Nina Ian John “G” Rachel Mark Jocelle Edo Gienah Jho Kath Aynz Je Glad Nickay Ricobear

Teacher Dadang Niňa Arlene Vivs Paulfie Rico Ren Mai Revs Mavis Jepay Yana Mayi Serge Hung Tope Ag Bien

S4 L2: NEMATODES I by Dr. Mary Antonette Madrid JJaannuuaarryy 1111,,22001111

*** Note: For consolidation purposes (naks!!), please refer to the table at the last 2 During migration:
pages. Intense na talaga tayo!  larvae may cause sensitization resulting in allergic manifestations
such as lung infiltration, asthmatic attacks and edema of lips
Ascaris lumbricoides symptoms similar to pneumonia may result due to penetration of lung
capillaries
GIANT ROUNDWORM Diagnosis
Most common intestinal nematode of man  finding ova in feces using the following techniques:
Occurs most frequently in the tropics
A soil-transmitted helminth (moist, shady soil) 1. DIRECT FECAL SMEAR (DFS)
Can cause varying degrees of pathology: 2 mg feces emulsified in a drop of NSS on a glass slide and
o Tissue reaction to invading larvae examined under LPO
o Intestinal irritation to the adult worms due to its 2. KATO TECHNIQUE OR CELLOPHANE THICK SMEAR
mechanical and toxic action METHOD
o Complications due to extraintestinal migration qualitative method; recommended for mass examination of
feces
Parasite Biology 3. KATO-KATZ TECHNIQUE
Has a polymyarian type of somatic muscle arrangement, in which (QUANTITATIVE)
cells are numerous and project well into the body cavity o modified Kato technique
Worms are large and whitish or pinkish, with smooth striated cuticles o amount of feces is measured in grams
Have a terminal mouth with 3 lips and sensory papillae o quantify number of eggs per gram (EPG)
Female: 22- 35 cm in length; contain paired reproductive organs in o determines egg reduction rate after treatment
posterior 2/3; lays 200, 000 eggs per day o determines intensity of Ascaris infection
Male: 10- 31 cm in length; has a ventrally curved posterior end with 2
spicules and a single long tortuous tubule Treatment
adults reside but do not attach to mucosa of small intestine Drug of Choice = ALBENDAZOLE
Alternative Drugs: Mebendazole; Pyrantel pamoate
INFERTILE OVUM
Ivermectin = as effective as albendazole if given at a dose of 20 micrograms/kg
longer and narrower than fertile single dose
eggs
has a thin shell and irregular Prevention and Control
 sanitation
mammilated coating filled with
 health education
refractile granules
 mass chemotherapy, done periodically

Life Cycle of Ascaris lumbricoides

FERTILE OVUM

has an outer, coarsely

mammilated albuminous covering
(may be absent or lost in
“decorticated” ovum)
has a thick transparent, hyaline
shell, immediately after the
albumin layer, and a
delicate vitelline, lipoidal, inner
membrane which is highly impermeable

INFECTIVE STAGE

 fully embryonated ovum

 when these eggs are ingested,
the larvae hatch in the lumen of
the small intestine and
penetrate the intestinal
walllarvae enter the
venulesgo to the liver
through the portal veinheart
and pulmonary vesselsbreak
out of the capillary
vesselsair sacsundergo motlingmigrate to larynx and
oropharnyxswallowed into digestive tract

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Adult worms live in the lumen of the small intestine. A female may produce Prevention and Control
approximately 200,000 eggs per day, which are passed with the feces . personal hygiene
Unfertilized eggs may be ingested but are not infective. Fertile eggs fingernails should be cut short
embryonate and become infective after 18 days to several weeks , frequent handwashing
depending on the environmental conditions (optimum: moist, warm, shaded
Life Cycle of Enterobius vermicularis
soil). After infective eggs are swallowed , the larvae hatch , invade the
intestinal mucosa, and are carried via the portal, then systemic circulation to the
lungs . The larvae mature further in the lungs (10 to 14 days), penetrate the
alveolar walls, ascend the bronchial tree to the throat, and are swallowed .
Upon reaching the small intestine, they d;evelop into adult worms .
Between 2 and 3 months are required from ingestion of the infective eggs ;to
oviposition by the adult female. ;Adult worms can live 1 to 2 years.

