Medical Human Parasitology

Cheng Yanbin chengyb@mail.xjtu.edu.cn Department of Immunology & Pathogenic Biology, School of Medicine, Xian Jiaotong University 2013

Pathogenic Biology
Study the biological causes to human infectious diseases.
Microbiology--- Pathogens (Microbe) : viruses, bacteria, and fungi. Parasitology--- Pathogens (Parasites) : protozoa, helminthes, and arthropods.

 Medical microbiology and

parasitology usually comprises part

of preventive medicine and is also

considered the important foundation of the clinical infectious diseases and public health sciences.

Overseas medical education

In USA, UK, and other countries,
medical microbiology include medical

microbiology and parasitology. Medical

parasitology is not a independent

curriculum.

Curriculum reform in China (Microbiology and parasitology)

Before 1997, two independent curricula Since 1997, integrated into a curriculum, and called Pathogenic biology. However, in our school, Microbiology and parasitology are two independent curricula in medical education of oversea students.

Teaching types
Lecture: 24 hours (3 hours8) Introduce main parasites and related parasitic diseases Experiment: 12 hours (3 hours4) Observe the morphologic characteristics of parasites under the microscope or by your eyes Draw the structures of parasites according to your observation

Websites for parasitolgy &parasitic disease

http://www.dpd.cdc.gov/DPDx/HTML/iM AGE_Library.htm http://www.cdc.gov http://www.dpd.cdc.gov/DPDx/Default.ht m http://apps.who.int/tdr/ http://www.parasite.org.au/

Introduction to Medical Parasitology

Contents of Medical Parasitology Conceptions related to medical parasitology Relationships between parasites and hosts The basic factors of transmission of parasitic diseases The preventive measures of parasitic diseases

Prevention

Parasitic diseases
Transmission Treatment Diagnosis

Medical Parasitology

Pathogenesis

Parasites

Life Cycle Morphology

Contents of Medical Parasitology

Include the biological features of parasites, the relationships between parasites and hosts, the pathogenic factors and the related pathogenesis, the diagnosis, the transmission and prevalence, and the prevention and control of the diseases.

Conceptions related to medical parasitology

Symbiosis
Parasite and type of parasites

Host and common type of host

Life cycle and type of life cycle

Symbiosis
------This is about the biological phenomenon. The relationship between two living things (animals). Two living things live together and involve protection or other advantages to one or both partner. Commensalism Mutualism

Parasitism*

Commensalism
---- commensalism is a class of relationship between two organisms where one organism benefits but the other is neutral (there is no harm or benefit).

Fig. A female pea crab in the mantle cavity of its mussel host. The crab does not damage the mussel and uses its shell purely for protection

Mussel

Mussel

Remora sharks are endowed with an adhesive disk on the dorsal surface of their heads. They use this adhesive disk to hitch a ride on larger animals, usually whales, which tend to be sloppy eaters. When food floats away from the whales mouth, the remora can unhitch itself and collect the scraps of food floating by.

Mutualism
------ An association which is beneficial to both living things.

Fig. A selection of ciliates from the rumen of cattle or sheep. The rumen contains enormous numbers of ciliates that break down cellulose in the feed. nourishment

 Red-billed oxpeckers are feed on an impalaa practice that benefits both animals.

Parasitism
------ An association which is beneficial to one partner and harmful to the other partner. The former that is beneficial to is called parasite, the latter that is harmful to is called host. Human / Hookworm

Parasite and the types of parasites

Parasite: It is an animal that is dependent on another animal (host) for its survival. Types of parasites Protozoa Nematodes Parasites Helminthes Trematodes EndoCestodes Arthropods ---------------- Ecto-

PROTOZOA: unicellular animals. It is very small and range in size from 2 to more than 100m. They have cell membrane, cell plasma, nucleus.

NEMATODES: vermiform, cylindrical, bilaterally symmetrical in structure and taper towards their anterior and posterior ends. Adults are diecious (sexes are separate)

TREMATODES: typically flattened and leaf-

shaped. There are male and female system in a fluke body. Adults are hermaphroditic (sexes are not separate)

CESTODES: long, ribbon-like in shape. Many ribbonlike chain of segments. Each segment bear a complete male and female system. Adults are hermaphroditic (sexes are not separate)

Other classification
Parasites may be classified according to different ways.
Obligate parasite: a parasite which cannot survive in any other manner. Facultative parasite: an organism which may exist in a free-living state and which if opportunity presents itself may become parasitic.

 Endoparasite and ectoparasite

----A parasite which lives in or on the body of the host is called endoparasite (protozoa and heminthes) or ectoparasite (arthropods).

Host and type of host

Host : An organism that harbors the parasite. usually larger than the parasite. Intermediate host : The host harboring the larvae or asexual stage of parasite. Final host : The host harboring adult or sexual stage of parasite. Reservoir host : Animals harboring the same species of parasites as man. Potential sources of human infection.

