Parasitology

INTRODUCTION
Parasitology science that deals with organisms that live, temporarily or permanently, on or within other living organisms for the purpose of processing food Tropical Disease a disease which is indigenous to and may be endemic in a tropical area but may also occur sporadic or in epidemic forms in area that are not topical Tropical Medicine deals with tropical diseases and special medical problems of the region such as prevention and control of tropical diseases, diagnosis, pharmacodynamics and pharmacotherapeutics Biological Relationships: y Symbiosis living together of unlike organism o Commensalism two species live together and one species benefits from the relationship w/o harming or benefiting the other o Mutualism two organisms mutually benefit from each other o Parasitism one organism, the parasite, lives in or on another depending on the latter for its survival and usually at the expense of the host Parasitology dependence of one living organism on another Medical Parasitology concerned with animal parasites of humans and their medical significance, as well as their importance in human communities Classification of Parasite: y Habitat o Endoparasite living inside the body of a host Infection presence of endoparasite o Ectoparasite living outside the body of host Infestation presence of ectoparasite o Erratic Parasite found in an organ w/c is not its usual habitat y Mode of Development o Obligate Parasite need a host at some stage of their life cycle to complete development and to propagate their species o Facultative Parasite exist in free living state or may become parasitic if the need arises y Period Inside Host o Incidental Parasite live inside host where it does not ordinarily live o Temporary Parasite lives on the host for short period of time o Permanent Parasite lives on the host for entire life o Spurious Parasite free-living organism that passes through the digestive tract w/o infecting the host y Sexes o Monoecious one body containing both organs: HERMAPHRODITE Complete functional set of sexual organs in one organisms o Dioecious separate sexes y Number of host o Monoxenous lives w/n single host o Heteroxenous lives w/n more than one host during its entire life cycle Classification of Host y Role in the Life Cycle of Parasite o Definitive or final host one in which parasite attains sexual maturity o Intermediate Host harbors the asexual stage of the parasite or larval stage o Paratenic Host one in w/c the parasite does not develop but the parasite remains live and can still infect another susceptible host o Reservoir Host allow parasite s life cycle to continue and become additional source of human infection

Parasitology
o Incidental Host Vectors responsible for spreading the parasite from one host to another y Biologic Vector transmits parasite after it has completed its development w/n the vector y Mechanical or Phoretic Vector simply transport the parasite Exposure act and process of inoculation Infection infective agent already resides in the host Disease manifestation of infection Carrier harbors pathogen but does not manifest any signs or symptoms Incubation Period / Clinical Incubation Period period between infection and evidence of symptoms Prepatent Period / Biologic Incubation Period period between infection or acquisition of the parasite and evidence or demonstration of infection Autoinfection infected individual becomes his own direct source of infection Superinfection / Hyperinfection already infected individual is reinfected with the same species leading to massive infection of the parasite Sources of Infection y Contaminated soil and water y Undercooked food y Arthropods y Infected Person Modes of Transmission y Eating contaminated food/water y Skin penetration y Vectors y Congenital Transmission y Inhalation of Airborne Eggs y Sexual Intercourse

Protozoan
Protozoan y single-celled eukaryotic organisms that exhibit considerable variation in size, shape, locomotory organelles and methods of reproduction y oldest forms of animal life y have adapted to most types of environment except those extremely dry Morphology y nucleus has chromosomes essential to life, reproduction and transmission o Macronucleus vegetative nucleus o Micronucleus reproduction nucleus y Endoplasm / Cytoplasm immediately surrounds nucleus where food vacuoles may be found y Food vacuoles where food synthesis occurs and acts as storage for food in the form of glycogen and protein y Ectoplasmic membrane less granular and homogenous that acts as the border of cytoplasm w/c may be rigid or pliable aryosome / nucleolus / endosome granular mass inside nucleus y y Locomotory apparatus for movement and ingestion of food, organ for respiration, means of excretion, protection found in ectoplasm Reproduction sexual and asexual like binary fission

Parasitology
Intestinal Amoebae Entamoeba histolytica
y y Invasive pathogen Intestinal Amoeba

