Introduction of Parasitic

Diseases

Master Program in Biomedical Science

Faculty of Medicine
Universitas Brawijaya
2018
Understanding
An Infectious diseases:
• diseases that is caused by the invasion
of host by agents whose activities harm
the host tissue (diseases) and can be
transmitted to other individuals
(infectious)
Some infectious agents are easily
transmitted  Contagious
Some infectious agents are very likely
to cause diseases  Virulent
The top 10 causes of death (WHO, 2016)
Leading causes of death by economy
income group (WHO, 2016)
 Burden of Infectious Disease
• Lower respiratory infections remained
the most deadly communicable
disease, causing 3.0 million deaths
worldwide in 2016.
• The death rate from diarrhoeal
diseases decreased by almost 1
million between 2000 and 2016, but
still caused 1.4 million deaths in 2016.
• Similarly, the number of tuberculosis
deaths decreased during the same
period, but is still among the top 10
causes with a death toll of 1.3 million. (DALY = Disabilty adjusted life year)
• HIV/AIDS is no longer among the
world’s top 10 causes of death, having
killed 1.0 million people in 2016
compared with 1.5 million in 2000.
From : Hotez , 2006
A total of 2797 international health hazards by type and country,
January 2001–September 2013. Eighty-four per cent were
outbreaks of infectious diseases. Unpublished WHO data (2013).
 Infectious and parasitic diseases
(WHO report, 2004; Retrieved on 2008)

Percent of
Group Cause
deaths
B.1 Respiratory infections 36.35
B.2 HIV/AIDS 25.47
B.3 Diarrheal diseases 16.47
B.4 Tuberculosis 14.38
B.5 Malaria 11.66
B.6 Childhood diseases 10.30
B.7 Sexually transmitted diseases non HIV 1.67
B.8 Meningitis 1.57
B.9 Tropical diseases 1.20
B.10 Hepatitis B 0.94
B.11 Hepatitis C 0.47
 Burden of infectious diseases in the world

Disease Condition Disease Burden

Lower respiratory Infection 91.3 million
HIV-AIDS 84.5 million
Diarrheal diseases 62 million
Neglected Tropical Diseases 56.6 million
Malaria 46.5 million
Tuberculosis 34.7 million
Measles 21.4 million

Hotez et al, 2006

 Nature of infectious Diseases
Pathogens: Microorganism that are capable
of causing disease
A true pathogen: Infectious agent that
causes disease in virtually any susceptible
host.
Opportunistic pathogens: Potentially
infectious agent that rarely cause diseases
in individuals with healthy immune systems.
Typically are found among elderly, cancer
patients, and AIDS
Opportunistic pathogens
(Pneumocystis jirovecii, DMAC, Candidiasis)
Summary
incident risk by
region for
antiretroviral
therapy (ART)–
naive (A) and
ART-exposed
(B) patients.
Abbreviations:
CMV,
cytomegalovirus;
LAC, Latin America
and the Caribbean;
PCP, Pneumocystis
pneumonia; SSA,
sub-Saharan Africa;
TB, tuberculosis.

B-Lajoie MR,Drouin O Bartlett

G, Nguyen, Q Low A,
Gavriilidis G, Easterbrook P
and Muhe P. HIV/AIDS • CID
2016:62 (15 June)
Emerging Infectious Diseases
- Have not occurred in human before
(Avian virus)
- Have occurred previously but affected
only small numbers of people in isolated
placed (AIDS, Ebola Hemorrhagic fever)
- Have occurred through-out human
history but have only recently been
recognized as distinct diseases due to an
infectious agent :Lyme diseases (Borrelia
burgdorferi), H.pylory gastrict ulcer
Re-Emerging Infectious Diseases
A diseases that once were major
health problem globally or in
particular country and then declined
dramatically but are again becoming
health problems for a significant
proportion of the population
(malaria and tuberculosis)
Emerging Infectious Diseases
Lassa Fever Arenaviridae 1969 Urbanization and
other condition that
favor the rodent host,
nosocomial

Ebola Filoviridae 1977 Unknown natural

hemorrhagic reservoir, nosocomial
fever

Lyme Diseases Borrelia 1982 Condition favoring

burgdorferi the tick vector and
deer such as
reforestation
AIDS Human 1983 Migration,
Immunodeficiency tranfusions, organ
virus transplant,
intravenous drug use
Emerging Infectious Diseases
Gastric Ulcers H. pylori 1983 Newly recognized
as due to infectious
agent
Cholera V. Cholera O139 1992 Evolution of new
strain of bacteria
combining increased
virulence and long-
term survival in the
environment
HPS (Hanta virus Bunyaviridae 1992 Environmental
Pulmonary changes favoring
syndrome) contact with rodent
hosts
Pandemic Orthomyxoviridae Pig-duck agriculture
Influenza
Re-Emerging Infectious Diseases
Cryptosporidiosis C.parvum Inadequate control of
water supply,
international travel

Diphteria C. diptheriae Interruption of

immunization program
due political changes

Rabies Rhabdovirus Breakdown in public

health measures, travel

Malaria Plasmodium Drug resistance,

favorable conditions for
mosquito vector
Re-Emerging Infectious Diseases
Rubela Morbilivirus Failure to vaccinate,
failure to receive
second dose of
vaccine
Schistosomiasis Schistosoma Dam construction,
ecological changes
favoring snail host
Tuberculosis M. tuberculosis Antibiotic-resistant
pathogens,
immunocopromised
population
Yellow fever Flavivirus Insecticide resistance,
favorable conditions
for mosquito vector
Nature of infectious Diseses
There are six major types of
infectious agents:
- Bacteria
- Viruses
- Fungi
- Protozoa
- Helminth
- Prions
Nature of infectious Diseses (2002)
Protozoa and Helminth
- Protozoa are unicellular,
heterotrophic, eukaryotic organism
- Protozoa can be acquired through
contaminated food or water ( G.
lamblia and Cryptosporidium parvum)
or by the bite of an infected
arthropod such mosquito
(Plasmodium)
- Helminth are simple, invertebrata
animal and some are infectious.
 Factors of pathogen which influencing
occurrence of disease
Number of Pathogens
The more number of pathogens infect, the more
capacity to cause disease

