1. Parasites II Protozoa, Helminths, Arthropods Meral Sönmezoğlu, Assoc Prof Infectious Diseases Department Yeditepe University Hospital

2. What is a parasite? Parasitism is a type of symbiotic relationship between two different organisms. The parasite benefits from a prolonged, close association with the host, which is harmed Many possess special adaptations

3. Definition Parasite – an organism that lives off or on another organism, generally without killing it. It comes from the Greek “one who eats off the table of another”.

4. Presence of Diseases in a Population (Prevalence): Factors required: 1. Source infected persons carriers animals

5. Presence of Diseases in a Population (Prevalence): 2. Mode of transmission direct indirect vectors 3. Susceptible host immunity

6. Parasite endoparasite ectoparasite temporary parasite permanent parasite obligatory parasite facultative parasite accidental parasite opportunistic parasite

7. Endoparasite

8. Ectoparasite

9. Host Host In parasitism, it supplies the parasite with nourishment and shelter, it is the injured partner. Carrier: A person who harbours parasite has no clinical symptoms, is an important source of infection in epidemiology.

10. Eukaryotic Microbes Table 12.1

11. Human Parasitology Medical Helminthology Medical Protozoology Medical Arthropodology Class Nematoda Class Trematoda Class Cestoda Class Metacanthocephala Class Lobosea Class Zoomastigophorea Class Sporozoa Class Ciliophora Class Insecta Class Arachnida Class Crustacea Class Chilopoda

12. Eukaryotic Microbe Parasites Protozoa –Amoeba Entamoeba histolytica Naegleria Acanthamoeba –Flagellates Giardia lamblia Trichomonas vaginalis Trypanosoma Leishmania –Ciliates Balantidium coli –Sporozoa Plasmodium Cryptosporidium Toxoplasma Helminths –Roundworms Intestinal Ascaris lumbricoides Enterobius vermicularis Necatur americanus Tissue Trichinella spiralis Wucheraria bancrofti –Flatworms Flukes Schistosoma Tapeworms Taenia Arthropods –Insects –Arachnids

13. (WHO) - Priority Diseases 1. Schistosomiasis 2. Malaria 3. Filariasis 4. Trypanosomiasis 5. Leishmaniasis 6. Leprosy (replaced by HIV/AIDS)

14. Protozoa Life Stages – –Trophozoite -vegetative; feeding, mostly motile –Cyst – dormant; protective thick wall Most are free living in water and soil Classified by motility & life cycle Subdivided by location in human host ( GI, blood, GU ) 1.Sarcodina- Amoeba - move by pseudopods 2.Ciliophora - Ciliates - move by cilia 3.Mastigophora - Flagellates - move by flagella 4.Apicomplexan - Sporozoa – complex life cycle

15. Diversity among Protozoa

16. Amoeba Entamoeba histolytica –Amoebic dysentery Naegleria –primary amoebic meningoencephalitis Acanthamoeba –contact lens contaminant Figure 12.18a

17. Amoebae Protozoa with no truly defined shape Move and acquire food through the use of pseudopodia Found in water sources throughout the world Few cause disease

18. Entamoeba histolytica Carried asymptomatically in the digestive tracts of humans No animal reservoir exists Infection usually occurs by drinking water contaminated with feces that contain cysts Trophozoites migrate to the large intestine where they multiply

19. Entamoeba histolytica Three types of amebiasis can result from infection –Luminal amebiasis Least severe form that is asymptomatic –Invasive amebic dysentery More common form of infection Characterized by bloody, mucus-containing stools and pain –Invasive extraintestinal amebiasis Trophozoites carried via the bloodstream throughout the body Maintaining clean water is important in prevention

20. The Course of Amoebiasis Due to Entamoeba histolytica

21. Acanthamoeba and Naegleria Cause rare and usually fatal brain infections Common inhabitants of natural waterways as well as artificial water systems Contact lenses wearers who use tap water to wash their lenses can become infected Acanthamoeba diseases –Infection occurs through cuts or scrapes, the conjunctiva, or through inhalation –Acanthamoeba keratitis results from conjunctival inoculation –Amebic encephalitis is the more common disease

