National University-Sudan

Faculty: Nursing & Midwifery Sciences

Program: BSc-Nursing & Midwifery Sciences
Course: Microbiology & Proctology/NUR-MICRO-122
Academic Year: 2024/2025
Semester: 2
Batch: 15
CL 9: Introduction to Parasitology
CL 10: Classification, Structure, & Types of Human Protozoa
Dr. Omnia.M.Hamid
Medical Microbiologist
[email protected]
Objective
• Define: parasitism, facultative & obligate parasites, ectoparasites & endoparasites
• Define: host, definitive host, intermediate host, reservoir host
• Discuss the major features of pathogenic protozoa and their classification
according to the mode of movement as well as the type of infections they cause,
namely infections of the:
a) Intestinal tract: Entamoeba, Giardia
b) Urogenital tract: Trichomonas
c) Blood and tissue diseases: Malaria, Toxoplasmosis, Trypanosomiasis,
Leishmaniasis
• Parasitology is the study of parasites, their hosts, and the relationships
between them.
• Parasites are with complicated life cycles, they are
also disease-causing organisms that live on or in a human or another
animal and derives its nourishment from its host.
• Include:
• Protozoa: Single-celled eukaryotic organisms
(e.g., Plasmodium falciparum, which causes malaria).
• Helminths: Multicellular worms
(e.g., tapeworms, roundworms, flukes).
• Ectoparasites: Parasites that live on the surface of the host
(e.g., lice, ticks, mites).
• Types of Human parasites:
a) Endoparasites Parasites that live inside the host's body-which cause
infection inside the body
b) Ectoparasites Parasites that live on the host's external surface-which
cause infection superficially within the skin
c) Microparasites: Small parasites like bacteria and viruses.
d) Macroparasites: Larger parasites like worms and arthropods.
• Other classification:
a) Facultative Parasites which can live in hosts if available, but are
capable of living independently if the host is not available
b) Obligate Parasites which depend upon the specific host throughout
life.
• An organism that harbors a parasite, providing nourishment and shelter,
and is typically harmed in the process.
Types of Hosts
§ Definitive host: The host in which the parasite reaches sexual maturity
and reproduces (second or third host)
§ Example: Mosquito, the definitive host for the malaria parasite
§ Intermediate host: The host in which the parasite undergoes
development but does not reach sexual maturity.
§ Example: Snail, the intermediate host for the Schistosoma parasite
§ Paratenic host: A host that serves as a temporary refuge for the
parasite but is not necessary for its life cycle.
§ Example: Frog, a paratenic host for a nematode parasite
§ Reservoir host: An animal that harbors a parasite that can also infect
humans, also known as Temporary host
§ In the absence of regular hosts, some parasites survive in the reservoir hosts.
are not essential for the parasite to complete its life cycle
§ Example: Rodent, a reservoir host for the Lyme disease bacteria
• Symbiosis (Mutualism): Both host and parasite are depend upon each
other (benefit from the relationship).
• Commensalism: Only the parasite derives benefit from association
without causing any injury to the host (host-is neither harmed nor
helped).
• A commensals is capable of living in dependent life
• Parasitism: the parasite drives benefits at the expense of the other
(the host).
• The parasite typically derives nutrients or shelter from the host, causing harm
in the process.
• The parasite cannot live in dependent life
• In parasitology, a vector is a living organism that transmits an
infectious agent (such as a parasite, bacteria, or virus) between hosts.
• Vectors are often arthropods, such as insects (mosquitoes, fleas, lice)
or arachnids (ticks, mites).
Types of Vectors:
§ Biological vector: The parasite undergoes development or multiplication
within the vector.
§ Mechanical vector: The parasite is simply carried by the vector without
undergoing any development or multiplication.
Examples of Vector-borne Diseases:
•Malaria: Transmitted by Anopheles mosquitoes.
•Sleeping sickness: Transmitted by tsetse flies.
•Lyme disease: Transmitted by ticks.
