INTRODUCTION Parasitology- deals w/ the phenomenon of dependence of 1 living organism on another Med. Para- concerned primarily w/ a.

the animal parasite of humans b. their med significance c. their importance in human communities Biological Significance- impt to the survival of the organism Parasite organism that cant manufacture own food Endoparasite- lives inside the body of host Ex. Trichuris trichiura Ectoparasite- lives on the body of a host Infestation- presence of ectoparasite on the host (either attached to skin or temporarily inside the superficial tissue of the host Ex. Sarcpotes scrabiei Parasitosis state of infection & infestation w/ an animal parasite Erratic parasite- when found in an organ w/c is not its usual habitat Ex. Ascaris lumbricoides Obligate para- needs a host at some stage of life cycle to complete their dev. & to propagate their spp. Ex. Strongyloides stercolaris Accidental/ Incidental paraestablishes itself in a

host where it doesnt ordinarily live Permanent para- remains on/in the body of host for entire life Temporary para- lives on the host only for a short period of time Spurious para- free living org. that passes through the digestive tract w/out causing infxn Commensal- para w/c are NOly harmless Pathogen- harmful para causing local & systhemic damage of 1type or another Host(provides nourishment): A. Definite/ Final H. harbors sexual stages/maturity B. Intermediate H. harbors asexual/larval stages a) 1st I.H. harbors very early larval stages b) 2nd I.H. harbors late stages C.Paratenic H.- para doesnt develop further to later stages D. Reservoir H.- allows the paras life cyde to cont. & become additional source of infxn Predator attack living; not necessarily killing them Prey victim Scavenger devouring dead; taking leavings of predator HP relationship obtain food thru close association: a. Continuous once inside, mature inside

b. Intervals part intermediate, part definite Symbiosis give & take - living together of 2 org -may be involve protection or other advantage to 1 or both partners -3 forms= based on whether or not the assoc. is detrimental to 1 of 2 partners a. Commensalism 2 spp. living together & 1spp. benefits frm the rel. w/out harming the one benefiting the other -eating at same table; beneficial to one, not disadvantageous to one Ex. E. coli in intestinal lumen Specialized type of commensalisms: a) Mutualism beneficial to both - 2org. benefit frm each other (ex. termites & flagellates in GIT) synthesize cellulose w/c aids in the breakdown of ingested food b)Parasitism host is injured thru paras activities - 1org (para) lives in or on another, depending on the latter for its survival & usually at the expense of the host Ex. E. histolytica Vectors resp. for transmitting para frm 1host to another a. Biologic transmits para only after the bitter has completed its dev. w/in the host

-essential to life cycle (plasmodium in malaria) b. Mechanical / Phoretic only transports para;infxn can go on w/o it Ex. domestic flies Zoonosis dss to animals; susceptibility of host to a para a. Euzoonosis common to man & reservoir host (maintain para in envi; not necessarily infectious) b. Parazoonosis man is incidental(infrequent) host (dog flea) c. Anthropozoonosis infxns acquired frm vertebrates (trichinosis) d. Zooanthroponosis dss. primarily of human origin that may be acquired by other vertebrates e. Amphixenosis dss common to man & animals Exposure & Infxn Exposure- process of inoculating an infective agent Infxn- establishment of the infective agent(endopara) in the host Superinfxn- when indi. harboring a para is reinfected w/ the same spp. of para Ex. Triumberates (hoowkworm, ascaris, Trichiuris trichuria) Autoinfxn- own direct source of reexposure the infected person Ex. E. vermicularis-peculiarity: pregnant female -migrate to perianal at nyt Types of para accdg. to host:

