• Embed Doc
  • Copy Link
  • Readcast
  • Collections
  • CommentGo Back
Download
 
THE INTESTINAL NEMATODES
♦
Phylum Nematoda
♦
Non-segmented, generally cylindrical
♦
 Tapered at both ends covered by toughcovering=
Cuticle
 
♦
Has complete digestive tract = both oral andanal openings
♦
Separate sexes: Males smaller than femalewormsMale : - single tubule, smaller end consists of testicularcells
-
Extends into a vas deferens and seminal vesicle- Terminates in an ejaculatory duct opening intothe cloacaFemale : - reproductive organs are tubular and lie coiledin the body cavity- Has 2 cylindrical ovaries which expand to theuteri- Uteri may open to the exterior through a singlevulva or there may be a common vagina between thevulva and the uteri- Vulva commonly located near the middle of thebody but varies in position in different species
♦
Majority are free living
♦
Estimated 500,000 species of nematodes
♦
Generally light cream-white color, females appeardarker when filled with dark-colored eggs
♦
Primitive form : mouth surrounded by three lips
♦
Hookworms: buccal capsule with cutting plates orteeth
♦
Anterior portion of digestive tract: Esophagus =muscular form
=
if caliber is uniform –
Filariform
 
=
if expanded posteriorly into a bulb containing avalve mechanism –
Rhabditiform
 
♦
Male nematodes: has a pair of copulatoryspicules, lie in pouches near the ejaculatory ductand may be inserted into the vagina of the female
♦
Stages of life cycle: egg-- larvae which undergoseveral molts--- adults
♦
Filariform type of esophagus: infective stagelarvae
♦
Ascaris = die in about a year in the absence of reinfection Trichuris = live more than a yearHookworm = may persist as long as 8 to 16years
♦
Diagnosis: Demonstration of the characteristicegg in the feces
HELMINTHIC DISEASESASCARIASISEtiology:
•
Ascaris lumbricoides = largest intestinalroundworm
•
Most prevalent human helminthiasis
•
Female worms = 20-35 cm in length= may be as thick as a lead pencil
•
Male worms = seldom more than 30 cm long= more slender and distinguished by anincurved tail
Both sexes are creamy white, sometimes with apinkish cast and fine circular striations in thecuticle
•
Mature larva-containing egg = infective stage
•
Eggs passed in the feces of infected person &mature in 5-10 days under favorable conditions tobecome infective
•
Female life span = 1-2 years
•
Produces 200,000 eggs/24 hrs.
Epidemiology:
•
Promiscuous defecation & use of human manure= unhygienic practices
 
•
Mode of transmission = hand to mouth; fingerscontaminated by soil contact
 
•
Eggs remain infective in soil for months
Life Cycle:
Embryonated egg swallowed (infective, containing fullydeveloped larva)
→
larva escapes from egg in S.I.
→
tissues and lymphatic vessels and lungs
→
furtherdevelopment in alveoli
→
larva from lung
→
larva in lungpass on to the intestine via trachea, esophagus and
 
stomach
→
develop maturity
→
adult in small intestine
→
eggs passed in feces
→
unfertilized egg
→
fertilized egg
→
swallowed again.
Pathogenesis:
•
Ingestion of mature egg – larva released from egg– penetrate intestinal wall—Via venous circulationpenetrate the lungs – break through pulmonarytissues to Alveolar spaces – ascend to thebronchial tree & trachea – re-swallowed
Clinical Manifestations:
•
Morbidity manifested during migration of thelarva thru the lungs = Pneumonitis – occur from 4days to 2 weeks after infection ( asthma attacks)
•
Pulmonary ascariasis = cough blood stainedsputum and eosinophilia (Loeffler’s-likesyndrome)
•
Adult worms in the small intestine = vagueabdominal pains, distention & obstruction due tomass of worms in heavily infected individuals
•
In obstruction = peak incidence 1-6 yrs old;abdominal pain sudden onset, severe, colicky andvomiting
•
Eosinophilia noted in 10% of patients
Diagnosis:
•
Direct fecal smear
 
•
Kato’s thick smear
 
•
Pulmonary & GI ascariasis complicated byobstruction= based on clinical symptoms & high index of suspicion
 
•
Fertilized egg: broadly ovoidal, 45 to75 umx35 to50um.
 
