Parasites occur in two distinct forms: single-celled protozoa and multicellular metazoa called helminths or worms. For medical purposes, protozoa are classified according to their most important site of infection, namely, the intestinal protozoa such as Giardia, the urogenital protozoa such as Trichomonas, the blood protozoa such as Plasmodium (the cause of malaria), and tissue protozoa such as Toxoplasma. This book discusses the protozoa according to these categories. In some contexts, the protozoa are classified into four groups: Sarcodina (amebas), Sporozoa (sporozoans), Mastigophora (flagellates), and Ciliata (ciliates).
Metazoa are subdivided into two phyla: the Platyhelminthes (flatworms) and the Nemathelminthes (roundworms, nematodes). The phylum Platyhelminthes contains two medically important classes: Cestoda (tapeworms) and Trematoda (flukes). This classification is shown in Figure VI–1. Examples of medically important flatworms include Taenia solium, the tapeworm that causes cysticercosis, and Schistosoma mansoni, the fluke that causes schistosomiasis. Medically important roundworms (nematodes) include the pinworm (Enterobius), the hookworms (Ancylostoma and Necator), the threadworm (Strongyloides; the cause of strongyloidiasis), and Trichinella (the cause of trichinosis).
Relationships of the medically important parasites.
Understanding the life cycle and pathogenesis of protozoa and helminths requires an explanation of certain terms. Many protozoa have a life cycle consisting of a trophozoite, which is the motile, feeding, reproducing form surrounded by a flexible cell membrane, and a cyst, which is the nonmotile, nonmetabolizing, nonreproducing form surrounded by a thick wall. The cyst form survives well in the environment and so is often involved in transmission. Certain protozoa, such as Leishmania and Trypanosoma, have flagellated forms called promastigotes or trypomastigotes and nonflagellated forms called amastigotes.
Transmission of the intestinal protozoa typically occurs by ingestion of cysts, whereas transmission of the blood and tissue protozoa usually occurs via insect vectors such as the mosquito in the case of Plasmodium (malaria), the reduvid bug in the case of Trypanosoma cruzi (Chagas’ disease), the tsetse fly in the case of Trypanosoma brucei (sleeping sickness), and the sandfly in the case of Leishmania donovani (visceral leishmaniasis or kala-azar). The main exception to this is Toxoplasma which is a tissue protozoan that is transmitted primarily by ingestion of cysts in cat feces and across the placenta from mother to fetus.
Prevention of these diseases involves interrupting the chain of transmission, in particular via proper sewage disposal and water purification in the case of the intestinal protozoa and insect control in the case of the blood protozoa.
Many helminths have a life cycle that progresses from egg to larva to adult. The egg contains an embryo that, upon hatching, differentiates into a larval form, which then matures into the adult form that produces the ...