INTESTINAL PARASITE

Helminths

Trematoda Heterophyes heterophyes (intestinal fluke) Diphylobothrium latum (broad/ fish tapeworm) Lake area of central Europe, central Africa, North America, Far East *not in Egypt D.F : small intestine of man Reservoir : fish eating mammals(cat, dogs, bears 10 meters /> *3000-4000 segments Elongate (length: 1mm) spoon shape, 2 longitudinal bothria/groove + Broader than long Mid ventral genital pore 4mm (L) X 12 mm (B) Testis : multiple, dorsolateral Vas deferens>seminal vesicle Cirrus, ootype, vagina: open in common genital pore Bilobed ovary (posterior) Tenia saginata (beef tapeworm) Cosmopolitan Ethiopia, Mexico, South America, East & West Africa D.F : small intestine of man (the only) *scolex attached to mucosa, the rest folded 4-10 meters (usually 5)

Cestoda Tenia Solium (pork tapeworm) Cosmopolitan *rare in Islamic country Hymenolypis nana (dwarf tapeworm) Cosmopolitan *more in warm climates

Geograpgical distribution

Egypt & Far East

Habitat

Size

D.F : small intestine of man reservoir : cats, dogs, fish eating birds Length : 1.5-3 mm Breadth : 0.5 mm -

Small intestine of man

Small intestine of man

3-8 meters *1000 segments Globular Rostellum armed Double row of hooks 4 suckers(cikgu ckp) +

Scolex

*1000-2000 proglottids Quadrate (diameter: 2mm Unarmed 4 strong hemispherical suckers + (thin neck) Broader than long

Length : 20-60 mm Breadth : 1 mm *100 segments Rhomboidal Short rostellum armed 20-30 spines in single row 4 suckers + (long & slender)

neck Mature segments

300-400 testis

150 testis

3 globular testis (in one line)

Vagina with terminal sphinter Bilobed ovary Trilobed ovary One small lobe ovary

Gravid segments

Vitelline glands (ventrolateral) Uterus: coiled rossete shape Open in uterine pore below common genital pore Same as mature segment *egg continuously discharged from uterine pore Uterus : darker, more coiled, rossete shape, pack with egg

Vitelline glands Blind tubular uterus Uterus : middle part of segment

Elongate & rectangular 2X7mm (L X B) Lateral side branch of uterus : 15-20 Lateral side branch of uterus : 7-13

Sac like uterus with 80100 eggs *segment usually rupture liberating egg in intestine

Eggs

Pass in faeces Immature, ovoid, operculated Yellowish brown 65x45mic Must reach fresh water to mature

Intermediate host

Infective stage Mode of infection

1st : Pirenella conica (Rt. Handed snail 2nd : Mugil cephalus (Boury) & Tilapia nilotica (Bolty) Encysted metacercariae Eating imperfectly cooked fish/ undersalted fish(sweet fessikh-salted <7days)

1st : Cyclops / diaptomus (crustacean copepod) 2nd : fresh water fish (perch, salmon, trout) Plerocercoid larvae Eating raw / insufficiently cooked flesh / fish

Usually detached singly from parent worm> very active-creep out of anus even without defecate Cannot differ from other Indistinguishable from tenia T.saginata Mature, spherical 30-42mic *Thin hyaline capsule shed after leave proglottid *Thick brown striated embryophore surround hexacanth embryo/oncosphere Pigs Man causing cysticercosis

Oval/spherical Colorless 40mic diameter 2 thin shell Inner shell:embryophore has 2 knob at opp. Sidearise 4-8 filaments Inside embryophore: hexacanth embryo

Cysticercus bovis Ingesting infected meat

Cysticercus cellulosae Ingest imperfectly cooked pigs meat

Eggs are immediately infective Ingestion of eggs in contaminated food/drink OR autoinfection

Pathogenesis & pathology

-Mild catarrhal inflammation -Superficial ulcer -necrosis Mild : asymptomatic Heavy : -abdominal colic, -chr. Intermittent diarrhea -blood in stool -Myocarditis, heart Failure -encephalitis

Clinical pictures

Depends on no of worm *competition for nutrients B12 & metabolic by products absorbed by host Usually assyptomatic -diarrhea, abdominal pain, -pernicious anemia (small in genetically predisposed) Multiple worm : intestinal obs.

Complication

Multiple worm : intestinal obs.

Diagnosis

Eggs in stool

Eggs/ segments in faeces

Treatment

Praziquantel orally

Prevention & control

-X eat raw/imperfect cook fish -molluscicides : ineffective (Pirenella conica is operculated)

Niclosamide (Yomesen) -morning, empty stomach, well chewed -strobila often evacuated -if not use purgative Praziquantel -thorough cooking of fish -freez 24-48h at -18C to kill plerocercoid -dewormed periodically RESEVOIR HOST (dogs,cat)

Often cause change in motility & secretion of GIT than pathological *reduce gastric secretion (70%) -vague abdominal pain -nausea -</> appetite,body weight -weakness -insomnia -irritability -abdominal discomfort(due to active crawling of proglottid from anus) -allergy(rare) -intestinal obstruction -sporadically straying : acute/ subacute appendicitis / cholangitis Gravid proglottid in faeces Eggs (rarely finding) *teniasis : most difficult to diagnose in 1st 3 months of infection (x egg, x proglottids discharged) Niclosamide (Yomesen) Praziquantel

Slight irritation at their site of attachment to mucosa Rarely intestinal obstruction -vague abdominal discomfort -hunger pain -diarrhea -diarrhea alternating with constipation -loss of appetite

Well tolerated even in large no. *Symptoms > allergic Usully asymptomatic -headache -dizziness -anorexia -periodic diarrhea -abdominal pain

Gravid segment in stool Rarely egg *egg xblh diff. dgn T.saginata (except kira lateral branch)

Egg in stool

Niclosamide (Yomesen) Praziquantel

Niclosamide -5-7 days :kill adult Praziquantel -systemically abs. -act on: cysticercoid in villi Adult in lumen

-X eat RAW / imperfect cooked Light infection : consumed after freezing at -18C for 5days -early detection & treat. Of human teniasis (helpful) -condemn/boil carcasses with intensive cysticerci