•Dengue fever: Transmitted by Aedes mosquitoes.
•Plague: Transmitted by fleas.
• Cyst: infective stage of parasite
• Trophozoite: active reproduction stage destroyed by stomach acid
• Excystation: Development of cyst into trophozoite
• Encystation: Development of trophozoite into cyst
Many protozoa have:
• Cyst stage: Dormant, immotile stage that permit survival under hostile
environmental condition
• Trophozoite stage: Motile, actively feeding and reproducing, vegetative
stage.
• Protozoa classification according to the mode of motion
• Amoebae: move by pseudopodia (extending cytoplasmic extensions).e.g.:
Entamoeba histolytica
• Flagellates: whip-like projections. e.g.: Trichomonas vaginalis, Giardia lambelia
• Ciliates: hair-like projections e.g. Balantidium coli
• Sporozoa: Are obligate intracellular parasites, adult form is non motile but male
gametes have flagella e. g.: Plasmodium vivax, Cryptosporidium parvum
• The mode of movement of protozoa-Locomotory structures:
• Cilia
• Pseudopodia
• Flagella
1. Amoebiasis
• Causal organism: Entamoebae histolytica – an amoeboid protozoan
• Has 2 life stages (trophozoite & cyst)
• Clinical features:
• Signs and symptoms: range from asymptomatic to luminal amebic dysentery,
(diarrhea progress to bloody diarrhea, accompanied by fever and painful
abdominal cramps, and the stool consist of mucus and blood )
• May persist as chronic relapsing state and progress to dilation of the colon,
with risk of intestinal perforation
• Complications: It can reach the blood and spread to the liver causing “Amoebic
abscess
Cont. Amoebiasis
• Epidemiology:
• Reservoir: humans
• Site of infection: large intestine
• Route of infection:
• Faecal-oral route/ingestion
• Infective stage: Mature cyst
• Laboratory diagnosis: Cyst is resistant to
chlorine concentration used in water treatment
• Sample: Faeces
• Diagnostic stage: motile trophozoite or
mature cyst
• Clotted blood : serological tests
• In liver abscess; biopsy from the edge of
the abscess (area where active amebas
accumulate)
2. Giardiasis (2 life stages)
• Causal organism: Giardia intestinalis ( Giardia
lamblia ) – a flagellate protozoan
• Clinical features:
• Signs and symptoms: diarrhea– sometimes
presents with light-colored fatty stools
(steatorrhoea); abdominal pain, with
flatulence and epigastric tenderness,
anorexia
• Complications: malabsorption syndrome
• Epidemiology:
• Reservoir: humans
• Route of infection: faecal-oral. /ingestion
• Site of infection: upper small intestine
(duodenum)
Cont. Giardiasis
• Infective stage: cyst ( 4- nucleate trophozoites
change to cyst in the colon and are shed in faeces)
• Cyst is resistant to chlorine concentration used in
water treatment
• Laboratory diagnosis:
• Faeces: examine by microscopy for cyst or the
characteristic trophozoite (binucleate trophozoite)
• Duodenal aspirates or biopsies: examine for trophozoites
• Diagnostic stage (cyst-trophozoites)
a) Trichomoniasis
• Causal organism: Trichomonas vaginalis – a
flagellate (pear-shaped) protozoan (No cyst form)
• Route of transmission: transmitted as a result of
sexual intercourse with males who have a
symptomless infection
• Clinical features:
• Vaginal discharge: typically frothy, offensive odor and
greenish-yellow color
• Urethral discharge: may also occur with excoriation of the
vulva and perineum; the mucosa of the vagina and cervix is
reddened and inflamed
• It infects male urethra , prostate ,.. Producing
white discharge
• Dysuria and frequency: if the bladder is involved
• Lab. Diagnosis: Swab of vaginal discharge
1. Toxoplasmosis-A world wide zoonotic
• Causal organism: Toxoplasma gondii
• Pathogenesis:
• Direct ingestion of the protozoan by a human, which is an
obligate intracellular parasite, disseminates widely via the
blood stream
• There are 2 types of trophozoites:
• Tachyzoite: seen in body fluids in early acute infection
• Bradyzoites: contained in cysts in the muscles, brain and eyes
• Clinical features:
• Primary infection usually asymptomatic
• Generalized infection: fever, myalgia, headache, fatigue, and
lymphadenopathy.
• Rarely hepatitis, encephalitis, myocarditis, chorioretinitis
 Toxoplasma gondii tachyzoites

