The Intestinal

Nematodes
Ascaris lumbricoides
Common name: Giant intestinal round worm
Disease: Human ascariasis
Morphology
 It is the largest and the most common
nematode in man.
 15-30 cm by 3 mm (male).
 20-45 cm by 5 mm (female).
 Creamy white or pinkish worm.
 Cylindrical, elongated, tapering gradually at
the anterior end.
Ascaris lumbricoides adult male and female © Dr Peter Darben, Queensland
University of Technology clinical parasitology collection. Used with
permission
Diagnostic Features
 Smooth finely striated cuticle with faint
longitudinal white lateral lines. Which is
seen as a whitish streak along the entire
length of the body.
 Terminal mouth with trilobate lips and a
small triangular buccal cavity
An adult Ascaris worm. Diagnostic characteristics: tapered ends; length 15-35 cm (the females
tend to be the larger ones). This worm is a female, as evidenced by the size and genital girdle (the
dark circular groove at bottom area of image). Worm passed by a female child in Florida. CDC

DPDx Parasite Image Library

 The male has a ventrally curved papillated
posterior extremity with 2 copulatory
spicules.
 The female has paired reproductive organs
on the posterior 2/3.
 And in the anterior and middle third is a
depression wherein a vagina is located.
Ova
 There are two types of ova:
 Fertilized: broadly ovoid, golden brown in
color.
 A. vitelline membrane: an inner non-permeable,
lipoidal layer.
 B. glycogen membrane: thick, transparent middle
layer.
 C. Albuminous/ mammillary coat: outermost layer.
A fertilized Ascaris egg, still at the unicellular stage, as they are when passed in stool.
Eggs are normally at this stage when passed in the stool (Complete development of the

larva requires 18 days under favorable conditions).

Eggs, unfertilized (left) and fertilized (right). Patient seen in Haiti. CDC

DPDx Parasite Image Library

 Unfertilized: generally larger and longer,
elongated or sometimes irregular in shape.
 With 2 layers, relatively thinner glycogen
membrane and irregular coating of
albuminous layer.
 The vitilline layer is absent.
 If mammilary coat is absent it is called
decorticated.
Larva hatching from an egg. CDC
DPDx Parasite Image Library
Life cycle
 Fertilized ovasoil 2 weeksembryonation ingestedcirculationheart
and lungsesophagusSI
Pathology
 A. Larval Migration to lungs can produce:
 Pneumonitis resembling asthmatic attack accompanied
by marked eosinophilia (ascaris pneumonitis of loeffler’s
syndrome).
Clinical manifestations:
Asthmatic type of respiration, cough, urticaria,
rash, edema of the lips and eosinophilia.
Ascaris lumbricoides larva in section of lung (H&E) © Dr Peter Darben,
Queensland University of Technology clinical parasitology collection. Used
with permission
 B. Pathology due to Adult Worm.
 Abdominal pain, diarrhea, nausea, loss of
appetite.
 Serious and sometimes fatal effects due to
erratic migration of adult worms. They maybe
regurgitated and vomited and may escape
through the nostrils.
 Intestinal obstruction.
 Ascaris may pass the larynx and may lead
to suffocation.
 Or they may reach the lungs and produce
pulmonary gangrene or may pass the
uestachian tube and provoke otitis media.
 They may invade the bile duct (obstruction),
gall bladder, liver and appendix.
Diagnosis
 Diagnosis is made by finding the eggs in
the feces, fertilized or unfertilized by
performing DFS, kato-thick, kato-katz or
concentration technique.
 Stool examination may give negative findings
in the following conditions:
 When the patient is actually free from Ascaris
infection.
 Worms are still immature in the lumen.
 During larval migration
 When only male worms are present in the intestine.
Treatment
 Piperazine citrate, pyrantel pamoate,
mebendazole, albendazole, levimazole.
 Piperazine and pyrantel pamoate are used
these days because these drugs have a
neuromuscular blocking effect on the
parasite causing paralysis.
  Toxocara canis and Toxocara catti
 Common name: Dog ascaris and Cat ascaris
 Disease: toxocariasis/visceral larval migrans
Life cycle
Pathology
 Larval migrans can produce hemorrhage,
necrosis and granuloma of the site.
 Eosinophilia, liver damage, pulmonary
inflammation, and ocular problems has
been observed.
 Among children anemia with high WBC
count.
Diagnosis
 Diagnosis is usually established on clinical
grounds.
 Examination of egg in the stool of the
patient is not useful because the egg laying
adults are not present.
 However, examination of fecal material from
infected pets often supports the diagnosis.
Treatment
 Because the clinical course of VLM is so
variable, it is very difficult to evaluate
efficacy of any treatment. Since the
infection is self limited. Only severe cases
needs to be treated. Thiabendazole
appears to shorten the course of the
disease.
Eggs of Toxocara canis. These eggs are passed in dog feces, especially puppies' feces.
Humans do not produce or excrete eggs, and therefore eggs are not a diagnostic finding
in human toxocariasis! The egg to the left is fertilized but not yet embryonated, while
the egg to the right contains a well developed larva. The latter egg would be infective if
ingested by a human (frequently, a child). CDC DPDx Parasite
Toxocara canis (Dog Roundworm) egg, embryonated © Dr Peter Darben,
Queensland University of Technology clinical parasitology collection. Used
with permission
  Trichuris trichiura
 Common name: whipworm
 Disease: Trichuriasis
Morphology
Adult

