2Parasitology The study of eucaryotic parasites, protozoa and helminths Cause 20% of all infectious diseasesLess prevalent in industrialized countries; increasingly common in AIDS patients
3Typical Protozoan Pathogens Single-celled, animal-like microbes, most having some form of motilityEstimated 100,000 species, approximately 25 are important pathogensLife cycles varyMost propagate by simple asexual cell division of the active feeding cell (trophozoite).Many undergo formation of a cyst.Others have a complex life cycle that includes asexual and sexual phases.
6Entamoeba histolytica and Amebiasis Alternates between a large trophozoite, motile by means of pseudopods and a smaller nonmotile cystTrophozoite has a large nucleus and lacks most other organelles.Humans are the primary hosts.IngestedCarried by 10% of world population
8Entamoeba histolytica Cysts are swallowed and arrive at the small intestine; alkaline pH and digestive juices stimulate cysts to release 4 trophozoites.Trophozoites attach, multiply, actively move about and feed.Asymptomatic in 90% of patientsAmeba may secrete enzymes that dissolve tissues and penetrate deeper layers of the mucosa.Causing dysentery, abdominal pain, fever, diarrhea and weight loss
9Entamoeba histolytica Life-threatening manifestations are: hemorrhage, perforation, appendicitis, and tumorlike growths, amebomas.May invade liver and lungSevere forms of disease result in 10% fatality rate.Effective drugs are iodoquinol, metronidazole, and chloroquine.
10Amebic Infections of the Brain Caused by Naegleria fowleri and AcanthamoebaOrdinarily inhabit standing waterPrimary acute meningoencephalitis is acquired though nasal contact with water or traumatic eye damage.Infiltration of brain is usually fatal.
11An Intestinal Ciliate: Balantidium coli An occupant of the intestines of domestic animals such as pigs and cattleAcquired by ingesting cyst-containing food or waterTrophozoite erodes intestine and elicits intestinal symptoms.Healthy humans are resistant.Rarely penetrates intestine or enters bloodTreatment – tetracycline, iodoquinol, nitrimidazine or metronidazole
16Trichomonas vaginalis Causes an STD called trichomoniasisReservoir is human urogenital tract50% of infected are asymptomatic.Strict parasite, cannot survive long outside of host3 million cases yearly, a top STDFemale symptoms – foul-smelling, green-to-yellow discharge; vulvitis; cervicitis; urinary frequency and painMale symptoms – urethritis, thin, milky discharge, occasionally prostate infectionMetronidazole
17Giardia lamblia and Giardiasis Pathogenic flagellateUnique symmetrical heart shape with concave ventral surface that acts like a suction cupCysts are small, compact, and multinucleate.Reservoirs include beavers, cattle, coyotes, cats, and humans.Cysts can survive for 2 months in environment.Usually ingested with water and foodID 10 to 100 cysts
19Cysts enter duodenum, germinate, travel to jejunum to feed and multiply Causes giardiasis – diarrhea, abdominal painDiagnosis is difficult because organism is shed in feces intermittently.Treatment: quinacrine or metronidazoleAgent is killed by boiling, ozone, and iodine.
20Hemoflagellates: Vector-Borne Blood Parasites Obligate parasites that live in blood and tissues of human hostCause life-threatening and debilitating zoonosesSpread in specific tropical regions by blood-sucking insects that serve as intermediate hostsHave complicated life cycles and undergo morphological changesCategorized according to cellular and infective stages
22Trypanosoma species and Tropanosomiasis Distinguished by their infective stage; trypomastigote is an elongate, spindle-shaped cell with tapered ends, eel-like motility2 types of trypanosomiasis:T. brucei – African sleeping sicknessT. cruzi – Chagas disease – endemic to Central and South America
23Trypanosoma brucei and African Sleeping Sickness Spread by tsetse fliesHarbored by reservoir mammalsTwo variants of disease caused by 2 subspecies:T.b.gambiense – Gambian strain; West AfricaT.b. rhodesiense – Rhodesian strain; East AfricaBiting of fly inoculates skin with trypomastigotes, which multiplies in blood and damages spleen, lymph nodes and brain.
24Chronic disease symptoms are sleep disturbances, tremors, paralysis and coma. Trypanosomes are readily demonstrated in blood, spinal fluid or lymph nodes.Treatment before neurological involvement melarsoprol, eflornithineControl involves eliminating tsetse fly.
