PARASITOLOGY LECTURE 3 - Nematodes

Notes from lecture, Zeibig (97) and Murray (98)

USTMED 07 Sec C AsM
OUTLINE IN THE STUDY OF PARASITE
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.

Nomenclature and synonyms

Geographic distribution
Morphology
Life cycle
Pathology in the host
Clinical symptomatology
Laboratory diagnosis
Treatment
Preventive measures

III.

in the US frequency is greatest in the Appalachian

Mountains and surrounding areas in the east, west and
south
Morphology

Unfertilized Egg

GENERALITIES

decorticated unfertilized
egg

helminths are multicellular and contain internal organ

systems
nematodes are commonly known as the intestinal
roundworms

Morphology and Life Cycle Notes

members of the class nematoda may assume three basic

morphologic forms: egg, larvae, and adult worms
eggs vary in size and shape
the developing larvae located inside fertilized eggs
emerge and continue to mature; they are typically long
and slender
sexes are separate
the adult female worms are usually larger than the adult
males
the adults are equipped with complete digestive and
reproductive systems
life cycles of the nematodes are similar yet organism
specific
infection may be initiated in one of two primary ways:
1. ingestion of the infected eggs
2. by burrowing through the skin of the foot
the adult worms reside in the intestine where they
concentrate on obtaining nutrition and reproduction
adult females lay eggs in the intestine
eggs may be passed into the stool; once outside the
body, the larvae inside the eggs warm, moist soil and 2-4
weeks to mature

unfertilized egg
Fertilized Egg

Laboratory Diagnosis
-

through recovery of eggs, larvae and occasional adult

worms
the specimens of choice vary by species and include
cellophane tape preparations taken around the anal
opening, stool, tissue biopsies and infected skin ulcers
ELISA is available for the diagnosis of select nematode
organisms

very corticated mature egg

mature egg

Pathogenesis and Clinical Symptoms

the following factors may contribute to the ultimate

severity of a nematode infection
1. the number of worms present
2. the length of time the infection persists
3. overall health of the host
with one exception, all of the nematodes may cause
intestinal infection symptoms at some point during their
invasion of the host
symptoms include: abdominal pain, diarrhea, nausea,
vomiting, fever and eosinophilia
other symptoms: skin irritation, formation of blisters,
muscle involvement

corticated mature egg

Adults

ASCARIS LUMBRICOIDES
I.

II.

Nomenclature and synonyms

Ascaris lumbricoides (askar-is/lum-bri-koydeez)
Common
names:
Large
Intestinal
Roundworm,
Roundworm of Man
Geographic distribution
most common intestinal helminth infection in the world
susceptible are warm climates and areas of poor
sanitations

adult male


VI.

adult female
IV.
Life cycle

1.
2.

infection begins following the ingestion of

infected eggs that contain viable larvae
inside the small intestine the larvae emerge
from the eggs

accompanied by eosinophilia and O2 desaturation

a tangled bolus of worms in the intestines may cause
obstruction, perforation and occlusion of the appendix
Clinical symptomatology
Asymptomatic : patients infected with a small number
of worms (5-10) will often remain asymptomatic
Ascaris/Roundwrom infection : patients who develop
symptomatic ascariasis may be infected with as few as a
single worm
o
Intestinal phase

VII.

VIII.

3.

the larvae complete a liver-lung migration by

first entering the blood via penetration
through the intestinal wall
4. first stop is the liver
5. continues through the blood stream to second
stop, the lung
6. once inside the lung, the larvae burrow their
way through capillaries into the alveoli
7. migration to bronchioles
8. larvae are transferred through coughing into
the pharynx
9. are swallowed and returned to the intestines
adult worms take up residence in the small intestine
adults multiply and a number of resulting undeveloped
eggs (up to 250,000/day) are passed in the feces
soil provides the necessary conditions for the eggs to
embryonate
infective eggs remain viable for years
eggs are not easily destroyed by chemicals

Infective stage: embryonated eggs

V.