 They attach to the cell wall of the cecum.
 Colored or pinkish, the anterior end is attenuated, whip-like,
while the posterior end is more robust.
 3.5-5 cm ( female) straight post. End
 3-4.5 cm ( male) coiled 3600 with a sheathed single spicule.
Trichuris trichiura adult male and female © Dr Peter Darben, Queensland
University of Technology clinical parasitology collection. Used with
permission
Ova
 barrel shaped/lemon shaped/football
shaped or Japanese lantern shape.
 With a prominent bipolar plugs on both
ends.
 The shell is thick and composed of three
layers. With a yellowish outer and a
transparent inner layer.
Egg of Trichuris trichuria as seen on wet mount. The diagnostic characteristics are: a
typical barrel shape two polar plugs, that are unstained size: 50-54 µm by 22-23 µm.
The external layer of the shell of the egg is yellow-brown (in contrast to the clear polar
plugs). The egg is unembryonated, as eggs are when passed with the stool. CDC

DPDx Parasite Image Library

Life cycle
 Eggssoil 3 weeksembryonationingestedlarvaececum
Pathology
 Small blood streaked diarrheic stool
 Abdominal pain
 Nausea, vomitting
 Anemia (hypochromic)
 Weight loss
 Rectal prolapse
Diagnosis
 DFS, kato-thick, kato-katz, concentration
technique
Treatment
 Abendazole, mebendazole, pyrantel
pamoate
Hookworms
 A. Necator americanus
 Common name: new world hookworm, american hookworm
 Disease: necatoriasis, uncinariasis, tropical anemia,
“laziness”
 B. Ancylostoma duodenale
 Common name: old world hookworm
 Disease: ancylostomiasis, miner’s anemia
  C. Ancylostoma braziliense
Common name: cat hookworm
 Disease: cutaneous larva migrans, creeping eruption

