Nematodes
Nematodes
Nematodes
Ascaris lumbricoides
2 BMT CN: giant intestinal roundworm
STH: soil transmitted helminths- soil plays a major
NEMATODES role in the development and transmission of the
parasite. (polymyarian)
Helminths- worms Most common intestinal nematode of man
Kingdom Anemalia Most frequent in tropics
Phylum Nemathelminthes/Aschelminthes FH: man
SHAPE: elongated and cylindrical IS: embryonated egg
Bilaterally symmetrical MOT: ingestion
Non-segmented Habitat: lumen of small intestine
Complete DIGESTIVE system (mouth-anus) o Larva: heart-lung migration
Complete NERVOUS system (receptors) o Back to small int. to be an adult worm and
o Amphids- anterior portion reproduce
o Phasmids- posterior portion o Egg: released in stool
Not all have phasmids (APHASMIDS) hepato-tracheal migration phase takes about 14
o Trichuris days, while the development of egg-laying adult
o Capillaria worms takes about 9 to 11 weeks after egg
o Trichinella ingestion. The life span of an adult worm is about 1
Tegument- protective covering (chitinous) year.
Pseudocoel- body cavity containing the organs have a terminal mouth with trilobate lips and
Life cycle sensory papillae
o Adult- mature form
o Larva- immature form
o Egg/Ovum Produces pepsin inhibitor 3 (PI-3)- protects worms
Dioecious- separate sexes (male and female) from digestion and phosphorylcholine that
o Male: suppresses lymphocyte proliferation.
Smaller Adult morphology:
Posterior portion is coiled/curved
Copulatory structures: 2 spicule &
copulatory bursa
Enterobius vermicularis
CN: pinworm, seatworm, society worm, tiwa
FH: man
Habitat: colon
MOT: secondary bacterial infection: Intense itching leads
o Ingestion to scratching due to the migration of egg-laying
o Inhalation females
o Autoinfection Other signs of infection are poor appetite, weight
o Retroinfection loss, irritability, grinding of teeth, and abdominal
Infection is characterized by perianal pain
itching/pruritus ani Complications such as appendicitis, vaginitis,
Not a usual cause of significant morbidity or endometritis, salpingitis, and peritonitis: due to
mortality aberrant adult worm migration
Most common helminth parasite in temperate prognosis of enterobiasis or oxyuriasis is good
regions This parasitic disease is extremely contagious and
Meromyarian (arrangement of somatic muscles)- 2-5 can easily spread among members of a family or in
cells per dorsal or ventral half institutions
Adult morphology: described as a familial or a group disease.
Diagnosis
suspected in children and adults who show perianal
itching
o relieved only by vigorous scratching
confirmed by finding adult worms or eggs on
microscopic examinations
o Stool sample- only 5% of infected persons
o Graham’s scotch adhesive tape swab (perianal
Males are rarely seen- usually die after copulation cellulose tape swab)- gives the highest
Gravid Females- migrate down the intestinal tract percentage of positive results, and the
and exit through the anus to deposit eggs (oviposit) greatest number of eggs seen. This low-cost
on the perianal skin, usually in the evening hours. diagnostic method is easy to perform and is
o Female: average of 11,000 eggs/day very sensitive and specific.
