PrefaceMedical parasitology is an interdisciplinary science that deals with the study of animal parasites whichinfect and produce diseases in human beings. This book is designed specifically for undergraduatemedical and paramedical students as well as for postgraduate students.Medical students alwayscomplainthatthere isno standard Indiantextbookon parasitologyatpresentwhich can fulfil the need of the examination andforthe management ofthe parasiticdiseases.CurrentlyavailableIndian medical parasitologybooks areneither updated with recent advances norpresented in a student-friendly manner. Day-to-day developments in the field of parasitology and theunavailability ofa standard textbookfulflling the needs and expectation ofthe students, motivated usto writea book in an updatedformatwith recent epidemiological data, laboratorytechniques, treatmentstrategies,etcinsuchawaythatstudentcangraspiteasilyThe whole content of the book has been arranged in a bulleted format and use of sub heads hasincreased the readability.Entirebook is divided into four sections-General introduction,Protozoology,Helminthology and Miscellaneous.Atthe end,six appendices have been incorporated which will be ofimmense use and initiate interestamong the students.Expected questions including McQshavebeenadded at the end of each chapter which will helpto reinforce and understand the related topic in abetter way.Life cycles are drawn in lucid and easy-to-grasp manner, exactlyaccording to the text.Realmicroscopicimagesofparasitesandspecimensfromvarioussourcesarebeingincorporatedtocorrelatetheir impressions with the related parasitic diseases. Laboratory diagnosis and treatment boxes areintroduced asa different entity for a quickreview for students as wellas for physicians.Ourendeavorwill besuccessful,ifthebookisfoundtobeusefulforstudentaswell asforthefacultyApurbaSankarSastry(drapurbasastry@gmail.com)SandhyaBhatK(sandhyabhatk@gmail.com)
Medical parasitology is an interdisciplinary science that deals with the study of animal parasites which infect and produce diseases in human beings. This book is designed specifically for undergraduate medical and paramedical students as well as for postgraduate students. Medical students always complain that there is no standard Indian textbook on parasitology at present which can fulfil the need of the examination and for the management of the parasitic diseases. Currently available Indian medical parasitology books are neither updated with recent advances nor presented in a student‐friendly manner. Day-to-day developments in the field of parasitology and the unavailability of a standard textbook fulfilling the needs and expectation of the students, motivated us to write a book in an updated format with recent epidemiological data, laboratory techniques, treatment strategies, etc in such a way that student can grasp it easily. The whole content of the book has been arranged in a bulleted format and use of sub heads has increased the readability. Entire book is divided into four sections—General introduction, Protozoology, Helminthology and Miscellaneous. At the end, six appendices have been incorporated which will be of immense use and initiate interest among the students. Expected questions including MCQs have been added at the end of each chapter which will help to reinforce and understand the related topic in a better way. Life cycles are drawn in lucid and