Pathology in the host

a worm can migrate into the bile duct and liver and
damage tissue
because the worm has a tough, flexible body, it can
occasionally perforate the intestine, creating peritonitis
with secondary bacterial infection
the adult worms do not attach to the intestinal mucosa
but depend on constant motion to maintain their
position w/in the bowel lumen
migration of worms to the lungs can produce
pneumonitis resembling an asthmatic attack
migration can occur in response to fever, drugs other
than those used to treat ascariasis and some anesthetics
pulmonary involvement is related to the degree of
hypersensitivity induced by previous infections and the
intensity of the current exposure and may be

IX.

may
produce
tissue
damage;
secondary bacterial infection may
occur following worm perforation

Px infected w/ many worms may

exhibit vague abdominal pain,
vomiting, fever and distention

Discomfort from adult worms exiting

the body through anus, mouth or
nose may occur

Protein malnutrition
Pulmonary phase

Low-grade fever

Cough

Eosinophilia

Pneumonia

Asthmatic reaction

Laboratory diagnosis
specimen of choice for the recovery of Ascaris
lumbricoides eggs is stool
adult worms may be recovered in several specimen
types, depending on the severity of infection, including
the small intestine, gall bladder, liver and appendix
adult worms may be present in stool, womited, or
removed from external nares
ELISA is also available
Treatment
several medications:
o
mebendazole
o
pyrantel pamoate
o
levamisole
o
peperazine citrate
intestinal tract obstruction
o
combo of drug therapy
suction, or surgery
pulmonary discomfort
o
corticosteroids

and

nasogastric

Preventive measures
Avoidance of using human feces as fertilizer
Proper sanitation and personal hygiene

HOOKWORM
NECATOR AMERICANUS/ANCYLOSTOMA DUODENALE
GENERALITIES
hookworm refers to Necator americanus and
Ancyclostoma duodenale

2 primary differences between the two organisms

o
geographic distribution
o
adult worms of each have minor morphologic
differences
o
eggs, larvae stages are indistinguishable
I.

Nomenclature and synonyms

Necator americanus (ne-kaytur/ahmerri-kaynus)
Common name: New World Hookworm
Ancylostoma duodenale (ansilostuhmuh/dewo-denaylee)
Common name: Old World Hookworm

II.

Hookworm filariform larva

Geographic distribution/Epidemiology

III.

nearly of the world population is infected w/

hookworm
frequency of hookworm is high in warm areas where the
inhabitants practice poor sanitation practices
mixed infections w/ any combo of hookworm, Trichuris
and Ascaris is possible because all organisms require the
same soil conditions
Necator is primarily found in North and South America
o
Also exist in China, India and Africa

Adults

Ancylostoma is a parasite of the Old World

o
Found in Europe, China, Africa, South America
and Caribbean
Morphology

Eggs

Necator americanus adult male

Hookworm egg
400x

Necator americanus buccal capsule

Hookworm egg
Rhabditiform Larvae

Ancyclostoma duodenale adult female

IV.

Life cycle

Hookworm rhabditiform larva

Hookworm rhabditiform larva 400x close up of buccal cavity

Filariform Larvae

short esophagus

1.
Pointed tail

humans contract hookworm when third-stage

filariform larvae penetrate through the skin,
particularly into areas such as unprotected
feet

2.

inside the body, the filariform larvae migrate

to the lymphatics and blood system
3. blood carries the larvae to the lungs where
they penetrate capillaries and enter alveoli
4. migration of larvae continues into the
bronchioles where they are coughed into the
pharynx, swallowed and deposited into the
intestines
maturation occurs in the intestine
adults live and multiply in the S.I.
females lay 10,000 to 20,000 eggs per day
eggs are passed into the outside environment via feces
first-stage rhabditiform larvae emerge from eggs w/in
24-48 hrs in warm, moist soil
larvae continue to develop by molting two times

Infective stage: third-stage filariform larvae

V.

VI.

VII.

VIII.

IX.

for asymptomatic infections : iron replacement and/or

other dietary therapy (proteins, iron, vitamins)
Preventive measures
similar to those of Ascaris
proper sanitation, fecal disposal
prompt treatment
personal protection

STRONGYLOIDES STERCORALIS
I.