22. Acanthamoeba and Naegleria Naegleria disease –Infection occurs when swimmers inhale contaminated water –Amoebic meningoencephalitis results when trophozoites migrate to the brain Prevention is difficult because these organisms are environmentally hardy

23. Trichomonas vaginalis –no cyst stage –Trichomoniasis - STI Giardia lamblia –intestinal malabsorption –Traveler's diarrhea, day care centers, hikers Flagellate Figure 12.17b-d

24. Giardia

25. Hemoflagellates –Trypanosoma African sleeping sickness or Chagas disease Transmitted by tsetse flies or reduviid bugs –Leishmania leishmaniasis – “Baghdad Boil”- Desert Storm Transmitted by sand fly vector

26. Complex cells with rudimentary mouth (cytostome) Balantidium coli is the only human parasite –intestinal disease –associated with pork Paramecium Vorticella Ciliates Figure 12.20

27. Ciliates Protozoa that use cilia in their trophozoite stage Balantidium coli is the only ciliate known to cause disease in humans Commonly found in animal intestinal tracts Humans become infected by consuming food or water contaminated with feces containing cysts Trophozoites attach to the mucosal epithelium lining the intestine B.coli infections are generally asymptomatic in healthy adults

28. Ciliates Balantidiasis occurs in those with poor health –Characterized by persistent diarrhea, abdominal pain, and weight loss –Dysentery results in severe infections Presence of trophozoites is diagnostic for the disease Prevention relies on good personal hygiene and efficient water sanitation

29. Characteristics: –Nonmotile, Intracellular parasites –Complex life cycles, Asexual/sexual reproduction Plasmodium – malaria –transmitted by Anopheles mosquito Cryptosporidium – diarrhea; AIDS related Toxoplasma – toxoplasmosis; AIDS related Apicomplexans (Sporozoa)

30. Plasmodium Figure 12.19 Infected mosquito bites human; sporozoites migrate through bloodstream to liver of human Sporozoites undergo schizogony in liver cell; merozoites are produced Merozoites released into bloodsteam from liver may infect new red blood cells Merozoites are released when red blood cell ruptures; some merozoites infect new red blood cells, and some develop into male and female gametocytes 12 3 4 6 Asexual reproduction Intermediate host Merozoite develops into ring stage in red blood cell Ring stage Merozoites Another mosquito bites infected human and ingests gametocytes 7 5 Ring stage grows and divides, producing merozoites Definitive host In mosquito’s digestive tract, gametocytes unite to form zygote 8 Male gametocyte Female gametocyte Zygote Sexual reproduction Resulting sporozoites migrate to salivary glands of mosquito 9 Sporozoites in salivary gland

31. Plasmodium

32. Cryptosporidium parvum Figure 25.19 Waterborne Found in cattle Attach to intestinal lining Cause watery diarrhea Acid-fast Oocysts Resistant to chlorine

33. Cryptosporidium life cycle

34. Toxoplasma gondii

35. Eukaryotic Microbes Table 12.1

36. Helminths - worms Life Stages –egg, larva, adult; complex life cycles –infective stage: egg or larva –definitive host: harbors adult stage –intermediate hosts: may be more than one Classifications: Nematodes - roundworms Platyhelminthes - flatworms –Trematodes - flukes- nonsegmented –Cestodes - tapeworms- segmented

37. Nematodes- Roundworms Intestinal roundworms: –Ascaris (Giant intestinal roundworm) –Enterobius (Pinworm) –Necator / Ancylostoma (Hookworm) Tissue roundworms –Trichinella spiralis - trichinosis