 D. Ancylostoma caninum
Common name: dog hookworm
 Disease: cutaneous larva migrans, creeping eruption
 Necator americanus is small and has a
tendency to go against the general body
curvature, hence a hook is formed (S
shaped)
 The buccal capsule is provided with a semi-
lunar cutting plates.
 They are also provided with long cephalic or
amphidial gland that secretes a potent
anticoagulant and promotes the flow of
blood.
 The bursa copulatrix is longer than broad
with a bidigitate or a bipartite dorsal ray with
long slender copulatory spicules that are
fused at the tip to form a delicate barb.
Morphology
 Ancylostoma duodenale: contour tends to
follow the general body curvature of the
body hence looks like letter C.
 Large buccal capsule, equipped with two
pairs of ventral teeth.
 The male worms have a fan like organelle
at the posterior portion known as copulatory
bursa/bursa copulatrix which is short and
broad with tripartite or tridigitate dorsal ray
with a pair of simple, long, bristle like
copulatory spicule, plain and free at the tip.
 Ancylostoma braziliense one of the smaller
species of hookworm with a pair of large
teeth and a pair of inconspicuous median
teeth in buccal capsule.
 The bursa copulatrix is almost as broad as
long and is supported by short lateral rays.
 Ancylostoma caninum is common parasite
of dogs. They have a wide buccal capsule
bearing three pairs of ventral teeth. The
cephalic or amphidial gland of the worm
secretes anticoagulant that delays
coagulation of blood. Long moderately
slender rays supports the male bursa.
Life cycle
 Eggssoillarva hatchesrhabditiform(with open mouth/feeding
stage)filariform(longer, with close mouth, non-feeding stage and
with protective sheath)skincirculationheart and
lungesophagusSI
Ova
 Hookworm egg provided with a very thin
egg shell ( with germ cell in the process of
segementation 2-8 cell stages)
Hookworm eggs examined on wet mount (eggs of Ancylostoma duodenale
and Necator americanus cannot be distinguished morphologically).
Hookworm filariform larvae © Dr Peter Darben, Queensland University of
Technology clinical parasitology collection. Used with permission
Necator americanus adult male, posterior end ©
Dr Peter Darben, Queensland University of Technology clinical
parasitology collection. Used with permission
Dental Pattern

 N. americanus 0
 A. braziliense 1
 A. caninum 3
 A. duodenum 2
 N.americanus A.
duodenale
 Dorsal Ray bidigitate tridigitate
 (bipartite) (tripartite)
 Copulatory ends with simple, bristle like,
spicules a barb plain and free at the tip

A.braziliense A. caninum
 Copulatory broad as long long moderately slender rays
spicules
Pathology
 Ground itch/ dew itch
percutaneous entry of the infective
filariform larvae often characterized by
itching sensation or dermatitis. It is often
severe and also known as ground itch or
dew itch.
 Pulmonary lesion/wakana disease
is caused by passive pulmonary migration
of larval stages of hookworm. Symptoms
may be similar to ascaris pneumonitis.
Creeping eruption/ cutaneous larva migrans
the infective laval stage can enter human
skin but cannot pass below stratum
germinativum producing serpiginous tunnel
in this stratum. Common among larvae that
do not normally infect human such as A.
braziliense and A. caninum.
 Hookworm anemia
 Adult worm suck the host’s blood and
mucosal substances.
 Microcytic hyopochromic anemia
 May cause hemorrhage to intestinal worm
 Hypoalbuminemia
 due to combined loss of blood, lymph and
protein.
Treatment
 Albendazole, mebendazole, flubendazole
 Thiabendazole –topical or systemic is
successful for creeping eruption
 Iron therapy for anemia
  Strongyloides stercoralis
 Common name: threadworm
 Disease : strongyloidosis, cochin china diarrhea
 Strongyloides stercoralis : known for its
extra ordinary conditions, it is capable of
both free living and parasitic existence.
People are the principal host but dogs and
monkeys have similar parasite.
Morphology
 Adult:
 Small, semi-transparent, with finely striated
cuticle.
 Male: cylindrical in shape, tail is pointed and
curved.
 Female: stouter than male, ovoviviparous
(they lay eggs containing larvae which are
immediately hatched out (parthenogenetic)
requiring no male to fertilize the eggs.
Ova
 The paired uteri of the adult female ova
contain single file of thin shelled
transparent, partially embryonated eggss
resembling “chinese lantern”.
 These eggs are seldom seen on feces.
Larvae
 Rhabditiform: short buccal cavity, elongated
esophagus with pyriform posterior bulb and
conspicuous genital primordium. Seen in
feces.

