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Medical Parasitology LECTURE NOTES Degree and Diploma Programs For Health Science Students Medical Parasitology Dawit Assafa, Ephrem Kibru, S. Nagesh, Solomon Gebreselassie, Fetene Deribe, Jemal Ali Jimma University Debub University University of Gondar In collaboration with the Ethiopia Public Health Training Initiative, The Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education 2004 Funded under USAID Cooperative Agreement No. 663-A-00-00-0358-00. Produced in collaboration with the Ethiopia Public Health Training Initiative, The Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education. Important Guidelines for Printing and Photocopying Limited permission is granted free of charge to print or photocopy all pages of this publication for educational, not-for-profit use by health care workers, students or faculty. All copies must retain all author credits and copyright notices included in the original document. Under no circumstances is it permissible to sell or distribute on a commercial basis, or to claim authorship of, copies of material reproduced from this publication. ©2006 by Dawit Assafa, Ephrem Kibru, S. Nagesh,, Solomon Gebreselassie, Fetene Deribe, Jemal Ali All rights reserved. Except as expressly provided above, no part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission of the author or authors. This material is intended for educational use only by practicing health care workers or students and faculty in a health care field. PREFACE This lecture note is useful to students of health science, medicine and other students and academicians. It is believed to provide basic knowledge to students on medical parasitology. It also serves as a good reference to parasitologists, graduate students, biomedical personnel, and health professionals. It aims at introducing general aspects of medically important parasites prevalent in the tropics and in Ethiopia in particular. It is our belief that this note will contribute much in alleviating the shortage of Parasitology texts. Students preparing to provide health care in their profession need solid foundation of basic scientific knowledge of etiologic agents of diseases, their diagnosis and management. To face the fast growing trends of scientific information, students require getting education relevant to what they will be doing in their future professional lives. Books that are of manageable size are increasingly important in helping students learn the seemingly overwhelming amount of information they must absorb. i ACKNOWLEDGEMENTS The writers are indebted to the Ethiopian Public Health Initiative (EPHI) for encouragement and financial support. We thank all who contributed in the write up of this lecture note and those involved in giving the secretarial service in all colleges and Universities. Included in the acknowledgment are also the reviewers of the draft material, Dr. Habtamu and Ato Asrat Hailu who are currently staffs of AAU-MF, Microbiology, Immunology, and Parasitology department. Their comments were quiet constructive and well taken up. ii TABLE OF CONTENTS Topic Page Preface ............................................................................................. ......... i Acknowledgement ............................................................................. ......... ii Table of Contents .............................................................................. ........ iii About the Authors ............................................................................. ....... vii List of Boxes and Tables .................................................................. ...... viii Abbreviations and Acronyms ............................................................ ........ ix UNIT ONE: General Parasitology ................................................... ........ 1 Association between parasite and host ........................................ ........ 1 Effect of parasites on the host...................................................... ........ 4 Basic concepts in medical parasitology ....................................... ........ 5 Classification of medical parasitology .......................................... ........ 8 General characteristics of medically important parasites ............. ...... 11 (1) Protozoa ............................................................................ ...... 11 (2) Heliminths .......................................................................... ...... 13 (3) Arthropods ......................................................................... ...... 14 UNIT TWO: Medical Protozology ................................................... ...... 17 Introduction ....................................................................................... ...... 17 Classification of protozoa .................................................................. ...... 20 UNIT THREE: Amoebiasis .............................................................. ...... 22 Introduction ....................................................................................... ...... 22 1.1. Entamoeba Histolytica .......................................................... ...... 22 1.2. Other Amebae inhabiting the alimentary canal ..................... ...... 27 1.3. Pathogenic free-living amoebae ............................................ ...... 35 UNIT FOUR: Pathogenic Flagellates ............................................. ...... 37 Introduction .................................................................................. ...... 37 2.1 Luminal Flagellates ................................................................ ...... 37 iii 2.1.1. Giardia Lamblia .............................................................. ...... 37 2.1.2 Trichomonas vaginalis .................................................... ...... 41 2.1.3 Dientamoeba Fragilis ...................................................... ...... 43 2.1.4 Other flagellates inhabiting the alimentary canal ............. ...... 44 2.2. Haemoflagelates .................................................................... ...... 47 2.2.1 Leishmania Species ........................................................ ...... 47 2.2.1.1 Visceral Leishmaniasis ............................................ ...... 47 2.2.1.2 Old world cutaneous leishmaniasis (Oriental sore) . ...... 50 2.2.1.3 New world cutaneous and mucocutaneous leishmaniasis52 2.2.2 Trypanosomiasis ............................................................. ...... 53 2.2.2.1 African trypanosomiasis .......................................... ...... 54 2.2.2.2 American trypanosomiasis ...................................... ...... 57 UNIT FIVE: Medically important ciliates ........................................ ...... 61 Balantidiasis .................................................................................. ...... 61 UNIT SIX: COCCIDIA (SPOROZOA) ............................................... ...... 63 4.1 Malaria .................................................................................... ...... 63 4.1.1 Plasmodium falciparum ................................................... ...... 66 4.1.2 Plasmodium vivax ........................................................... ...... 69 4.1.3 Plasmodium malariae ...................................................... ...... 70 4.1.4 Plasmodium ovale ........................................................... ...... 71 4.2 Other cocidian parasites ......................................................... ...... 74 Review Questions ......................................................................... ...... 80 UNIT SEVEN: Medical heminthology ............................................. ...... 82 UNIT EIGHT: Medically important treatodes (Flukes) .................. ...... 84 1.1. Blood Flukes .......................................................................... ...... 84 1.1.1. Schistosomiasis (Bilharziasis) ........................................ ...... 84 Schistosoma Mansoni .............................................................. ...... 85 Urinary Scistosomiasis ............................................................. ...... 85 Schistosoma Japonium ............................................................ ...... 86 Schistosoma Intercalatum ........................................................ ...... 86 1.2. Intestinal Flukes ..................................................................... ...... 89 iv 1.3. Liver Flukes ............................................................................ ...... 89 1.4. Lung Flukes ........................................................................... ...... 89 UNIT NINE: Nematodes (Round Worms) ....................................... ...... 89 General Characteristics of nematodes .......................................... ...... 90 2.1. Intestinal nematodes with tissue stage .................................. ...... 91 2.1.1. Ascaris lumbricoides ...................................................... ...... 91 2.1.2. Hook worms ................................................................... ...... 93 2.1.2.1. Ancylostoma duodenale ......................................... ...... 93 2.1.2.2. Necator Americanus ............................................... ...... 94 2.1.3 Larva migrans ................................................................
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