Pathology in the host

human phase of hookworm life cycle is initiated when a
filariform (infective form) larva penetrates intact skin
egg laying is initiated 4 to 8 weeks after the initial
exposure and can persist for 5 years
on contact w/ soil, the rhabditiform (noninfective) larva
are released from the eggs
the rhabditiform larva develop into filariform w/in 2
weeks
both species have mouthparts designed for sucking blood
from injured intestinal tissue
A. duodenale has chitinous teeth

drugs of choice : mebendazole or pyrantel pamoate

Nomenclature and synonyms

Strongyloides stercoralis (stronji-loydeez/sturkorraylis)
Common name: Threadworm

II.

Geographic distribution

III.

found predominantly in tropics and subtropics

Morphology

Eggs

N. americanus has shearing chitinous plates

Clinical symptomatology
Rhabditiform Larvae
Asymptomatic Hookworm infection: does not exhibit
clinical symptoms
Hookworm
Disease/Ancylostomiasis/Necatoriasis
:
patients who are repeatedly infected may develop
intense allergic itching at the site of hookworm
penetration known as ground itch; other symptoms:

Sore throat

Bloody sputum

Wheezing

Headache

Mild pneumonia w/ cough

o
Intestinal phase

Symptoms depend on # of worms

present

Chronic infections (light worm

burden ~500 eggs/g feces)

Vague mild GI symptoms

Slight anemia

Weight loss or weakness

Acute infections (greater than 5000

eggs/g feces)

Diarrhea

Anorexia

Edema

Pain

Enteritis

Epigastric discomfort

Patients may develop a

microcytic
hypochromic
iron deficiency

Weakness

Hypoproteinemia

Mortality due to blood loss

rhabditiform larva 400x

Strongyloides stercoralis rhabditiform larva

Strongyloides
stercoralis
rhabditiform larva, close-up of
anterior end showing a typical
short buccal cavity
Filariform Larvae

Laboratory diagnosis
primary means is by recovery of the eggs in stool
samples
larvae may mature and hatch from the eggs in stool that
has been allowed to sit at room temperature w/o
additive fixatives
recovery and examination of the buccal capsule is
necessary to determine the specific hookworm organism
reverse enzyme immunoassay for specific IgE
Treatment

Strongyloides stercoralis filariform larva

Adult

3.

IV.

can

be

Life cycle
unlike in the hookworm life cycle, where eggs are the
primary morphologic form seen in feces, in the
threadworm life cycle rhabditiform larvae are usually
passed in the feces
eggs are only occasionally found
the rhabditiform larvae develop directly into the thirdstage infective filariform larvae (in soil)
remaining phases of the threadworm life cycle mimic
those of the hookworm
there are 3 possible routes threadworms may take in
their life cycles:
o

direct

intestines and cause autoinfection

a free-living, nonparasitic cycle
established outside the human host

a skin-penetrating larvae enters the

circulation
and
follows
the
pulmonary course
adults develop in the small intestine
adult females burrow into the
mucosa of the duodenum, and
reproduce parthogenetically
@ female produces about 1 dozen
eggs/day
eggs hatch w/in the mucosa and
releaserhabditiform larvae into the
lumen of the bowel
rhabditiform
larvae
are
distinguished from hookworms by:

short buccal capsule

large genital primordium

rhabditiform larvae are passed into
the stool and may either:

develop into filariform and

continue the direct cycle

develop into free-living

adult worms and initiate
indirect cycle

indirect

Rhabditiform larvae are passed into

the outside environment (soil) and
mature into free-living adults that
are nonparasitic

Adult females produce eggs that

develop into the rhabditiform larvae

Larvae mature and transform into

the filariform at w/c time they may
either initiate a new indirect cycle
or become infective

Several
generations
of
this
nonparasitic existence may occur
before new larvae become skinpenetrating
Autoinfection

Occurs when the rhabditiform larvae

develop into the filariform stage
inside the intestine of the host

Penetrate the intestinal or perianal

skin and follow the course through
the circulation and pulmonary
structures-coughed-swallowed
(become adults)

The larvae may then enter the

lymphatics or blood stream

Persist for years and can lead to

hyperinfection and massive or
disseminated, fatal infection

S. stercoralis differs from the life cycle of hookworms in

three aspects:
1. eggs hatch into larvae in the intestine before
they are passed in feces
2. larvae can mature into filariform in the

V.

VI.