Reproduction Capacity
The capacity of organism to multiply within a
certain period of time (≈ species/strain)
Pl falciparum is more productive than Pl.vivax
T. gondii RH strain is more productive than others
 Localization of pathogens in the hosts
• Intracellular localization
– Plasmodium vivax in red blood cells
– Toxoplasma gondii in macrophages
– Salmonella, Mycobacterium, Chlamydea etc

• Extracellular localization
– Helicobacter pylori
– Vibrio cholera
– Ascaris lumbricoides

• Outside of body
– Fungi : candidiasis
– Ectoparasite : lice, fleas
 How Pathogens Damage
Host Cells/organs
• Direct Damage  Mechanical (Intracellular pathogens)
– Cytopathic action
– Intracellular multiplication  cell bursts and dies
– Production of Toxins (endotoxins or exotoxins)
• Indirect Damage  Immune reaction
– Type I reaction :Th2 responses  IgE, Eo, mast-cells activation
– Type II reaction:Th2 responses.IgM,IgGComplement &ADCC
– Type III reaction:Ab/Ag excessComplex Ab-Agchronic malaria
infection
– Type IV : Delayed typed hypersensitivitygranuloma/fibrosis
 Immunopathological consequences of
tropical infections
Hypersensitivity Mechanism Examples
type involved
Type I (allergic) IgE Lung ascariasis
Type II (antibody- IgG Malaria anaemia
mediated) Autoantibody Streptococci
(RHD)
Type III (immune immune Malaria kidney
complex) complexes

Type IV (cell- Macrophages Tuberculoid

mediated) Leprosy
 Pulmonary Ascariasis
In the lung, the larvae produce a
hypersensitivity reaction. This may
result in peribronchial inflammation,
increased mucus production in the
bronchi and bronchospasm.

In addition to peripheral blood and

tissue eosinophilia, Ascaris infection
produces both specific and polyclonal
IgE. Elevated levels of antibodies (IgG4)
to Ascaris lumbricoides have also been
reported.
Granuloma formation
Granuloma form as a consequence of the
body’s defence mechanism for walling
off pathogens

Granuloma can be defined as a focal,

compact collection of inflammatory cells
in which mononuclears predominate and
are ussually formed as a result of
undegradable or persisting
microorganism and are due to Delayed
Type Hypersensitivity (DTH).
• The migrating larvae of helminth and
trophozoite of E. histolytica can
induce granuloma formation with
eosinophils, neutrophils and
macrophages.
Entamoeba histolytica

• Fedor Alexandrewitch
Lösch describes amoebae
associated with severe
dysentery in a patient in
1873
• He transferred amoebae to a
dog by rectal injection,
which became ill and
showed ulceration of colon
• Patient who died from
infection showed similar
ulcers upon autopsy
amoebae the most primitive
eukaryotes?
• Classical taxonomy puts amoebae at the
very base of the eukaryotic tree as they
lack many derived morphological
characters
• No special organelles for locomotion
(cilia, flagella)
• No mitochondrion and no typical
mitochondrial enzymes
• A fermentative “bacteria-like”
anaerobic metabolism
• It was assumed that amoeba represent
the stage of early eukaryotes before the
endosymbiosis event that let to the
mitochondrion
trophozoites and cysts
Lyfe Cycle
trophozoites and cysts

• Trophozoites encyst and

cysts mature as they travel
through the colon
• Only mature cysts are
infective
• penetration of mucus layer
• contact-dependent killing of epithelial cells
• breakdown of tissues (extracellular matrix)
• contact-dependent killing of neutrophils,
leukocytes, etc.
Colitis is the most common form of disease
associated with amoebae

• Gradual onset of
abdominal pain, watery
stools containing mucus
and blood
• Some patients have only
intermittent diarrhea
alternating with
constipation
• Fever is uncommon
• Formation of ulcers
• ‘flasked-shaped ulcer’
• trophozoites at boundary of necrotic
and healthy tissue
• trophozoites ingesting host cells
• dysentery (blood and mucus in feces)
Ulceration can lead to secondary infection
and extraintestinal lesions
Entamoeba pathogenesis factors

• What are pathogen proteins (and genes) that are required

to cause disease?
• Several candidates have been studied for their
involvement in contact dependent cell killing by amoeba:
• The surface lectins: These are proteins that allow the
amoeba to bind to sugars on the surface of cells and
establish tight contact
• Proteases: several protein degrading enzymes have been
linked to tissue penetration and liver abscess formation
• Amoebapores: protein toxins that perforate target cells
 Helminthes
• Many helminth parasites are long-lived and cause
chronic infections. The immune response that
develops during this time often proceeds to cause
pathologic changes

• In the majority of cases the immune responses of the

hosts to worm infection are remarkably similar, being
Th2-like with the production of significant quantities of
interleukin-4 (IL-4), IL-5, IL-9, IL-10, and IL-13 and
consequently the development of strong
immunoglobulin E (IgE), eosinophil, and mast cell
responses
 POOR SANITATION, IMPURE FOOD
AND CROWDED LIVING CONDITIONS

Viral, bacterial
and protozoan Helminthic
infections infections

Excess Regulatory T Cell

Conditioning
Immune reactivity

Inhibits
Crohn’s disease (Prevents) Excess
and other diseases Reactivity

GENETIC PREDISPOSITION