stage of the parasite (e.g., cow for the cysticercus
larva of the beef tapeworm Taenia saginata), or where the asexual
stage of the life cycle of the parasite occurs (e.g., humans for the
malaria parasite Plasmodium). Reservoir hosts are vertebrate hosts
that harbor the parasite and may act as additional source of
infection in man. Migratory birds serve as the reservoir host for the
parasite Capillaria philippinensis which people normally get rom
contaminated fresh water. Finally, paratenic hosts are those that
serve as a means of transport for the parasite (e-g, is vectors) so
that the infective stage of a certain parasite may reach its final host.
Sources of Exposure to Infection or
Infestation
Exposure to parasites may occur through one or more of the following sources:
(1) contaminated soil or water;
(2) food containing the parasite's infective stage;
(3) a blood- sucking insect;
(4) a domestic or wild animal harboring the parasite;
(5) another person and his or her clothing, bedding, or the immediate
environment he or she has contaminated; or
(6) one's self (auto-infection).
The most common source of exposure to infection is soil contaminated or polluted
with human feces. This is true for most of the parasitic worms or helminths such as
Ascaris lunmbricoides, Trichuris trichiura, Strongyloides stercoralis, and human
hookworms. Water may be the source of the viable cysts of the parasitic amobae
and intestinal flagellates, the larvae of the blood flukes, and the eggs of the pork
tapeworm Taenia solium. Freshwater fish serve as the source for the fish
tapeworm Diphyllobothrium latum, as well as other intestinal and liver flukes. Raw
pork is the source of Trichinella spiralis and Taenia solium, while improperly
Modes of Transmission
Ingestion of contaminated food and water (fecal-oral transmission) is the most
common mode of transmission of most intestinal parasites. Those that are
transmitted by ingestion of contaminated water include the intestinal protozoa (cyst
stage), and the embryonated egg stage of the intestinal roundworms (e.g., Ascaris
lumbricoides, Trichuris trichiura). Trichinella spiralis, Taenia solium, Taenia saginata,
Dipbyllobothrium latum, intestinal flukes and the lung flukes are transmitted by
eating food containing the larval stage of the parasites.
Some parasites actively enter the body through penetration of the skin from the soil
(e.g., hookworms and Strongyloides) or from contaminated water (e.g., blood fluke).
Other modes of transmission include:
(1) bite of blood-sucking insect vectors (e.g., malaria, leishmaniasis, trypanosomiasis,
and filariasis);
(2) inhalation of eggs (pinworm or Enterobius vermicularis);
(3) transplacental or congenital infection (Toxoplasma gondii and occasionally
Plasmodium);
(4) transmammary (mother's milk) infection (Strongyloides, Ancylostoma); and (5)
through sexual intercourse (Trichomonas vaginalis).
Portals of Exit of Parasites
The most common portal of exit of parasites is through
the anus. Eggs of medically important roundworms are
excreted together with human feces and contaminate
soil and water. Urine may serve as the portal of exit for
Trichomonas vaginalis, Strongyloides stercoralis, and
Schistosoma haematobium while the lung fluke
Paragonimus westermani and the intestinal
roundworm Ascaris lumbricoides (larval stage) may be
excreted with sputum. Trichomonas vaginalis, which is
transmitted through sexual intercourse, may be
isolated from vaginal discharge.
Mechanisms of Disease Production by
Parasites
The term pathogenesis refers to the dynamics of any disease process.
Some parasites may cause inapparent infection, causing no
symptoms, and producing no detectable harm. The infection can
remain inapparent continuously for long periods or between short
periods of relapse (e.g., malaria). For most helminthic infections, signs
and symptoms usually manifest only if a large number of worms are
present. Parasites damage the host through one or more of the
following mechanisms:
(1) trauma or physical damage;
(2) lytic necrosis;
(3) stimulation of host tissue reaction;
(4) toxic and allergic phenomena, and
(5) opening of pathways for entry of other pathogens into the tissues.
1. Traumatic Damage
In this mechanism of damage, the manifestations
may be due to the direct physical damage caused by
the parasite in the organ it parasitizes or at the point
of entry of the parasite. Entry of the infective larvae
of hookworms or blood flukes into the skin may
produce relatively slight physical damage. Small
lesions may result from the bite of mosquitoes (e.g,,
malaria) and other insects (e.g., tsetse fly in African
sleeping sicknes). Migration of the larval stage of
certain roundworms (Ascaris and hookworms) may
lead to ruptured capillaries in the lungs. Large
number of worms may produce acute intestinal
2. Lytic Necrosis
Enzymes and other substances produced by many
parasites that are necessary for them to digest food
available in the immediate environment may cause
harm to the host tissues. A good example is that of
the parasitic protozoan Entamoeba histolytica
which releases enzymes that lyse tissues for their
nutritional needs. These enzymes also enable the
parasite to penetrate the tissues of the colon,
producing ulcerations in the colon, and extra-
intestinal viscera.
3. Stimulation of Host Tissue Reaction
Majority of animal parasites provoke host tissue reactions.
These reactions may be in the form of cellular proliferation and
infiltration at the site of the parasite entry or may involve
systemic increase in certain types of cells, especially those
circulating in the blood. One may see an increase in circulating
cosinophils. This is true for most infections caused by
helminths. In some cases, stimulation of red blood cell
production may occur, especially in infections that lead to
mechanical loss or destruction of the red blood cells, as in
hookworm infection or in malaria. Certain parasitic infections
may also lead to stimulation of neoplastic (cancer) growth in
the organ infected. For example, infection with the blood fluke
Schistosoma japonicum may eventually lead to development of
cancer of the liver. Cancer of the biliary ducts may be seen in
infection with the liver fluke Clonorchis sinensis.
4. Toxic and Allergic Phenomena (Immunopathology)
Proteins or other metabolites produced by the parasites may lead to
hypersensitivity or allergic reactions due to stimulation of antibody
production. An example of this is infection with pinworm Enterobius
vermicularis where an allergic reaction occurs in the anus as a
response to the female worm and its eggs leading to its most
prominent manifestation of pruritus ani.
5. Opening of Pathways for entry of Other Pathogens into the Tissues
The presence of the parasites and the damage they produce to the
tissues may favor the entry and proliferation of other organisms,
especially bacteria. For instance, infection with pinworm leads to
intense itchiness in the anus. This causes the infected individuals,
usually children to scratch their anus and in the process, may lead to
development of superficial erosions in the anus. These erosions may
serve as the point of entry for bacteria present in the anus or those
contained in the feces causing secondary bacterial infection in the
General Life Cycle of Parasites
• The life cycle of parasites may vary from the very simple
to the most complex. There are several important
components in the life cycle of parasites--source of
infection, node of transmission, the infective stage
(morphologic form that infects humans), the pathogenic
stage (morphologic form that is responsible for the
pathology produced leading to clinical manifestations),
and the diagnostic stage (morphologic form that can be
detected through laboratory methods). In some
instances, some parasites require an intermediate host
while others may require only a definitive host. Figure
11.1 shows the general schema in the life cycle of
parasites.
• End.
Reference:
Bartolome, Fe. A. & Quiles, Elizabeth P.
Microbiology and Parasitology: A Textbook and
Laboratory Manual for Health Sciences. Second
Edition. Quezon City: C & E Publishing, Inc. p.
151-157.