Pathology in the host

Heavy worm loads may involve the biliary and
pancreatic ducts, the entire small bowel and colon
o
Causes inflammation and ulceration leading to
epigastric pain and tenderness, vomiting,
diarrhea and malabsorption
Symptoms mimicking peptic ulcer disease coupled w/
peripheral eosinophilia
Individuals w/ chronic strongyloidiasis are at risk of
developing severe, life-threatening hyperinfection
syndrome if the host-parasite balance is disturbed by
any drug or illness that compromises the immune status
Hyperinfection syndrome:
o
Seen in individuals immunocompromised by
malignancies
and
those
undergoing
corticosteroid therapy
o
Also observed in Px who have undergone solid
organ transplantation and in malnourished
people
o
Intestinal symptoms: diarrhea, malabsorption,
and electrolyte abnormalities
o
Fatal
complications:
bacterial
sepsis,
meningitis, peritonitis and endocarditis
Loss of cellular immune function may be associated w/
the conversion of rhabditiform larvae to filariform
larvae, followed by dissemination of the larvae via the
circulation to virtually any organ
Extraintestinal infection involves the lung and includes
bronchospasm, diffuse infiltrates and cavitation
Widespread dissemination that involves the abdominal
lymph nodes, liver, spleen, kidneys, pancreas, thyroid,
heart, brain and meninges
Clinical symptomatology
Asymptomatic: patients infected w/ only a light
infection often remain asymptomatic
o
Usually seen in intestinal infections
Strongyloidiases/Threadworm infection:
o
Most common symptoms include diarrhea and
abdominal pain
o
Also exhibit urticaria accompanied by
eosinophilia
o
Additional intestinal symptoms may occur such
as vomiting, constipation, weight loss, and
variable anemia
o Malabsorption syndrome for Px w/ heavy
infection
o
Site of larvae penetration may become itchy
and red
o
Recurring allergic reactions
o
When larvae migrate to the lungs, Px may
develop pulmonary symptoms

o
o

Pneumonitis from migrating larvae

Immunocompromised persons

Severe autoinfections lead to spread

of larvae throughout the body

Increased
secondary
bacterial
infections

VII.

VIII.

IX.

Death

Laboratory diagnosis
diagnostic eggs, often indistinguishable from those of
hookworm, may be present in stool samples from
patients suffering from severe diarrhea
stool concentration with zinc sulfate has successfully
recovered these eggs
rhabditiform larvae may be recovered in fresh stool
samples and duodenal aspirates
careful screening of feces is necessary to differentiated
rhabditiform larvae of hookworm from Strongyloides
Enterotest and ELISA
Sputum samples have yielded Strongyloides larvae in
patients suffering from disseminated disease
Treatment
Thiabendazole although not always successful
Alternative medications include: albendazole
ivermectin

and

Preventive measures
same as hookworm
proper handling and disposal of fecal material and
adequate protection of the skin from contaminated soil

GNATHOSTOMA SPINEGERUM (SPINIGERUM)

* cant find any chapter or topic that discusses this parasite.

The closest was in

reference to the Copepods of the phylum Arthropoda

GENERALITIES

The arthropods are the largest of the animal phyla

Phylum Arthropoda comprises invertebrate animals w/ a

segmented body, several pairs of jointed appendages,
bilateral symmetry, and a rigid, chitinous exoskeleton
that is molted periodically as the animal grows

Arthropods develop from eg to adult by a process known

as metamorphosis

They pass through several distinct morphological stages

including egg, larvae, pupa and adult

5 important classes
o
Chilopoda
o
Pentastomida
o
Crustacea

Copepods

Decapods (crabs, crayfish)

o
Arachnida
o
Insecta
Copepods

are small, simple aquatic organisms

lack a carapace, have one pair of maxillae, and have 5

pairs of biramous swimming legs
are intermediate host in the life cycle of several human
parasites including:
o
Dracunculus medinensis
o
Diphyllobothrium latum
o Gnathostoma spinigerum
o
Spirometra species
Epidemiology
o
Worldwide distribution
o
Serve as intermediate hosts for helminthic
diseases in the US and Canada
o
Human infections result from ingesting water
contaminated with copepods or from eating
the raw or insufficiently cooked flesh of
infected fish

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