 Filariform: long delicate larva with long

esophagus and forked notched tail.
Broncho alveolar Strogyloides stercoralis larva
Life cycle
 Direct
 SIeggs in intestinal mucosa
rhabditiformfilarifom(soil)skin blood
streamheartlung esophagus
 Indirect
 SIeggs in intestinal
mucosarhabditiform(soil)(free living
adults)rhabditiform(repeat free
living)/filariform(or become infective)
 Autoinfection
 SIeggs in intestinerhabditiform
transformed into filariform penetrates
intestinal mucosa blood
streamheartlungesophagus
Pathology
 Often light and unnoticed
 Cutaneous infection: pruritus and erythema at
the site of penetration causing larva currens
(racing larva)
 Pulmonary infection: pneumonitis may develop
as a result of larval migration to lungs.
 Intestinal infection
Treatment

Albendazole and thiobendazole

  Capillaria philippinensis
 Common name: Pudoc worm
 Disease: Intestinal capillariasis, Pudoc’s disease
Morphology
 Adult:
 Very tiny worms the male measures 2.13 to
3.17mm with extraordinary long, smooth
spicular sheath.
 The female 2.5-4.3mm, the anterior portion
contains esophagus (stichosoma), the
posterior contains intestine and
reproductive organs:
Female Capillaria
 Typical (oviparous): 8-10 eggs in uterus,
arranged in single row. Gives rise to a
typical capillaria egg.
 Atypical (larviparous): 40-45 eggs in uterus,
arranged in 2-3 rows; hatch while still in
uterus
Ova
 Typical capillaria egg: yellow in color,
moderately thick with striated egg shell and
flattened bipolar plugs. Characteristically
with indentation in the middle thus appear to
be peanut shaped.
 Atypical : thin shelled without bipolar plugs
and multi-segmented or embryonated. This
eggs hatch while still in utero into 1st stage
larva.
Life cycle
 SI eggs laid by typical female
embryonation in water 3-5 days ingested
by fresh water fish man ingest raw fish
with larva
Pathology
 Persistent diarrhea and dehydration, rapid
weight loss, abdominal pain, gurgling of the
stomach (borborygmus), muscle wasting,
anorexia, vomiting and edema.
 Malabsorption of fats and sugar
 Low K, Ca, carotene and TP
 Hypotension and cardiac failure may develop
and lead to death.
Diagnosis

 DFS, conc. Technique, AECT,

Treatment

 Mebendazole and abendazole

 Enterobius vermicularis
 Common name: seatworm/pinworm
 Disease: enterobiasis/oxyuriasis
Morphology
 Adult:
 Small whitish or brownish in color, the male
measures 2-5 mm, the posterior end is
strongly curved and single copulatory
spicule is present.
 The female measures 8-13mm with long
pointed end.
 The diagnostic features of adult enterobius
are:
 1. a pair of lateral cuticular wing like
expansion at the anterior end known as
cephalic alae.
 2. adistinct prominent esophageal bulb.
Ova
 Elongated wherein the ventral side is
flattened thus the appearance similar to
letter D, lopsided in appearance.
 The eggs are usually embryonated when
laid and mature within 6 hours after
oviposition of gravid female and these are
already infective.
Life cycle
 LIfemale migrates to perianal region
deposit ebryonated eggigested or
inhaledlarva hatch in duodenum
migrate to LI
Pathology
 Insomnia, grinding of teeth
 Appendicitis, vulvovaginitis
The most common modes of transmission are
 Hand to mouth
 Inhallation or airborne eggs from dust
 autoinfection
Diagnosis
 Graham scotch tape anal swab technique
 DFS
Treatment
 Abendazole, mebendazole, pyrantel
pamoate
 fin