Lecture 7 Nematodes Part 2 New 2023

Parasitology
Nahda University, Faculty of Pharmacy

Microbiology & Immunology Department
Lecture 7 Class: Nematode

11 Lectures
3. The Hookworms:
Ancylostoma duodenale
Distribution: worldwide, Middle East and North Africa.

N. americanus:. Americas and Australia.
Habitat: Small intestine of man particularly jejunum, ileum

and rarely the duodenum.
DH: Man.
Morphology:
–Male: about 10 mm, has one set of genitalia, bursa at its
posterior end. Female: about 13 mm, (20,000 eggs/day).
Life
cycle
Infective stage: 3rd stage filariform larva.

Mode of infection: Penetration of the skin of man, while
walking bare-footed in infected soil.
Pathogenesis and Clinical
Manifestations: Hookworm
infection or Ancylostomiasis
Cutaneous phase: (Ground itch): Itching, Pruritus, Erythema,

oedema, 2nd infections.
Migratory (pulmonary phase): Fever, cough, hemoptysis,

dyspnea, wheezing, eosinophilia, asthma-like symptoms.
Intestinal phase: anemia (due to sucking and loss of blood at

site of its attachment in intestine), mechanical and lytic
destruction of tissues at sites of attachment (ulcers), Epigastric
pain, Malabsorption, avitaminosis, Diarrhea and occult blood in
stool.
Treatment
Mebendazole, Albendazole and Pyrantel pamoate.

Treatment of anaemia: by oral administration of iron
preparations, transfusion of packed red cells (in severe case),
High protein diet, Folic acid and vitamin B12 in some cases.
4. Trichuris trichiura
(Trichocephalus trichiurus, Whipworm)
• Distribution: worldwide; high prevalence in countrieswith
inadequate sanitation, and where human feces are used as
fertilizer
• DH: Man.
• Habitat: Large intestine, mainly caecum.
• Morphology:
- Male: female 20-35, male 15-30 mm
• Infective stage: Embryonated egg.

Mode of infection: Life cycle
ingestion of the embryonated
eggs, in food contaminated with
human feces.
Pathogenesis & Clinical
manifestations: (Trichuriasis
or Trichocephaliasis)
1. Light infection: no symptoms.
2. Heavy infection: Blood streaked diarrhea.
• Chronic dysentery, tenesmus and gastro-intestinal problems
(abdominal pain, dysentery, rectal prolapse, hypochromic

anaemia).
• Growth retardation from severe malnutrition in severe

condition.
3. Complication: Appendicitis, Peritonitis and Rectal prolapse.

Tissue (Filarial) Nematodes
Lymphatic
Wuchereria bancrofti
Brugia malayi
Sub-Cutaneous
Loa loa
Onchocrca volvulus
m
Lymphatic
1-Wuchereria bancrofti
Distribution: •worldwide in tropical areas
Disease: •Elephantiasis, Wuchereriasis, Bancroftian filariasis,
lymphatic filariasis
Vector: •Mosquito (Culex sp. Or Anopheles sp.)
Infective stage: •motile microfilaria (has sheath)

Site of infection:
•lymph nodes, lymphatic glands and vessels in legs,
arms and genitalia (testes)
Symptoms: •Inflammation of vessels, fibrosis, leading to obstruction,

rupture of lymphs,. Thickening, hypertrophy of tissues,
enlargement of tissues (especially extremeties and genitalia)
Stage Clinical manifestations
1. Asymptomatic - Microfilaria in blood, no symptoms.
2. Acute - Swollen vessels, fibrosis, obstruction,
inflammatory stage rupture of lymphatics, thickening,
enlargement and hypertrophy of tissues,
lower limb and genitalia (W. bancrofti).
3. Chronic - Elephantiasis, Chyluria, chylocele, Chylous

obstructive stage diarrhoea, and chylous ascites.
- Microfilaria are usually absent in blood.
Diagnosis
1. Clinical: Inflammation of vessels and lymphatics and
genitalia,, chronic elephantiasis, chylocele or chyluria.
2. Laboratory: Wuchereria
bancrofti
a) Detection of microfilariae in blood between 10 pm and 2 am
by:
-Wet drop (moving microfilaria) - Giemsa stained blood films
-Membrane filtration technique.
b) PCR for the detection of parasite’s DNA in blood
c) Detection of antigen.
Treatment
Anti-filarial therapy: a) Diethyl carbamazine (DEC) Hetrazan: microfilaricidal