26Trypanosoma cruzi Causes Chagas disease Reduviid bug (kissing bug) is the vector.Infection occurs when bug feces is inoculated into a cutaneous portal.Local lesion, fever, and swelling of lymph nodes, spleen, and liverHeart muscle and large intestine harbor masses of amastigotes.Chronic inflammation occurs in the organs (especially heart and brain).Treatment nifurtimox and benzonidazole
28Leishmania species and Leishmaniasis Leishmaniasis - zoonosis transmitted among mammalian hosts by female sand flies that require a blood meal to produce eggsEndemic to equatorial regionsPromastigotes are injected with sand fly bite, convert to amastigote and multiply; if macrophage is fixed the infection is localized; systemic if macrophage migrates.
30Cutaneous-oriental sore, Baghdad boil - localized ulcerated sore Espunda – skin and mucous membrane infection of the head; chronic infectionSystemic-visceral - high intermittent fever; weight loss, enlarged spleen, liver, and lymph nodesKala azar is the most severe and fatal form if untreated.
31Apicomplexan parasites SporozoansLack locomotor organelles in the trophozoite stateAlternate between sexual and asexual phases and between different animal hostsMost form specialized infective bodies that are transmitted by arthropod vectors, food, water, or other means.PlasmodiumToxoplasmaCryptosporidium
32Plasmodium: The Agent of Malaria Dominant protozoan diseaseObligate intracellular sporozoan4 species: P. malariae, P. vivax,P. falciparum and P. ovaleFemale Anopheles mosquito is the primary vector; blood transfusions, mother to fetusmillion new cases each year2 million deaths each year
332 distinct phases of malarial parasite development: asexual phase – human hostInfected female mosquito injects asexual sporozoite which localizes in liver; it then undergoes schizogony generating 2,000-40,000 merozoites which enter circulation in 5-16 days depending on species.Merozoites attach to and enter red blood cells, convert to trophozoites and multiply; red cell bursts releasing merozoites that differentiate into gametes.
34Sexual phase – mosquito host Mosquito draws infected RBCs; gametes fertilize forming diploid cell which forms sporozoites in stomach.Sporozoites lodge in salivary glands; available to infect human host
36PlasmodiumSymptoms include episodes of chills-fever-sweating, anemia, and organ enlargement.Symptoms occur at hour intervals as RBCs rupture; interval depends on species.P. falciparum most malignant type; highest death rate in childrenDiagnosis by presence of trophozoite in RBCs, symptomsIncreasing drug resistanceTherapy is chloroquine, quinine, or primaquine.
37Coccidian ParasitesZoonotic in domestic animals and birds
38Toxoplasma gondii and Toxoplasmosis Intracelllular apicomplexan parasite with extensive distributionLives naturally in cats that harbor oocysts in the GI tractAcquired by ingesting raw meats or substances contaminated by cat fecesMost cases of toxoplasmosis go unnoticed except in fetus and AIDS patients who can suffer brain and heart damage.Treatment: pyrimethamine and sulfadiazine
40Sarcocystis and Sarcocystosis Sarcocystis – parasites of cattle, swine, and sheepDomestic animals are intermediate hosts; they pick up infective cysts while grazing on grass contaminated with human feces.Humans are infected when the meat is consumed.Symptoms include diarrhea, nausea, and abdominal pain.No specific treatment
41Cryptosporidium: A Newly Recognized Intestinal Pathogen An intestinal pathogenInfects a variety of mammals, birds, and reptilesExists in tissue and oocyst phases1990s – 370,000 cases in Milwaukee, WI due to contaminated water; filtration required for removalIngestion of oocysts which give rise to sporozoites that penetrate intestinal cellsCauses gastroenteritis, headache, sweating, vomiting, abdominal cramps, diarrheaAIDS patients may suffer chronic persistent diarrhea.No effective drugs
42Isospora belli and Coccidiosis Intracellular intestinal parasite with oocyst stageTransmitted in fecally contaminated food or drinkInfection usually asymptomatic or self-limitedSymptoms include malaise, nausea and vomiting, diarrhea, fatty stools, abdominal cramping, and weight loss.Treat with sulfadiazine and pyrimethamine, when required
43Cyclospora cayetanensis and Cyclosporiasis Emerging protozoan pathogen; causes cyclosporiasisOral-fecal transmission; fresh produce and waterOocysts enter small intestine and invade the mucosa.Symptoms of watery diarrhea, stomach cramps, bloating, fever, muscles achesDiagnosis can be complicated.Treatment: trimethoprim and sulfamethoxazole
44Babesia species and Babesiosis First protozoan found to cause a disease – redwater fever of cattleFirst protozoan found to be associated with a vector - tickHuman babesiosis - relatively rare zoonosisAssociated with infected rodentsInfection resembles malaria.