a. Obligate cant exist w/o host; most infectious b. Facultative free living or parasitic (Strongyloides stercoralis / threadworm) Types of para: a. Amphizoic free living amoeba invade brain & other sites (Genus Naegleria & Acanthamoeba) b. Spurious free living para accidentally ingested; not equipped to live in humans; recovered in human feces Infection vs Infestation endopara ectopara; external manifestation Sources of exposure to infection: 1. Contaminated soil & H20 Ex. Ancylostoma duolenale (soil); E. hystolytica (H20) 2. Food containing immature infective stage of the para Ex. Capillaria philippinensis 3. Bld-sucking insect Ex. Wuchereria bancrofti (Anopheles) 4. Domestic wild ani. harboring the para Ex. Strongyloides stercolaris- larva in meat 5. Another person his clothing, bedding or the immediate envt that has been contaminated Ex. Enterobius vermicularis 6. Ones self Ex. Cryptosporidium Portals of entry

1. Mouth most common ex. intestinal protozoa (Plasmodium) & helminths 2. Skin hookworm & bld flukes 3. Nose inhalation of air-borne eggs of E. vermicularis into the posterior pharynx 4. Placenta congenital infxn ex. Toxoplasma gondii 5. Genitalia through sexual intercourse ex. Trichomonas vaginalis 2 Types of Incubation period a. Biologic/ Prepatent Pd pd. bet. exposure & the time when the para can be recovered frm the hosts specimen (ascaris 1 month) b. Clinical pd. bet. exposure & evidence of symptoms H-P Interrelationship: - In majority, 1host is required for the para to carry on its life cycle Maybe fast host specificity for a particular spp of para, as occurs in Pinworm in man: Human body louse (Pediculus humanus humanus) : Anopheline mosquitoes has preference for human bld when available Other para are less discriminating, & man constitutes only 1 of several satisfactory host: Chinese liver fluke (Clonorchis sinensis) : Oriental liver fluke (Schistosoma japonicum) : Trichina worm (Trichinella spiralis) Envt & Metabolism of Para

-Habitat of para is varied -Among para of man, there are ex. of protozoa, helminthes & arthropods: NOly inhabits intestines, liver, lungs, muscles, brain, bld & lymphatic tissues -Many spp. have complicated l.cycle involving developmental stages that live in soil & H2O or use diff kinds of I.H, inc. vertebrates & invertebrate host. Para have adapted to use/tolerate widely O2, CO2 & hydrogen ion conc & temp -Nutrional requirements are varied, for obtaining & utilizing nutrients required for growth, motility & reproduction -Para found ways to deal w/ the immune rxns of their host & to induce physical & physiologic host changes that are advantageous to them & tolerated by their host Epidemiologic Measures Epidemiology- study of patterns distribution & occurrence of dss - concerns disease in human pop./ communities rather than in an indiv. Incidence- no. of new cases of infxn appearing in a pop. In a given period of time Prevalence- no. (usually expressed as %) of indi. in a pop. estimated to be infected w/ a particular para spp. at a given time Cumulative prevalence- % of indiv. in a pop. infected w/ at least 1para

Intensity of infxn or worm burdenrefers to no. of worms per infected person Endemic- dss maintains a steady, mod. level Hyperendemic- prevalence is high Epidemic- sharp rise in the incidence or an outbreak of a dss of considerable intensity Sporadic- dss appears occasionally in 1 or at most, few members of a community Endemicity- assoc. w/ certain degree of tolerance to pathogen Nomenclature: Binomial Scientific Name Kingdom Phylum Order Class Family Genus - Species Threadworm US: S. stercoralis; England: E. vermicularis H-P relationship: a. Carrier infxn exists w/ the prod. of little or no damage to the host & w/out symptoms then host=carrier -damage immediately repaired b. Pathogen one w/c causes dss; damage Pathogenesis dynamics of any dsss process Types of damage: 1. Traumatic damage -on skin: ex. Sarcoptes scrabiei, hookworm, Blood fluke larvae - internally: migration of larval stage of several helminths through the lungs;