easy-to-grasp manner, exactly according to the text. Real microscopic images of parasites and specimens from various sources are being incorporated to correlate their impressions with the related parasitic diseases. Laboratory diagnosis and treatment boxes are introduced as a different entity for a quick review for students as well as for physicians. Our endeavor will be successful, if the book is found to be useful for student as well as for the faculty. Apurba Sankar Sastry (drapurbasastry@gmail.com) Sandhya Bhat K (sandhyabhatk@gmail.com) Preface
AcknowledgmentsACKNOWLEDGEMENTFORCONTRIBUTINGTHEFIGURESAttheveryoutset,weexpressourdeepestsenseofgratitudetoall whohavegivenconsenttoprovidetheirvaluable photographs.SINCEREACKNOWLEDGEMENTSFORHELPINGIN MANUSCRIPTPREPARATION:This bookwouldhave never seenthe lightwithoutthe immeasurablegenerosityofthefollowingpeoplewho guided, supported and stood by us throughout the journey of manuscript preparation.DrAnand Janagond,AssociateProfessor,Dept.of Microbiology,Velammal Medical College, Madurai,forhis valuable suggestions duringthe manuscript preparationDr Sharadadevi Mannur,AssociateProfessor,Dept.ofMicrobiology,Sri SiddharthaMedical College,Tumkur,karnatakaforhelpinginthecorrection ofthemanuscript.Dr Rudresh Shoorashetty Manohar,Assistant Professor, Dept.ofMicrobiology,ESIC Medical College,BangaloreinhelpingthepreparationofTrematodechaptermanuscript.DrPranayPanigrahi,Postgraduatestudent (Surgery),MkCGMedicalcollege,Berhampur,Orissa,forhelpinginthecorrectionofthemanuscriptDrS.Sujatha,Professor,Dept.ofMicrobiology,JIPMERforhervaluable suggestions duringtheinitialmanuscriptpreparation.Dr Rahul Dhodapkar,AssociateProfessor,Dept.ofMicrobiology,JIPMERforhisvaluable suggestionsduringtheinitialmanuscriptpreparationMrkaviyarasan andMs Rajeswari,Meenakshi Medical College, Chennai fortheirhelp indrawingfewschematicdiagrams.SPECIALACKNOWLEDGEMENTSTOOURPUBLISHERS:(JaypeeBrothersMedicalPublishers (P)Ltd)Shri Jitendar PVij (Group Chairman)Mr Ankit Vij (Group President)MrBhupeshArora (AssociateDirector Marketingand GMPublishing)DrSakshiArora (ChiefDevelopmentEditor)MrsNitashaAroraandDrMrinaliniBakshi (Editors)Mrs Seema Dogra (Senior Designer)Mr Phool kumar, Mr Sachin Dhawan, Mr Shekhar Bhatt and Mr Neeraj Choudhary (Operators andDesigner)HEARTYACKNOWLEDGEMENTSTODEPARTMENTSTAFFSANDRELATIVESFORTHEIRBLESSINGANDSUPPORTDr.Reba kanungo, Dean Research, Professor and Head, Department of Clinical Microbiology,Pondicherry Institute of Medical Sciences (PIMS)forgiving the foreword.DrSRavikumar,Director,JIPMERDr John Abraham, Director-Principal, Pondicherry Institute of Medical Sciences (PIMS)JIPMER,DeparmentofMicrobiologyFaculty:>DrSBadrinath,Projectconsultant,ExProfessorandHead>Dr SC Parija,Dean Research,ExProfessor and Head
Acknowledgments ACKNOWLEDGEMENT FOR CONTRIBUTING THE FIGURES At the very outset, we express our deepest sense of gratitude to all who have given consent to provide their valuable photographs. SINCERE ACKNOWLEDGEMENTS FOR HELPING IN MANUSCRIPT PREPARATION: This book would have never seen the light without the immeasurable generosity of the following people who guided, supported and stood by us throughout the journey of manuscript preparation. • Dr Anand Janagond, Associate Professor, Dept. of Microbiology, Velammal Medical College, Madurai, for his valuable suggestions during the manuscript preparation. • Dr Sharadadevi Mannur, Associate