45A Survey of Helminth Parasites Adults are large, multicellular animals with specialized tissues and organs.Adult worms mate and produce fertilized eggs that hatch; larvae then mature in several stages to adults.The sexes may separate or are hermaphroditic.Adults live in the definitive host.Eggs and larvae may develop in the same host, the external environment of the intermediate host.A transport host experiences no parasitic development.Four basic patterns of life and transmission
47HelminthsPathology arises from worms feeding on and migrating through tissues, accumulation of worms and worm products.Diagnosis based on blood cell count (eosinophilia), serological tests; eggs, larvae, or adult worms in feces; sputum, urine, blood, or tissue biopsies.Antihelminthic drugs suppress a helminthic metabolic process that differs from the human process, inhibit the worm’s movement, prevent it from holding position, and act locally in the intestine.
49Nematode (Roundworm) Infestations Most abundant animal groups; 50 species that affect humansEnlongated, cylindrical worms with protective cuticles, circular muscles, a complete digestive tract, and separate sexesAscaris lumbricoides, Trichuris trichiura, Enterobius vermicularis, hookworms, Strongyloides stercoralis, Trichinella spiralis, filarial worms
50Ascaris lumbricoides A large intestinal roundworm Most cases in the U.S. occur in the southeastern statesIndigenous to humansAscaris spends its larval and adult stages in humans; release embryonic eggs in feces, and are spread to other humans; food, drink, or contaminated objectsIngested eggs hatch into larvae and burrow through the intestine into circulation and travel to the lungs and pharynx and are swallowed.Adult worms complete cycle in intestines and reproduce – 200,000 eggs/day.
51Ascaris lumbricoides Worms retain motility, do not attach. Severe inflammatory reactions mark the migratory route.Allergic reactions can occur.Heavy worm loads can retard physical and mental development.
52Trichuris trichiura and Whipworm Infection Humans sole hostTrichuriasis has its highest incidence in the tropics.Eggs hatch in intestines, larvae attach, penetrate the outer wall and develop into adults.Females lay 3,000-5,000 eggs daily.Worms can pierce capillaries, cause localized hemorrhage, and allow bacteria to leave intestine.Heavy infestations can cause dysentery, rectal prolapse – can be fatal in children.
53Enterobius vermicularis and Pinworm Infection Pinworm or seatwormEnterobiasis most common worm disease of children in temperate zonesEggs are picked up from surroundings and swallowed.After hatching in the small intestine, they develop into adults.Anal itching occurs when mature females emerge from intestine to release eggs.Self-inoculation is common.Tape test
54Hookworms Characteristic curved ends and hooked mouths Necator americanus and Ancylostoma duodenaleHumans shed eggs in feces, which hatch into filariform larvae and burrow into the skin of the lower legs.Larvae travel from blood to lungs, proceed up bronchi and throat and are swallowed.Worms mature and reproduce in small intestine and complete, the cycle.May cause pneumonia, nausea, vomiting, cramps and bloody diarrheaBlood loss is significant – anemia.
56Strongyloides stercoralis and Strongyloidiasis ThreadwormTiny roundworms completes life cycle in humans or moist soil.Larvae penetrate skin and migrate to lungs, are swallowed and complete development in the intestine.Can reinfect the same host without leaving the bodyHeavy worm loads can cause pneumonitis and eosinophilia, bloody diarrhea, liver enlargement, bowel obstruction and malabsorption.