o After egg deposition, the female usually dies Treatment
Rhabditiform larva: w/ esophageal bulb, w/o Albendazole and mebendazole
cuticular expansion on the anterior end Treatment of the entire household is recommended
Egg morphology: Considered cure after 7 negative perianal smears on
o Asymmetrical (one side flattened, other side consecutive days
convex) Epidemiology
o D-shaped/ lopsided only intestinal nematode infection that cannot be
controlled through sanitary disposal of human feces,
because the eggs are deposited in the perianal
region instead of the intestinal lumen
Risk factors: overcrowding, thumb-sucking, nail-
biting, and lack of parental knowledge on pinworms
o becomes fully mature outside the host within Prevention and Control
4 to 6 hours Personal cleanliness and personal hygiene
o Eggs are resistant to disinfectants Fingernails should be cut short
o Succumb to dehydration in dry air within a day Hand washing should be done
o Mist condition- viable for up to 13 days
o viable longest under conditions of fairly high Infective stage: larva
humidity and moderate temperature Hookworms
Pathogenesis and Clinical Manifestations Soil transmitted helminth
relatively innocuous parasite and rarely produces Blood sucking- attaches to the mucosa of the small
any serious lesions intestine
Mild catarrhal inflammation of the intestinal Meromyarian- 2-5 cells arranged per dorsal or
mucosa: from the attachment of the worms ventral half
IS: filariform larva (L3) [fenetrates the skin]
Egg Ancylostoma braziliense Ancylostoma caninum
o Thin shell
o Starts w/ a single embryo then divide divide
o All looks similar, undistinguishable
o Oviparous- unembryonated
Causes microcytic hypochronic anemia = pain, lazy
Lab diagnosis
o DFS
o Kato-katz
Larva o Kato thick
o L1: rhabditiform o Harada Mori culture technique
Diagnostic stage Pathogenesis and Clinical Manifestation
Feeding form- open mouth Penetration of filariform causes
o Maculopapular lesions
o Localized erythema
o Severe itching- ground itch, dew itch
o L2 Lung migration
o L3: filariform o Bronchitis
Infective stage (skin penetration) o Pneumonitis
Ecdysis- shedding = sheath Adult worm in the small intestine
Appears fiat (thin) o Abdominal pain
Dies in alcohol o Steatorrhea
o Diarrhea with blood and mucus
o Eosinophilia
heavy hookworm infection results in a progressive,
After skin penetration it will circulate in the body secondary, microcytic, hypochromic anemia of the
o Results in elevated eosinophil iron-deficient type, due primarily to continuous loss
Heart-lung migration of blood
o Wakana disease (lungs) Hypoalbuminemia- due to combined lost of blood,
It will travel to the pharynx where it will be lymph and protein
swallowed back to the small intestine Good prognosis
Small intestine- where it will become an adult Treatment
Human hookworms Albendazole
o Necator americanus- CN: new world hw. Mebendazole
o Ancylostoma duodenale- CN: old world hw.
Animal hookworms- can still infect humans Strongyloides stercoralis
(cutaneous larva migrant “creeping eruption”) CN: threadworm
o Ancylostoma braziliense- CN: cat hw. Cochin-china diarrhea or vietnam diarrhea
o Ancylostoma caninum- CN: dog hw. Facultative (free-living)
Buccal cavity- differentiation of human and animal Parthenogenetic
hookworm Ovoviviparous- embryonated
Necator americanus Ancylostoma duodenale Honey-comb appearance in intestinal mucosa
Filariform female- larger than free-living male and
free-living female
Filarial worms
(Wuchy and Brugy)
Vector transmitted: mosquito
Does not lay eggs
Lymphatic worm- one of the most debilitating
diseases
Treated with diethylcarbamazine
Kinky curves (bruha)
Wuchereria bancrofti 1: longer than wide
CN: Bancroft’s filarial worm 2: overlapping, disorganized
Transmitted by mosquito bites at night 3: 2 terminal nuclei
o Anopheles- slow flowing, clear, shaded 4: stains pink in Giemsa stain
o Aedes- from abaca and banana leaves Pathogenesis and Clinical Manifestation
o Culex Lymphatic filariasis- caused by the adult worm
DS: microfilaria (can be observed in a wet smear) Weingartner’s syndrome- tropical pulmonary
eosinophilia
Mayer’s-Kouwenaar syndrome- massive eosinophilia
Expatriate syndrome- people who get infected after
migration to the endemic regions (di taga doon)
Lymphangiectasia- Filarial adult worms cause
IS: filiform (thread-like) parasite-induced lymphatic dilatation.
The parasite is nocturnal (10 pm-2 am/ 8 pm-4 am) Chyluria- milky urine
Specimen for diagnosis: blood collected at night The most common chronic manifestation of LF is
Causes Bancroftian filariasis lymphedema, which on progression leads to
elephantiasis
Brugia malayi o The lower limbs are commonly affected, but
CN: Malayan filarial worm upper limb and male genitalia may be
Transmitted by mosquito bites at night involved.
o Mansonia- fresh water or rice fields o In females, breasts and genitalia may be
DS: microfilaria affected, but this is relatively uncommon
IS: filiform (thread-like) Diagnosis and Treatment
The parasite is nocturnal (10 pm-2 am/ 8 pm-4 am) Knott’s concentration technique- recovery of
Specimen for diagnosis: blood collected at night microfilaria
Causes Malayan filariasis