Professor, Dept. of Microbiology, Sri Siddhartha Medical College, Tumkur, karnataka for helping in the correction of the manuscript. • Dr Rudresh Shoorashetty Manohar, Assistant Professor, Dept. of Microbiology, ESIC Medical College, Bangalore in helping the preparation of Trematode chapter manuscript. • Dr Pranay Panigrahi, Post graduate student (Surgery), MkCG Medical college, Berhampur, Orissa, for helping in the correction of the manuscript • Dr S. Sujatha, Professor, Dept. of Microbiology, JIPMER for her valuable suggestions during the initial manuscript preparation. • Dr Rahul Dhodapkar, Associate Professor, Dept. of Microbiology, JIPMER for his valuable suggestions during the initial manuscript preparation. • Mr kaviyarasan and Ms Rajeswari, Meenakshi Medical College, Chennai for their help in drawing few schematic diagrams. SPECIAL ACKNOWLEDGEMENTS TO OUR PUBLISHERS: (Jaypee Brothers Medical Publishers (P) Ltd) • Shri Jitendar P Vij (Group Chairman) • Mr Ankit Vij (Group President) • Mr Bhupesh Arora (Associate Director Marketing and GM Publishing) • Dr Sakshi Arora (Chief Development Editor) • Mrs Nitasha Arora and Dr Mrinalini Bakshi (Editors) • Mrs Seema Dogra (Senior Designer) • Mr Phool kumar, Mr Sachin Dhawan, Mr Shekhar Bhatt and Mr Neeraj Choudhary (Operators and Designer) HEARTY ACKNOWLEDGEMENTS TO DEPARTMENT STAFFS AND RELATIVES FOR THEIR BLESSING AND SUPPORT • Dr. Reba kanungo, Dean Research, Professor and Head, Department of Clinical Microbiology, Pondicherry Institute of Medical Sciences (PIMS) for giving the foreword. • Dr TS Ravikumar, Director, JIPMER • Dr John Abraham, Director-Principal, Pondicherry Institute of Medical Sciences (PIMS) • JIPMER, Deparment of Microbiology Faculty: h Dr S Badrinath, Project consultant, Ex Professor and Head h Dr SC Parija, Dean Research, Ex Professor and Head
xiiEssentialsofMedical Parasitology>Dr BN Harish, Professor and Head>DrSSujatha, Professor>DrJharnaMandal,AssociateProfessor>Dr Rakesh Singh, AssociateProfessor>DrRahulDhodapkar,AssociateProfessor>DrRakhiBiswas,Assistant Professor>DrNoyal MJoseph,AssistantProfessor>DrHitenderGautam,AssistantProfessorPondicherryInstituteof Medical Sciences (PIMS),Deparmentof MicrobiologyFaculty:>DrRebakanungo,DeanResearchandProfessor&Head>DrShashikala,ProfessorDr Sheela Devi, Professor>DrEstherPaul,AssociateProfessor>Dr Johny Asir, Assistant Professor>DrPVivianJoseph,AssistantProfessor>DrSujithaV,AssistantProfessor>DrAnandhalakshmi, Assistant Professor>Ms SMShanthi,Tutor>MrsDesdemona Rasitha,TutorJIPMER, Department of Microbiology: Residents, PhD scholars, technicians and non teaching staff.Pondicherry Institute of Medical Sciences (PIMS), Department of Clinical Microbiology -PGstudents, technicians and non teaching staffMeenakshi Medical College,Chennai,Department of Microbiology staffs-Dr Amshavathani(ProfessorandHOD),DrSenthamarai(AssociateProfessor),DrSivasankari(AssociateProfessor),Drkumudavathi (Tutor)and DrAnitha (AssistantProfessor)ESIC Medical College and PGIMSR, Chennai, Department of Microbiology staffs and residentsSri Siddhartha Medical College, Tumkur, karnataka, Department of Microbiology staffs->DrERNagaraj,ProfessorandHead>Dr SharadadeviMannur,AssociateProfessor>Dr Renushree,Associate ProfessorOur friends: Dr Godfred, Mr Sisir, Dr Sadia, Dr Srinivas, Dr Chaya, Dr Manisa, Dr IraAllmaternalandpaternalrelativesandcousinsLast, but not theleast, wewanttothank theAlmightyforbestowing all hisblessings