Unsporulated T. gondii oocyst

Toxoplasma gondii cyst in

brain tissue

Toxoplasma gondii sporulated oocyst

• Clinical features
• Congenital infection : infection acquired from the mother in utero may cause
stillbirth- brain lesion-hydrocephaly-blindness..
• Infection in the immunocompromised
• Epidemiology:
• Definitive host : cat
• Intermediate host: Human
• Routes of human infection:
• Ingestion of soil containing infected cat faeces or tissue cysts in undercooked
meat
• Trans-placental,
• Rarely, organ donation, blood transfusion
• Laboratory diagnosis:
• Clotted blood: screen serum for IgG- IgM antibodies by latex agglutination
• Tissue or body fluids: molecular methods
 An endemic disease through the tropics and subtropics
• Causal organism: Plasmodium spp
• Clinical features:
• Signs and symptoms: periodic fever and flu-like symptoms, e.g. headache, muscle
pain, anorexia
• Pathogenesis:
• Haemolysis – with the release of toxic metabolites that causes fever. Lysis can also
cause anemia
• Plugging of capillaries by parasitized erythrocytes
• Epidemiology:
• Reservoir: humans
• Life cycle:
• Sexual multiplication in the mosquito
• Asexual multiplication in human hepatocytes &erythrocytes
I. P. vivax/ovale (relapsing infection): sporozoites do not immediately divide in hepatocytes →
form dormant hypnozoites→ relapses years → reactivation then recurrence (true relapse)
II. P.falciparum (most severe infection): knobs formed of infected RBCs → RBCs stick to
capillary walls → intravascular hemolysis &
- Hemoglobinuria& renal failure: "black-waterfever"
- CNS involvement(cerebral malaria) = siezures, coma
• Routes of transmission:
• The bite of female Anopheles mosquitoes
• Human – human transmission: via blood transfusion or blood contaminated
needles
• Infective stage: sporozoite • Laboratory diagnosis:
• Complications: • Thick blood smear stained with Giemsa:
• Cerebral malaria demonstrate parasites inside the RBCs.
• Thin blood smear .. Detect the species
• Blackwater fever
(important to plan the course of treatment)
• Proteinuria
• Serology
• Hypoglycemia
• Prevention:
• Tropical splenomegaly • Awareness
• Avoidance of mosquito bites
• Chemoprophylaxis, seeking early diagnosis
• Rapid assessment of febrile or flue like illness
• Causal organism: Leishmania spp – haemoflagellate protozoa
• Clinical features:
• Visceral (kala-azar) – L.donovani complex
• Signs and symptoms: intermittent fever, weight loss, splenomegaly,
hepatomegaly, anemia, leucopenia, hypergammaglobulinaemia
• Cutaneous (Oriental sore)- L.major, L.tropica .
• Signs and symptoms: a single skin ulcer or multiple skin sores ulcerate –
lesions heal spontaneously but can leave large and disfiguring unsightly scar
• Mucocutaneous, espundia – L.viannia braziliensis .
• Signs and symptoms: attack tissue at the mucosal-dermal junction in the
nose and mouth producing multiple lesions.
• Pathogenesis:
• Survive within macrophage in the human body
as intracellular parasite, cell mediated immunity
determine host response to infection.
• Epidemiology:
• Reservoir: humans, dogs, rodents, and others
• Routes of transmission: via the bite of infected
blood sucking sand flies of the genus
Phlebotomus or Lutzomyia
• Laboratory diagnosis:
• Film from lesion: stain demonstrate
intracellular parasite (non-flagellate amastigote)
the only form occur in human
• Bone marrow aspirate, or splenic puncture
sample.
• Skin biopsy: by PCR. Leishmania sp. amastigotes
• Systemic protozoan disease to the haemoflagellate trypanosomes
a) African trypanosomiasis: sleeping sickness
• Because the end stage CNS disease causes somnolence (sleeping sickness) →
coma & death.
• Vector: Tsetse fly (arthropods feeding on blood).
• Trypansoma brucei (gambiense, rhodesiense)
b) American trypanosomiasis (Chagas disease):
• Serious long-term effects including fatal heart disease.
• Trypanosoma cruzi.
Trypansoma cruzi
Habitat: South America,
transmitted by (kissing bug)
Causes Chagas disease
• West African SS caused by T. b.
gambiense → Occurs slowly
• East African SS caused by T. b.
rhodesiense → Occurs quickly
• Sporozoans: obligate intracellular + non-motile
• Pathogenesis: Cryptosporidiosis → worldwide.
• Ingestion of oocysts (contaminated food or water)
with animal feces (Pig, cow, rodent, feces) →Can
cause autoinfection
• Oocysts release sporozoites in small intestine
(excystation) → 4 sporozoites differentiate into
trophozoites which attach to intestinal microvilli
(and possibly the respiratory tract) → watery, non-
bloody diarrhea
• DIAGNOSIS:
• stool sample-Thick-walled oocysts seen by acid-fast
stain = thin-walled oocysts involved in internal
auto-infective cycle & not recovered from stools