but eliminates the adult worms slowly.
b) Ivermectin: microfilaricidal but does not kill the adult worm.
Antibiotics for septic complications- Antihistaminic- Surgical intervention in
cases of elephantiasis.
Prevention and Control
Control of mosquitoes: anti-mosquito measures, destruction of breeding places,
insecticides and repellents.
Control of human sources: treatment of patients, DEC can be safely added to the table salt.
Ivermectin in a single dose.
Prophylaxis: a single dose of 50-200 mg DEC at monthly intervals is given in

endemic area.
Sub-Cutaneous
1-Loa loa
• Common name Eye worm
• Geog. Distrib. Africa
• Length female 6 cm, male 3 cm
• Vector Fly of genus Chrysops
(mango fly)
subcutaneous tissues, and muscles
• Disease Loiasis, Calabar swelling
• Symptoms Adults migrate through subcutaneous tissues and
even the eye causing swelling, pain, edema
(Calabar swelling) and impaired vision
• Diagnosis demonstration of microfilaria in blood (since adult wormlives in

subcutaneous tissue and microfilaria in blood)
• Treatment diethylcarbamazine for microfilaria and adult,
soothing lotion for Calabar swelling
Note about
periodicity of larva
in blood:
The sheathed
microfilaria present in
blood only by day
(diurnal).
Diagnosis: Demonstration of microfilaria in blood. (adult in SC)

2-Onchocrca volvulus
• Common name Blinding worm
• Geog. Distrib. Africa, latin America,
• Length F: 33-50 cm, male 4 cm
• Vector:Black fly; genus Simulium.

• Site of infection: nodules in subcutaneous tissues
• Disease:Onchocrcosis, River blindness
• Symptoms:
• Pruritis, papule dermatitis with thickening, fibrous onchocercoma,
scaling & dryness of skin (lizard skin), SC nodules, ocular lesion leadsRiver blindness
to blindness.
• Treatment
Ivermectin against unsheathed microfilaria,
suramin (Bayer 205,antropyl) against adult, surgery
Diagnosis: Examination of
nodule aspirate, adult lives
in SC tissue, microfilaria in
SC fluid

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Parasitology

Nahda University, Faculty of Pharmacy

Lecture 7 Class: Nematode

Distribution: worldwide, Middle East and North Africa.

Habitat: Small intestine of man particularly jejunum, ileum

Infective stage: 3rd stage filariform larva.

Cutaneous phase: (Ground itch): Itching, Pruritus, Erythema,

Migratory (pulmonary phase): Fever, cough, hemoptysis,

Intestinal phase: anemia (due to sucking and loss of blood at

Mebendazole, Albendazole and Pyrantel pamoate.

• Habitat: Large intestine, mainly caecum.

- Male: female 20-35, male 15-30 mm

• Infective stage: Embryonated egg.

1. Light infection: no symptoms.

2. Heavy infection: Blood streaked diarrhea.

• Chronic dysentery, tenesmus and gastro-intestinal problems

(abdominal pain, dysentery, rectal prolapse, hypochromic

• Growth retardation from severe malnutrition in severe

3. Complication: Appendicitis, Peritonitis and Rectal prolapse.

Vector: •Mosquito (Culex sp. Or Anopheles sp.)

Infective stage: •motile microfilaria (has sheath)

Symptoms: •Inflammation of vessels, fibrosis, leading to obstruction,

3. Chronic - Elephantiasis, Chyluria, chylocele, Chylous

b) PCR for the detection of parasite’s DNA in blood

Anti-filarial therapy: a) Diethyl carbamazine (DEC) Hetrazan: microfilaricidal

Prophylaxis: a single dose of 50-200 mg DEC at monthly intervals is given in

• Diagnosis demonstration of microfilaria in blood (since adult wormlives in

Diagnosis: Demonstration of microfilaria in blood. (adult in SC)

• Vector:Black fly; genus Simulium.

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