Albuminoid outer covering Thick yellowish inner shell
•
Infertile eggs: longer, narrower than fertile eggsMeasures 90 x 40 umBoth inner shell and albuminoid coat are thinIf albuminoid coat is absent – may resemble Trichostrongylus eggs
•
Can also be diagnosed through radiography =worm-shaped radioluscent areas in a barium-filled intestine
Treatment:
•
Albendazole = a nitroimidazole that bindsirreversibly to tubulin, blocking microtubuleassembly and inhibiting glucose uptake by theworm= 400mg p.o. single dose (200 mg forchildren <2 years old)= drug of choice
•
Mebendazole 100 mg BID for 3 days or 500 mgonce
•
Pyrantel pamoate 11 mg/kg single dose
•
Piperazine salts (citrate, adipate or phosphate)= causes neuromuscular paralysis & rapidexpulsion of the parasite; used for intestinal &biliary obstruction; given 50-75 mg/kg for 2days
•
Surgical treatment for severe obstructive cases
Prevention:
•
 Treating human feces before it is used as fertilizer
•
Providing hygienic sewage disposal facilities
•
Deworming every 3-6 months
ENTEROBIUS VERMICULARIS
•
Pinworm
 
•
Affects 10% of pediatric population
 
•
Spread is facilitated by crowded indoor living intemperate climates but also common in thetropics
 
•
Male : inconspicuous, 2-5 mm long and not morethan 0.2 mm wide
 
•
Female : 8-13 mm in length and 0.5 mm in width
 
Light yellowish whiteDistinguished by a long thin, sharply pointedtail
•
Inhabit the cecum and adjacent portions of thelarge and small intestines
 
•
Female worms, when fully gravid, migrate downthe intestinal tract to pass out the anus anddeposit their eggs
 
•
 The worms may migrate several inches out of theanus, depositing eggs as they crawl or liberatingmasses of them as the worms dry and literallyexplode
 
 
•
Eggs are fully embryonated and are infectivewithin a few hours of the time they are deposited
 
•
Eggs live longest under conditions of fairly highhumidity and moderate temperature
 
•
Reinfection of the patient by contamination of thehand is common and makes control of theparasite very difficult
 
•
Development of adult worm = 6 weeks
 
•
Familial outbreaks : Infection throughcontaminated clothing and beddings
 
•
Eggs may survive for some days in dry dust
 
•
Airborne eggs may infect persons at somedistance
 
•
Retrofection = a type of autoinfection, involveshatching of the embryonated eggs after theirdeposition in the perianal area and subsequentmigration back into the rectum and largeintestine
 Life Cycle:
•
Mature egg ingested by human
→
egg hatch inthe duodenum
→
larva develops to maturity in S.I.
→
proceed to L.I. (final habitat)
→
adult in largeL. I. (male and female)
Diagnosis:
 
•
Recovery of the characteristic eggsMethod: Scotch Tape Swab Technique
•
Suspected in children with pruritus ani
•
Occasionally, adult female worms seencrawling in the perianal region or in thefeces
•
Females do not ordinarily oviposit untilthey leave the intestinal tract
•
Eggs: 50-60 um in length, 20-32 inbreadthTranslucent shell of moderate thicknessFlattened on one side = flattening, consequentreduction in diameter and thicker shell – differentiatesfrom hookworm eggs
Symptoms:
•
Pruritus ani = migration of the female wormsfrom the anus
•
In small children, worms may invade the vaginaafter leaving the rectum producing a localirritation
•
Local itching may interfere with the sleep of children or adults = worms migrate from the anusduring the resting hours
Pathogenesis:
•
Considered as a commensal
•
Attachment of the adult worms to the intestinalwall may produce some inflammation
•
Invasion of the appendix can also be expected asa cause of appendicitis
•
Entrance into the peritoneal cavity via the femalereproductive system may result in formation of granulomas around eggs and worms = chronicpelvic peritonitis
•
Occasionally reported in other sites: Liver andlungs
Treatment:
•
Albendazole = DOC= single dose of 400mg or 200 mg inchildren < 2 y.o.= should be repeated in 2 weeks to kill anyworms that migrated and hatched from eggs present atthe time of initial treatment
•
Pyrantel pamoate = single dose of 11 mg/kg bodyweight and repeated in 2 weeks
HOOKWORM INFECTIONS:ANCYLOSTOMA DUEDENALE
•
Old World hookworm
•
Adults : - grayish white or pinkish
of 00

Leave a Comment

You must be to leave a comment.
Submit
Characters: ...
You must be to leave a comment.
Submit
Characters: ...