38. Features of the Life Cycle of Roundworms Parasites of almost all vertebrates Have a number of reproduction strategies –Most intestinal nematodes shed their eggs into the lumen of the intestine Eggs are eliminated in feces Eggs are consumed in contaminated food or water –Some intestinal nematodes release their eggs into the soil Larvae actively penetrate the skin of a host Inside the body, they travel to the intestine –Other nematodes encyst in muscle tissue and are consumed in raw or undercooked meat –Mosquitoes transmit a few species of nematodes Adult sexually mature stages are found only in definitive hosts

39. Nematodes - roundworms Ascaris lumbricoides- adult stage

40. Roundworms

43. Pinworm disease is the most prevalent helminthic infection in the the world Enterobius vermicularis Life cycle Diagnosis with cellophane tape Transmission

44. Enterobius - Pinworm Figure 12.29

45. Diagnosing Pinworm Disease

46. Necator or Ancylostoma - Hookworm

47. The Life Cycle of the Hookworms Ancylostoma duodenale and Necatur americanus

48. Trichinella

49. Filariasis is a lymphatic system infection Wuchereria bancrofti Life cycle Transmission by mosquito Symptoms  Elephantiasis

51. Platyhelminthes - Flatworms Trematodes – Flukes - nonsegmented –Schistosoma - blood fluke; Swimmer’s itch Cestodes – Tapeworms - segmented –Taenia – beef or pork tapeworm –Echinococcus – wild dog tapeworm

52. Trematodes - Flukes Figure 12.25

53. Schistosoma – blood fluke

54. Cestodes - Tapeworms Figure 12.27 Tapeworm parts: Scolex head with attachment site Proglottids body segments with testes and ovaries Taenia saginata beef tapeworm Taenia solium pork tapeworm cysticercosis

55. Tapeworms

58. A few other tapeworms also cause disease Hymenolepis nana, the dwarf tapeworm, most common human tapeworm worldwide Echinococcus granulosus, the dog tapeworm, humans are intermediate hosts

59. Echinococcus Figure 12.28

60. Kingdom: Animalia –Phylum: Arthropoda (exoskeleton, jointed legs) Class: Insecta (6 legs) –Lice, fleas, mosquitoes Class: Arachnida (8 legs) –Mites and ticks –May transmit diseases (vectors) Arthropods as Vectors Figure 12.31, 32

61. Arthropods as Vectors Figure 12.33

62. Arthropod Vectors Figure 23.24

63. Scabies - mite

64. Arachnids Adult arachnids have four pairs of legs Ticks and mites resemble each other morphologically Ticks are the most important arachnid vectors –Serve as vectors for bacterial, viral, and protozoan diseases –Second only to mosquitoes in the number of diseases they transmit –Hard ticks are the most prominent disease vector –Transmit Lyme disease, Rocky Mountain spotted fever, tularemia, relapsing fever, and tick-borne encephalitis

65. Arachnids Parasitic mites are found wherever humans and animals coexist –Transmit rickettsial diseases among animals and humans

66. Insects Adults have three pairs of legs as well as a head, thorax, and abdomen Fleas –Most fleas are not associated with humans but a few do feed on humans –Plague is the most significant disease transmitted by fleas Body lice –Parasites that can also transmit disease –Most common among poor or overcrowded communities

67. Insects Flies –Among the most common insects –Those that transmit disease are generally bloodsuckers Mosquitoes –Most important arthropod vector of disease –Carry some of the world’s most devastating diseases Kissing bugs –Often take blood meals near the mouth of their human hosts –Feed on blood nocturnally while the host sleeps

68. Human Bot Fly

69. Eukaryotic Microbe Parasites Protozoa –Amoeba Entamoeba histolytica Naegleria Acanthamoeba –Flagellates Giardia lamblia Trichomonas vaginalis Trypanosoma Leishmania –Ciliates Balantidium coli –Sporozoa Plasmodium Cryptosporidium Toxoplasma Helminths –Roundworms Intestinal Ascaris lumbricoides Enterobius vermicularis Necatur americanus Tissue Trichinella spiralis Wucheraria bancrofti –Flatworms Flukes Schistosoma Tapeworms Taenia Arthropods –Insects –Arachnids