h Dr BN Harish, Professor and Head h Dr S Sujatha, Professor h Dr Jharna Mandal, Associate Professor h Dr Rakesh Singh, Associate Professor h Dr Rahul Dhodapkar, Associate Professor h Dr Rakhi Biswas, Assistant Professor h Dr Noyal M Joseph,Assistant Professor h Dr Hitender Gautam, Assistant Professor • Pondicherry Institute of Medical Sciences (PIMS), Deparment of Microbiology Faculty: h Dr Reba kanungo, Dean Research and Professor & Head h Dr Shashikala, Professor h Dr Sheela Devi, Professor h Dr Esther Paul, Associate Professor h Dr Johny Asir, Assistant Professor h Dr P Vivian Joseph, Assistant Professor h Dr Sujitha V, Assistant Professor h Dr Anandhalakshmi, Assistant Professor h Ms SM Shanthi, Tutor h Mrs Desdemona Rasitha, Tutor • JIPMER, Department of Microbiology: Residents, PhD scholars, technicians and non teaching staff. • Pondicherry Institute of Medical Sciences (PIMS), Department of Clinical Microbiology — PG students, technicians and non teaching staff • Meenakshi Medical College, Chennai, Department of Microbiology staffs — Dr Amshavathani (Professor and HOD), Dr Senthamarai (Associate Professor), Dr Sivasankari (Associate Professor), Dr kumudavathi (Tutor) and Dr Anitha (Assistant Professor) • ESIC Medical College and PGIMSR, Chennai, Department of Microbiology staffs and residents • Sri Siddhartha Medical College, Tumkur, karnataka, Department of Microbiology staffsh Dr ER Nagaraj, Professor and Head h Dr Sharadadevi Mannur, Associate Professor h Dr Renushree, Associate Professor • Our friends: Dr Godfred, Mr Sisir, Dr Sadia, Dr Srinivas, Dr Chaya, Dr Manisa, Dr Ira • All maternal and paternal relatives and cousins Last, but not the least, we want to thank the Almighty for bestowing all his blessings. xii Essentials of Medical Parasitology
ContentsSectionl:Introducion3-15Chapter 1:General Introduction To ParasitologyTaxonomy of parasitesLifecycle of theparasites636Parasite3Pathogenesis of parasitic diseasesHost48Immunologyof parasiticdiseases0Host-parasite relationship4Laboratory diagnosis of parasitic diseasesTransmissionofparasites5Treatment of parasitic diseases10Section2:Protozoology19-23Chapter2:IntroductiontoProtozoa1919General features of protozoaClassificationofprotozoa24-48Chapter3:AmoebaClassification of amoeba24Entamoebagingivalis38Intestinal amoeba 24Entamoebapolecki 3924>PathogenicintestinalamoebaEndolimaxnana39Entamoeba histolytica24lodamoeba butschlii39Nonpathogenic intestinal amoeba35Free-living(opportunistic)amoeba40Entamoebadispar 35>Naegleriafowleri 40Entamoeba moshkovskii3643>Acanthamoebaspecies>Balamuthia mandrillarisEntamoebacoli 364638>Sappiniadiploidea47Entamoebahartmanni49-62Chapter4:Flagellates-I (lntestinalandGenital)4958ClassificationofflagellatesChilomastixmesniliGiardialamblia 5059Enteromonashominis60Trichomonas vaginaliss55RetortamonasintestinalisaPentatrichomonas hominis58Dientamoeba fragilis60Trichomonastenax 58