57Trichinella spiralis and Trichinosis Life cycle entirely within mammalian hostAcquired from eating undercooked pork or bear meatLarvae migrate from intestine to blood vessels, muscle, heart, and brain, where it forms cystsFirst symptoms –flulike, diarrheaSecond symptoms – muscle and joint pain, shortness of breath, pronounced eosinophiliaNo cure after larva have encysted
59Tissue NematodesComplete their life cycle in human blood, lymphatics, or skinFilarial worms; elongate, filamentous bodies, spread by biting arthropodsCause chronic, deforming diseaseWuchereria bancrofti – elephantiasisOnchocerca volvulus – river blindnessLoa loa – eye worm
60Wucherereia bancrofti and Bancroftian Filariasis Tropical infection spread by mosquitoesVector deposits larvae which move into lymphatics and develop into adults.Chronic infection causes blockage of lymphatic circulation and elephantiasis, massive swelling in the extremities.
61Onchocerca volvulus and River Blindness Transmitted by biting black fliesLarvae develop into adults in subcutaneous tissues.Adult females migrate via the blood to the eyes, provoking inflammatory reactions.Coinfection with Wolbachia bacteria causes river blindness.Treatment: tetracycline and ivermectin
62Loa loa: The African Eye Worm Spread by bite of small fliesTemperature-sensitive worm migrates around/under the skin and may enter the eye.Treatment – pull worm from a small hole in conjunctiva or diethylcarbamazine
63Trematodes or Flukes Flatworms with ovoid leaflike bodies Have digestive, excretory, neuromuscular, and reproductive systemsLack circulatory and respiratory systemsAnimals such as snails or fish are usually the intermediate hosts and humans are the definitive hosts.
64Blood Flukes: Schistosomes Schistosomiasis - prominent parasitic diseaseSchistosoma mansoni, S. japonicum,S. haematobiumAdult flukes live in humans who release eggs into water; early larva (miracidium) develops in freshwater snail into a 2nd larva (cercaria).This larva penetrates human skin and moves into the liver to mature; adults migrate to intestine or bladder and shed eggs, giving rise to chronic organ enlargement.
65Liver and Lung Flukes Zoonotic Liver flukes: Opisthorchis (Chlonorchis) sinesis - cycles between mammals and snails and fish; humans are infected by eating inadequately cooked fish containing cercaria, larvae crawl into bile duct, mature and shed eggs into feces; snail are infected.Fasciola hepatica-cycles between herbivores, snails, and aquatic plants; humans are infected by eating raw aquatic plants; fluke lodges in liver.
66Lung fluke:Paragonimus westermani – cycles between carnivorous animals, snails, and crustaceans; humans infected by eating undercooked crustaceans; intestinal worms migrate to lungs.
67Cestode (Tapeworm) Infestations FlatwormsLong, very thin, ribbonlike bodies composed of sacs (proglottids) and a scolex that grips the intestineEach proglottid is an independent unit adapted to absorbing food and making and releasing eggs.Taenia saginataTaenia solium
68Taenia saginata Beef tapeworm Very large, up to 2,000 proglottids Humans are the definitive host.Animals are infected by grazing on land contaminated with human feces.Infection occurs from eating raw beef in which the larval form has encysted.In humans, larva attaches to the small intestine and becomes an adult.Causes few symptoms; vague abdominal pain and nausea; proglottids in stool
70Taenia solium Pork tapeworm Infects humans through ingesting cysts or eggsEggs hatch in intestine, releasing tapeworm larva that migrate to all tissues and encyst.Most damaging if they lodge in heart muscle, eye, or brainMay cause seizures, psychiatric disturbances
71The Arthropod Vectors of Infectious Disease Arthropods – exoskeleton and jointed legs; includes arachnids and crustaceans; many must feed on blood and tissue fluid of host during life cycle; ectoparasitesThose of medical importance transmit infectious microbes in the process of feeding – biological vectors
72InsectsMosquitoes – require an aquatic habitat; females take blood meal transmitting disease: malaria, filariasis, zoonosesFleas – highly motile, flattened bodies; feed on warm-blooded animals; carry zoonotic diseases: plague, murine typhusLice – small, soft; attach to head and body hair feeding inconspicuously on blood and tissue fluid; release feces that contaminate wound; epidemic typhus, relapsing feverFlies – tsetse fly, sand fly
73ArachnidsTicks – cling on vegetation and attach to host on contact; larvae, nymph and adults get blood meal by piercing skin of hosthard ticks – Dermacentor, Ixodes – small compact, rigid bodies; transmit rickettsial, borrelial, and viral diseasessoft or argasid ticks – Ornithodoros- flexible outer bodies; transmit relapsing fever