.Enterobius vermicularis

HUMAN PINWORM
causes ENTEROBIASIS or OXYURIASIS
characterized by perianal itching or pruritus ani
classified as “meromyarian” based on arrangement of somatic
muscles where there are 2 to 5 cells per dorsal or ventral half

Parasite Biology
adult worms have cuticular alar expansions at the anterior end
(cephalic alae used for migration) and a prominent posterior
esophageal bulb
Female: 8-13 mm x 0.4 mm and has a pointed tail; uteri of gravid
female are distended with eggs
Male: 2- 5 mm x 0.1 to 0.2 mm and has a curved tail and single
spicule; rarely seen, usually die after copulation

Rhabditiform larvae
Eggs are deposited on perianal folds . Self-infection occurs by transferring
has the esophageal bulb but has no cuticular expansion
infective eggs to the mouth with hands that have scratched the perianal area
Ovum . Person-to-person transmission can also occur through handling of
contaminated clothes or bed linens. Enterobiasis may also be acquired through
11, 105 eggs per day surfaces in the environment that are contaminated with pinworm eggs (e.g.,
asymmetrical, with one side curtains, carpeting). Some small number of eggs may become airborne and
flattened and the other side convex inhaled. These would be swallowed and follow the same development as
translucent shell consist of an
ingested eggs. Following ingestion of infective eggs, the larvae hatch in the
outer triple albuminous layer
covering for mechanical protection small intestine and the adults establish themselves in the colon . The
and an inner embryonic lipoidal time interval from ingestion of infective eggs to oviposition by the adult females
membrane for chemical protection is about one month. The life span of the adults is about two months. Gravid
resistant to disinfectants females migrate nocturnally outside the anus and oviposit while crawling on the
susceptible to dehydration in dry
skin of the perianal area . The larvae contained inside the eggs develop (the
air within a day
may remain viable for 13 days in moist conditions eggs become infective) in 4 to 6 hours under optimal conditions .
Retroinfection, or the migration of newly hatched larvae from the anal skin back
Clinical Manifestations into the rectum, may occur but the frequency with which this happens is
innocuous parasite unknown.
rarely produce serious lesions
mild catarrhal inflammation of intestinal mucosa Capillariasis philippinensis
migration of egg laying females to anus causes irritation of perianal
region Female: 2.3-3.2 mm Male: 2.5 – 4.3 mm
children affected may suffer from insomnia due to pruritus Currently considered a parasite of fish eating birds (natural definitive
easily spread within the family host)
Endemic in the Phil, Thailand
Diagnosis Rare cases: other Asian countries, Middle East, Colombia
GRAHAM’S SCOTCH ADHESIVE TAPE SWAB/ PERIANAL
CELLULOSE TAPE SWAB/ SCOTCH TAPE METHOD Clinical Features
Abdominal pain, diarrhea
Treament Protein losing enteropathy  cachexia and diarrhea
Drug of Choice = PYRANTEL PAMOATE
Alternative Drugs = Albendazole, Mebendazole

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  Smaller, 1mm
 Short and stout (i’m a little teapot? Hehehe )
 Double bulbed, muscular esophageal pharynx
Free living form (male)
 broadly fusiform tail pointed and curved ventrad

Clinical Features

Frequently asymptomatic
3 phases of Infection
Life Cycle of Capillaria philippinensis o invasion of skin  filariform
o migration of larvae thru the body
o penetration of intestinal mucosa by adult female worms
Light infection : no intestinal symptom
Moderate infection : diarrhea alternating with constipation
Heavy infection : intractable, painless intermittent diarrhea
(numerous, thin, watery bloody)
Complication : edema, emaciation, loss of appetite, anemia, lobar
pneumonia, malabsorption
Frequently asymptomatic
GIT symptoms : epigastric pain, diarrhea
Pulmonary symptoms : Loeffler’s syndrome pulmonary migration
of filariform larvae
Dermatology : urticarial rash in buttocks or waist area

Massive hyperinfection /Disseminated strongyloidiasis

immunosuppressed patient : Severe enterocolitis and widespread

dissemination to heart, lungs and CNS
abdominal pain, distention, shock, pulmonary and neurologic
complication; septicemia
Blood eosinophilia: acute/chronic stage ; (-) in dissemination

Life cycle of Strongyloidiasis stercoralis

Diagnosis
Stool exam
intestinal biopsy
eggs larva or adult worm

Capillaria philippinensis eggs:

Unembryonated eggs:
1. peanut shaped
2. measures 36-45 um x 21 um

Treatment
Mebendazole
Albendazole

Strongyloides stercoralis

Smallest of intestinal nematodes

Rural areas, institutional settings, lower socioeconomic group
Acquired thru: direct contact of skin with soil dwelling larvae;
ingestion of filariform contaminated food
Facultative parasite
Parasitic form (female)
 delicate filariform 2.2 mm
 esophagus: 1/3 or 2/5 of the anterior part of the body
 parthenogenetic
parasitic form (male)
 none
Free living form (female)