Life cycle and type of life cycle

Life cycle : The whole process of parasite growing and developing. The direct life-cycle : Only one host (no intermediate host). The indirect life cycle : Life cycle with more than one host (intermediate host and final host).

Relationships (Effects) between parasite and host

injure to

Parasites harbour in Host (animal or human)

to response immune produce

Effects of the parasites on the host Effects of the host on the parasites

Effects of parasites on the host

Depriving the host of essential substance Hookworm Suck blood Anemia Mechanical effects of parasites on the host
Ascaris Perforate(peritonitis)/Obstruction (ileus)

Toxic and allergic effect E.h Proteolytic enzyme Necrosis/ulcer Parasite antigen Immune system e.g Anaphylaxis
Immune response
Allergy/ Hypersensitivity

Depriving the host of nutrition

Pathogens utilize nutrition from host environment for their development and reproduction. Helminthes (nematodes or flukes --have a gut and mouth) feed upon the surrounding tissues, body fluids or even host cell debris. Tapeworms (no gut or mouth) reply on the hosts daily intake by their body wall absorbing for their own food. (osmosis)

 The hookworms, after completing its migration to small intestine, feeds by biting deeply into the mucosa and sucking blood and tissue fluids. Hookworm infection cause anemia due to simple blood loss.

Mechanical effects of parasites

Entering the cells: Some protozoa must live and reproduce in certain cells. Finally result in the rupture of the host cells. Migration or penetration through tissue or organ. Blockage and pressure: The intestinal lumen can be blocked by worms. Hydatid cyst in liver may reach volumes of 1-2 litres, it can cause severe damage to organ.

Toxic and hypersensitivity

Toxin: Many parasites can introduce or secret toxin and cause damage to host. Hypersensitivity: The metabolites, secretion, excretion or other products of parasites or dead worms may act as foreign antigen, to stimulate the immune system of host to produce immune response or hypersensitivity. Hypersensitivity is harmful to host, which may lead to severe or even fatal reaction.

 Rupture of hydatid cysts with sudden release of large amounts of fluid can produce severe allergic reaction (anaphylaxis), sometime lead to shock or dead of patients.

Effects of the host on the parasites

----The host can produce certain degree resistance to parasites in human body or reinfection. The resistance (Immunity) is not very strong. In general, It dont wipe out parasites completely, but may limit the number of parasites and establish balance with parasites. Innate immunity Acquired immunity

Innate immunity
Barrier : Prevent parasites to invade in certain degree. Skin/Mucous membrane / Placenta. Acid in skin or stomach can cause damage of the parasites. Phagocytosis of phagocyte. ----Non-specific/effective against a wide range of parasitic infection/controlled by genetic factors. But not very strong!

Acquired immunity
Mechanism : cellular and humoral immunity. Sterilizing immunity : Wipe out the parasites completely, meanwhile get a long-term specific resistance to re-infection. Rare! Non-sterilizing immunity : Wipe out most of the parasites, but not completely. On the premise of parasites in the bodylimit the number of parasites in bodyand get a part of resistance to re-infection. Common! No parasite, no immunity!

The basic factors of transmission of parasitic diseases

Parasitic diseases Infectious diseases Transmission The source of the infection The routes of transmission The susceptible host ----The combined effect of those factors determine the dispersal and the prevalence of the parasites at a given time and place and regulate the incidence of the parasitic diseases in certain local population.

The source of the infection

Patient : Persons who have parasites in their body and show clinical symptoms. Carrier : Persons who have parasites in their body, not show symptoms. Reservoir host : Animals that harbors the same species of parasites as man. Sometimes, the parasites in animals can transmit into human.

The routes of transmission I

Congenital transmission : From pregnant women to infant. Toxoplasmosis Contact transmission : Direct contact--Trichomonas vaginalis; Indirect contact--Ascaris lumbricodes Food transmission : The infectious stage of parasites contaminated food / The meat of the intermediate hosts containing infectious stage of parasites.

The routes of transmission II

Water transmission : Drink or contact the water contaminated the infectious stage of parasites. Soil transmission : Contamination of the soil by feces containing the certain stage of parasites and this stage can develop into stage. Arthropod transmission : Vectors of certain parasitic diseases.

The susceptible host

----In general, most people is the susceptible host (Why?). The parasite reaching a susceptible host must gain entrance and set up a favorable residence in order to complete its life cycle and cause the transmission of parasitic diseases.

The avenues of invasion

Digestive tract : Most common avenue of entrance. (Food/ Water transmission) Skin : Infective larvae perforate skin and reach to body and establish infection. (soil/ water transmission) Blood : Bloodsucking insects containing infective parasites bite the skin and inject parasites into human blood. (Arthropod transmission---malaria).

The prevention measures of the parasitic diseases

Controlling the source of the infection.
----Treatment of the patients, carriers and reservoir hosts.

Intervention at the routes of transmission

----Managing feces and water resource,controlling or eliminating vectors and intermediate hosts.

Protecting the susceptible hosts.

----Paying attention to personal hygiene, changing bad eating habit, taking medicine.