Stages: 1. Trophozoite o Located in lumen, glandular crypts of colon and in tissues o Active vegetative stage o Size: 10 t0 60m (average measurement of 20 to 30m) o Cytoplasm: 1/3 of the amoeba, delineated into clear refractile ectoplasm with finely granular endoplasm containing food vacuoles sometimes red blood cells o Locomotion: pseudopodium o Nucleus: single eccentric spherical with diameter of 1/5 to 1/6 of the entire amoeba o aryosome a cluster of granules in a capsule o No mitochondria or Golgi apparatus o Endoplasmic reticulum is not well developed 2. Precyst o Develops a thin, tough, hyaline wall (unripe cysts) o Single nucleus w/c is 1/3 of the diameter of the amoeba 3. Cyst o 10 to 20 m o Two kinds of inclusion in maturing cysts w/c acts as food storage and disappear as the cysts ages: i. Glycogen vacuoles ii. Chromatoidal bars dark-staining, refractile, sausage-shaped bodies with rounded ends o quadrinucleate cysts w/c is the infective stage o passed with feces 4. Metacyst o Located in small intestine 5. Metacystic Trophozoite Reproduction 1. Binary fission 2. Trophozoites may encyts to produced mature quadrinucleate cysts Pathogenesis: o o o

Cytoadherence trophozoites adhere to luminal surface then invades the mucosal epithelium Cytolysis trophozoites lyse the mucosal cells Proteolysis proteolytic enzymes produced by trophozoites further lyse the tissue

Clinical Manifestation y Intestinal Lesions / Amoebic Intestinal Ulcer o Flasked shaped o Amoebic Appendicitis and intestinal perforation o Cecum (most common site) y Extraintestinal lesions o Liver (most common site), lungs, brain, pericardium, spleen, genitalia, skin, adrenals, kidneys, ureters, bladder, urethra o Diffuse Amoebic Hepatitis enlargement of liver due to invasion of trophozoites

Parasitology
o o Pulmonary amoebiasis Amebic brain Incubation Period: 2 to 5 days Clinical Incubation: 4 to as long as a year (expected 1 to 4 months) Diagnosis y Demonstration of parasites in stools (cysts) and tissues (trophozoites) y Stool: small, bloody and mucoid stools y Stool Examination o saline or iodine mounts for amoebic cysts o formalin-ether concentration technique increases the yield two to three folds o Buffered methylene blue added to differentiate leukocytes with trophozoites o Sigmoidoscopy Treatment replacement of fluids and electrolytes losses and eradication of trophozoites y Metronidazole or tinidazole y Diloxanide furoate asymptomatic carriers, eliminates surviving organisms in the colon Difference Endoplasm Pseudopodium Movement Karyosome Size Number of Nuclei Chromatoidal bodies E. histolytica Granular with food vacuoles and rbc Broader and rounder Directional Small and central Smaller 4 Sausage shaped w/ rounded ends E. coli Granular with bacteria but no rbc Broader and blunter Sluggish Large and eccentric Larger 8 Splinter-like bodies

Trophozoites

Cysts

Entamoeba dispar
y Morphologically similar to E. histolytica but different DNA and ribosomal RNA

Entamoeba hartmanni
y y y y y Similar to E. histolytica but smaller Does not ingest red blood cells Sluggish movements Mature cysts measure 5 to 10m, quadrinucleated and have a coarse cytoplasm Chromatoidal bars: short with tapered ends or thin and bar-like

Entamoeba polecki
y y Parasite of pigs and monkey w/c rarely infect human Cysts has a single nucleus

Entamoeba gingivalis
y y y y y y y Found in the mouth, lives in the gums and teeth surfaces and sometimes in tonsillar crypts Trophozoite measures 10 to 20m Moves quickly and has numerous blunt pseudopodia Food vacuoles are numerous and they contain cellular debris and bacteria Abundant in some oral disease No cyst stage Transmitted through direct contact, kissing, droplet spray and sharing of utensils

Parasitology
Endolimax nana
y y 6 to 15m, sluggish movements and nucleus has large irregular Karyosome Cysts are quadrinucleated

Iodamoeba butschlii
y y y y Trophozoite size: 9 to 14m long and 6 to 20m width Has large vesicular nucleus with large endosome No peripheral chromatin granules on the nuclear membrane Cysts: uninucleated and has a large glycogen body w/c stains deeply with iodine

Liquid stools: trophozoites Formed stools: cysts

Free living pathogenic amoebae Acanthamoeba

y y y active trophozoite stage and dormant cyst stage sluggishly motile trophozoite feeds on gram-negative bacteria, blue-green algae, or yeasts reproduction: binary fission and trophozoites encyts if environment is not favorable

Stages y Cysts o Double-walled with outer-wrinkled wall and inner polygonally-shaped wall o Pores or ostioles are seen in between walls y Trophozoites o single and large nucleus o nucleolus: centrally located, densely staining o cytoplasm: finely granulated o vacuole: large contractile vacuole o locomotory apparatus: small, spiny filaments known as acanthapodia- responsible for polydirectional sluggishly movement Pathogenesis and Clinical Manifestation: y Granulomatous Amebic Encephalitis (GAE) o Destructive encephalopathy