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Diagnosis Life cycle of Trichuris trichiura

Derived from S. stercoralis filariform larva

Antibody detection
Immunodiagnostic test : indicated when infection is suspected and
organism cannot be demonstrated by duodenal aspiration, string test
or stool exam
EIA : 90% sensitivity
(+) in immunocompromised with disseminated strongyloidiasis
Cross reaction with filariasis and some nematode infection
Ab levels decrease within 6 mos post treatment
Peptic-ulcer like pain associated with peripheral eosinophilia strongly
suggest diagnosis of strongyloidiasis

Laboratory tests

Microscopy: larvae ( rhabditiform, filariform)

Stool or duodenal fluid
Wet mounts: Baermann funnel technique
Harada Mori filter paper technique
Culture: agar plate
Enterotest string ; duodenal aspiration
Larva : sputum : patient with disseminated strongyloidiasis
Clinical features

Morphology Most frequently asymptomatic

Heavy Infection: GIT problem:
Parasitic of Filariform larvae o Abdominal pain, diarrhea, rectal prolapsed, growth retardation
o Long esophagus
o No constriction of the esophagus Diagnosis
o Long intestine
o Esophagus equal in length to the intestine Stool concentration methods to recover the eggs
o Longer and more slender than rhabditoid Moderate eosinophilia
o Nonsheathed Rectal mucosa: proctoscopy
Rhabditiform larva in wet mount after fixation in 10% formalin Trichuris eggs (wet prep)
Diagnostic characteristics:
Diagnostic characteristic : o Typical BARREL-shaped
o Length 200-250µm o 2 polar plugs that are
o Short buccal cavity unstained
o Prominent genital primordium o Size: 50-54 µm x 22-23 µm
o Rhabditiform esophagus clearly visible in the larva o The external layer of the shell
o Consists of a club shaped anterior portion, a post median constriction of the eggs is yellow brown in
and a posterior bulb contrast to clear polar plugs
o Eggs: unembryonated eggs
Treatment are when passed in the stool
Ivermectin
Albendazole Treatment
Mebendazole
Prevention Albendazole
Medical personnel caring for patients with hyperinfection syndromes
should wear gowns and gloves as stool, saliva, vomitus and body Hookworm
fluids may contain infectious filariform larvae
Patients who have resided in an endemic area should be examined Infect > 900 M
for presence of this parasite before and during steroid treatment or Moist warm cimate
immunosuppressive therapy
Local distribution: agricultural areas, rice fields, vegetable garden
Prevalence: 40-45%
Trichuris trichiura
Criteria Ancylostoma duodenale Necator americanus
Human WHIPWORM
Common Old world hookworm New world hookworm
Adult : 0.50 mm in length
name
Anterior 2/3 is thin and threadlike
Female 10-13 mm 9-11 mm
Posterior end is bulbous
Male 8-11 mm 7-9 mm
Tail: Male – Coiled; Female – straight
Transmission Oral:percutaneous Percutaneous
Tropical weather and poor sanitation practices
Temperature Eggs and developmental Sensitive to low temp
stages more tolerant of low
temp

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Factors that contribute to transmission o Determine species
Hookworm eggs on wet mount:
Suitable environment o Egg, advanced cleavage.
o Damp, sandy or friable soil with decaying vegetation T 24- (Iodine)
32° C
Mode and extent of fecal pollution of the soil unsanitary disposal of
human feces. Use of night soil for fertilizer Diagnostic characteristic:
Mode and extent of contact between infected soil and skin or mouth Size: 57-76 µm x 35-47 µm
Oval or ellipsoid shape
Clinical Features Thin shells
The embryo has begun cellular division and is at an early
Iron deficiency Anemia: Microcytic, hypochromic moderate or developmental stage – gastrula
heavy chronic infection. Blood loss at the site of intestinal attachment Hookworm rhabditiform larvae on
of adult worm with cardiac complication wet preparation
Blood eosinophilia: 30-60% Long buccal cavity
GIT, Nutritional, metabolic symptom, abdominal pain, steatorrhea, Small genital primordium
bloody/mucoid stools, edema, albuminuria Constriction of esophagus
Skin manifestation: ground itch/dew itch: penetration of filariform (L3) Larger than Strongyloides
larvae (+) itching, edema, erythema  papulovesicular eruption for 2 rhabditoid
weeks More attenuated posteriorly than
Respiratory symptom: pulmonary migration of larvae bronchitis or Strongyloides rhabditoid
pneumonitis Non-sheated
(+) minute hemorrhage with eosinophilic and leukocytic infiltration
Hookwork filariform larva (wet prep)
Life cycle of hookworm
Short esophagus
No constriction of the esophagus
Long intestine
Ratio:: esophagus: intestine: 1:4
Longer and more slender than
rhabditoid stage
(+) striations on the surface sheath