attachment of hookworm to intestinal wall Manifestations: a. Slight harmonious w/ para b. Moderate c. Severe toxemia, ascaris, pinworm in appendix Lesion localized (manifestation at site) or generalized (diff. areas) Inapparent infxn no symptoms, but infected; can be long or short periods not all para are excreted low immunity relapse dormant remain 2. Lytic necrosis para has lytic enzymes lyse tissues & incorporate them to their cytoplasm bloody stool a.Plasmodium b. E. histolytica c. Toxoplasma gondii (reticuloendothelial cells) d.Trypanosoms cruzi (WBC) & Leishmania Peritonitis intestine has holes due to enzymes Amoebiasis 3. Stimulation of H-Tissue rxn. Para stimulation beneficial: shows symptoms Cellular proliferation & infiltration at paras site (hyperplasia flukes) May involve in certain types of cells esp those circulating in bld (L. donovani)

Metazoan, infrequently Protozoan infxnmod. to notable Eosinophilia Inc. erythropoiesis (infections w/c cause RBC loss or destruction) ex.hookworm, plasmodium, deep amoebic invasion of colon Host walls off para by fibrous encapsulation ex. Filarial worm (lymph nodes), Encysted larva of T.spiralis (muscles) Amoebic granuloma lesion by E. histolytica o Tumor= Amoeboma (Polypoid or Ulcerative) Uncomplicated amoebic colitis ONLY w/o H-Cell stimulation 4. Toxic and allergic phenomena due to venom-producing arthropods Spiders & ticks prod. venom in mouth parts Scorpions, bees, wasp, ants venom in caudal end Caterpillars base of hollow hairs Helminth larva: o Echinococcus larva cyst allergy if ruptured o Ascaris prod. Ascarase 5. Open pathways for secondary invaders Ground itch penetration of hookworm larva Amoebic colitis hole in colon bacteria Balantidiasis ulcer

1st 4 Immunocompromised for bacteria Oncogenic Para: Gongylonema neoplasticum gastric tumors Cysticereus fasciolaris larva of threadworm Immunity - rarely solid/permanent Exception: Cutaneous Leishmaniasis Trichinosis (Trichinella spirasis) light exposure in animals prevent clinical infxn (large amt. given) Similar Info: Hookworm (belief) Blood fluke infection (Schistosoma japonicum) Condylobia (C.anthrophaga): fly maggot infestation Clinical evidence of Parasitism: Not pathognomonic (diagnostically specific); dependent on: o Scientific knowledge & clinical experience o Acute or chronic infxn Blood picture: (depenends on para & patient) No dyscrasia (manifestation) in early amoebic colitis normal (bleed anemia) Mod. neutrophilic leucocytosis bacterial invasion of colonic lesion in hepatic / extraintestinal amoebiasis

Monocytosis, neutropenia, erythropenia Visceral Leishmaniasis Anemia (mod severe) malaria (plasmodium RBC) Polymorphonuclear leucocytosis, monocytosis, leucopenia (chronic) Helminthiasis (infected w/ all roundworms) Hypereosinophilia (90%; No eosinophil 1%): Trematode, Stronglyoides, Visceral larval migrans, arthropod Microcytic hypochromic anemia hookworm infxn Delusional Parasitosis obsessive complusive neurosis Diagnosis (2 methods): 1. Clinical by physician In endemic familiar w/ manifestations Uncommon disease difficult diagnosis 2. Laboratory by MTs; one should know: a. Type of specimen to be obtained for lab analysis b. How & when specimen is to be obtained Plasmodium at height of fever RBC rupturing Ascaris wait 1 month before collection Elephantiasis (filariasis) young forms eliminated to blood at 10 pm 2 am c. Precautions to be taken

d. Specimen - processed by skilled & experienced technician Treatment Deworming- use of antihelminthic drugs in an indiv. or a public health prog. Cure rate- refers to no. (expressed as %) of previously (+) subj. found to be egg-negative on exam of stool/urine sample using a standard procedure at a set time after deworming Prevention & Control

Protozoology- study of 1celled para Entomology- study of anthropods( invertebrate w/ jointed appendages) Helminthology- study of multicelled para Protozoa- single cell w/c can perform all fxns of life ex. digestion, respi