Section 1: Introducion Chapter 1: General Introduction To Parasitology 3–15 Contents • Taxonomy of parasites 3 • Parasite 3 • Host 4 • Host-parasite relationship 4 • Transmission of parasites 5 • Life cycle of the parasites 6 • Pathogenesis of parasitic diseases 6 • Immunology of parasitic diseases 8 • Laboratory diagnosis of parasitic diseases 9 • Treatment of parasitic diseases 10 Section 2: Protozoology Chapter 2: Introduction to Protozoa 19–23 Chapter 3: Amoeba 24–48 • General features of protozoa 19 • Classification of protozoa 19 • Classification of amoeba 24 • Intestinal amoeba 24 h Pathogenic intestinal amoeba 24 Entamoeba histolytica 24 h Nonpathogenic intestinal amoeba 35 Entamoeba dispar 35 Entamoeba moshkovskii 36 Entamoeba coli 36 Entamoeba hartmanni 38 Entamoeba gingivalis 38 Entamoeba polecki 39 Endolimax nana 39 Iodamoeba butschlii 39 • Free-living (opportunistic) amoeba 40 h Naegleria fowleri 40 h Acanthamoeba species 43 h Balamuthia mandrillaris 46 h Sappinia diploidea 47 Chapter 4: Flagellates—I (Intestinal and Genital) 49–62 • Classification of flagellates 49 • Giardia lamblia 50 • Trichomonas vaginalis 55 • Pentatrichomonas hominis 58 • Trichomonas tenax 58 • Chilomastix mesnili 58 • Enteromonas hominis 59 • Retortamonas intestinalis 60 • Dientamoeba fragilis 60
xivEssentials of Medical Parasitology63-89Chapter5:Flagellates-ll(Hemoflagellates)Introduction63Leishmania mexicana complex77Morphologyofhemoflagellates63Leishmania viannia braziliensisLeishmania64complex77OldWorldLeishmaniasis64Leishmania leishmaniachagasi78Leishmania donovani64Trypanosoma79Trypanosoma cruzi 79Leishmania tropicacomplex74Trypanosomabruceicomplex85>NewWorldLeishmaniasis7690-117Chapter6:Sporozoa-l(MalariaandBabesiosis)Classification90Babesia114Malariaparasite90118-139Chapter7:Sporozoa-ll(OpportunisticCoccidianParasites)Introduction118Cyclospora cayetanensis 131Toxoplasma gondii 118Isosporabelli 133126135Sarcocystis speciesCryptosporidiumparvum140-150Chapter8:MiscellaneusProtozoaMicrosporidium species140Blastocystishominis149Balantidium coli146Section3:Helminthology153-155Chapter9:IntroductiontoHelminthsGeneral charactristics153Lifecycle155Morphology154156-189Chapter10:CestodesGeneral characteristics of cestodes156Cyclophyllidean cestodes165>Classificationofcestodes 156>Taenia species165,175>Morphologyofcestodes157>Echinococcusspecies176Pseudophyllideancestodes160>Hymenolepisnana184,186160>Diphyllobothriumspecies>Dipylidiumcaninum187>Spirometraspecies163
Chapter 10: Cestodes 156–189 Chapter 5: Flagellates—II (Hemoflagellates) 63–89 Chapter 6: Sporozoa—I (Malaria and Babesiosis) 90–117 Chapter 7: Sporozoa—II (Opportunistic Coccidian Parasites) 118–139 Chapter 8: Miscellaneus Protozoa 140–150 • Introduction 63 • Morphology of hemofl agellates 63 • Leishmania 64 h Old World Leishmaniasis 64 Leishmania donovani 64 Leishmania tropica complex 74 h New World Leishmaniasis 76 Leishmania mexicana complex 77 Leishmania viannia braziliensis complex 77 Leishmania leishmania chagasi 78 • Trypanosoma 79 • Trypanosoma cruzi 79 • Trypanosoma brucei complex 85 • Classification 90 • Malaria parasite 90 • Babesia 114 • Introduction 118 • Toxoplasma gondii 118 • Cryptosporidium parvum 126 • Cyclospora cayetanensis 131 • Isospora belli 133 • Sarcocystis species 135 • Microsporidium species 140 • Balantidium coli 146 • Blastocystis hominis 149 • General characteristics of cestodes 156 h Classification of cestodes 156 h Morphology of cestodes 157 • Pseudophyllidean cestodes 160 h Diphyllobothrium species 160 h Spirometra species 163 • Cyclophyllidean cestodes 165 h Taenia species 165, 175 h Echinococcus species 176 h Hymenolepis nana 184, 186 h Dipylidium caninum 187 Section 3: Helminthology Chapter 9: Introduction to Helminths 153–155 • General charactristics 153 • Morphology 154 • Life cycle 155 xiv Essentials of Medical Parasitology