Adult worm:
o A. duodenale: anterior end depicted showing cutting teeth

o N. americanus: anterior end

depicted showing mouth
parts with cutting plates

Diagnosis
Treatment
Adults: pinkish white
Head often curved in a direction opposite that of the body Prioritize: pregnant women, children and patients with malnutrition,
Males: unique fan shaped copulatory bursa pulmonary TB and anemia
Oral cavity: Albendazole
o A. duodenale: 4 sharp toothlike structure Mebendazole
o N. americanus: dorsal and ventral cutting plates Pyrantel pamoate
DFS (Direct Fecal Smear): Correct anemia: Iron therapy
o Only when infection is heavy
o May not detect parasite in light infection (400 eggs/gm Prevention
feces)
Concentration methods: detect presence of egg Sanitary disposal of human feces
o Zinc sulfate centrifugal flotation Wear shoes, slippers, boots
o Formalin ether method
Health education:
Culture (Harada Mori)
o Personal, family and community hygiene

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 Treatment of affected individual
Mass chemotherapy when incidence >50%
Protection of susceptible individual
Natural food preservative substances:: salt, sugar, acetic acid, onion
garlic, mustard, pepper, spices: lethal to eggs and larvae

------------------------------------------end of trans-----------------------------------------------

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 CRITERIA Ascaris lumbricoides Trichuris trichura Enterobius vermicularis
Common name Giant intestinal roundworm/ eelworm Whipworm Pinworm/ seatworm
Habitat Upper end of the small intestine Large intestine Large intestine
Classification based on the presence or absence Phasmid Aphasmid Phasmid
of caudal chemoreceptors
Classification of adult female based on life Oviparous Oviparous Ovoviparous/ oviviparous
stages
Infective stage Embryonated egg Embryonated egg Embryonated egg
Mode of transmission Ingestion of fully embryonated egg Ingestion of fully embryonated egg Ingestion of fully embryonated egg`
Life cycle Egg embryonates on soil and larva undergoes lung Egg embryonates on soil but larval form do not Eggs do not embryonates on soil and larval form do
migration undergo lung migration not undergo lung migration
Pathogenesis Intestinal Ascariasis and Ascaris Pneumonitis Trichuriasis/ Whipworm Infection Enterobiasis/ Pinworn Infection
Larva can cause allergy, and eosinophilia. Generally, there are few or no symptoms but in the The main symptom is pruritus ani which is caused
Occasionally, ectopic larva are found in other cases of a very heavy infection, there may be local by female migration. Itching results in insomnia and
organs with local inflammation and necrosis. Adult inflammation with abdominal discomfort and restlessness. In some cases, gastrointestinal signs
worms can cause obstruction of the small intestine, diarrhea and in some cases, rectal prolapse. like pain, nausea and vomiting may develop
bile duct and trachea. Also, appendicitis and
pancreatitis. Children may vomit up a bolus of adult
worms! (eeeeew!!)
Laboratory diagnosis For intestinal ascariasis: Finding ova in the stool through: Ova are found in perianal and fingernail scrapings
 Direct fecal smear  Direct fecal smear
 Concentration technique  Concentration technique
 Kato-Thick smear  Kato-Thick smear
 Kato-Katz  Kato-Katz
For Ascaris pneumonitis:
 Rarely, embryos can be found in sputum
Ova/ egg Female adults produce 2 types of egg: Eggs measure 50-60 um x 20-30 um. Eggs are Egg measure 50-54 um x 23 um. Eggs are barrel/
ovoid with one side flattened. Shell is transparent football/ lemon/ lantern shaped with polar
Fertilized Unfertilized and with 2 layers and with a coiled occasionally prominences. Egg has a yellowish outer and a
- 45-70 um x 35- 50 um - 88- 94 um x 39-44 um motile embryo/ Lop sided or D shaped.
transparent inner shell. Commonly known as
- regularly ovoid with - irregularly ovoid with
Japanese Lantern ova. Eggs are more susceptible
thick shell thin shell
- cytoplasm contains - disorganized germ to desiccation than eggs of Ascaris
organized germ cells cells are coarsely
that are finely granular granular
- shell with 3 layers: - longer and narrower
outer mamillary coat, than fertilized egg
middle glycogen layers
and inner lipoidal
vitelline membrane
Adult worms Male or female adult worms are usually pink or Whitish. With cuticular alar expansion at the anterior Pinkish gray. Anterior 2/3 of the worm is slender,
white, both with terminal mouth provided with 3 lips end and a prominent esophageal bulb. Adult female giving it a whipworm appearance. Adult male is 30-
(trilobite lip). Males are 10-31 cm long with s curved is 3-8mm x 0.4mm long and with am pointed tail 45 mm and are slightly shorter than females. Long
posterior end. Females are 22-35 cm long. They end. Adult male is 2-5 mm x 0.1-2 mm. Has a
and with a coiled posterior end Adult female is 35-50
may superficially resemble an earthworm. curved tail.
mm long and it has a bluntly rounded posterior end.
Larva stimulate the morphology of adult worms

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 Criteria Hookworms Strongyloides stercoralis
Common name Ancylostoma duodenale- Old world Hookworm Threadworm
Necator americanus- new world hookworm
A. caninum- dog hookworm
A. braziliense- cat hookworm
Habitat Small intestine Small intestine
Classification based on the presence or Phasmid Phasmid
absence of caudal chemoreceptors
Classification of adult female based on life Oviparous Ovoviparous
stages
Infective stage Filariform larva Filariform larva
Mode of transmission Larval skin penetration Larval skin penetration
Life cycle Egg embryonates and hatch on soil, larva undergoes lung migration Undergo 3 different life cycles:
 Direct
 Indirect
 Autoinfection
Pathogenesis Hookworm infection (Ancylostomiasis/ Uncinariasis) Cochin china diarrhea/ Vietnam diarrhea/ Strongyloidiasis
 Skin at the site of entry: There is a general allergic reaction
known as ground itch In the direct cycle, this can cause local dermatitis. Local migration can cause localized
 Lungs during larval migration: localized pneumonitis and pneumonitis in the viscera and ectopic larva can sometimes be found in the brain and
eosinophilia may develop other viscera. There is a genral allergic reactions and eosinophilia. Adult worms can cause
 Small intestine which is the habitat of adult worms. Parasites start inflammation of the intestinal mucosa producing diarrhea and occasionally, pneumonitis
to ingest blood. There can be occult bleeding from intestinal
mucosa
Laboratory diagnosis Finding the characteristic egg in the feces through: Finding the motile rhabditiform larva rarely; the egg in feces through:
 Direct fecal smear  Concentration technique
 Concentration technique  Beale’s string test
 Serologic tests (ELISA)
Culture methods to identify the species
Larva can be found in feces and occasionally in the sputum
Ova All hookworm eggs are alike. Ovoid with thin hyaline transparent shell Eggs have thin clear shell and are similar to those of hookworms except that they measure
contains 2-8 germ cells only about 5-=58 um x 30-34 um. Commonly referred as Chinese :Lantern Ova
Rhabditiform Larva 250 um in length. Resembles those of Strongyloides but larger. With short buccal cavity and has a large genital primordium
Characterized by a long buccal cavity and has a small genital primordium
Filariform Larva 700 um in length. With short esophagus and with pointed tail. Sheathed. Long esophagus and with distinct cleft at the tip of the tail (notched tail end)
Adult worm Grayish white. Females are generally larger than males. A. duodenale is Free living male and female measures 1 mm x 0.06 mm, found in the soil. Smaller than
slightly larger than N. americanus. Anterior end has a buccal cavity with a filariform larva
dental pattern. N. americanus has semi lunar teeth. A. duodenale has two
pairs of buccal teeth. A. caninum has three pairs and A. braziliense has one Parasitic female measures 2.2 mm x 0.04 mm. colorless semi transparent with slender
pair. Male posterior end is expanded due to copulatory bursa. Female tapering anterior end and a short conical pointed tail. Has a short buccal cavity with 4
posterior end is pointed. In A. duodenale, head continues in the same indistinct lips.
direction as the curvature of the body. In N. americanus, head is curved
opposite to the curvature of the body which is like a hook at the anterior end. Parasitic male is indistinguishable from the free living ma,le since both measures 0.7 mm x
0.04 mm

Male worm is smaller than female

Source: CEU College of Medical Technology Parasitology Review Notes by Ma. Cristina Liwanag

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