Intest|na| Nematodes 1 and 2

Genera| Character|st|cs of Nematodes

8ound unsegmenLed worms
2 fs compleLe dlgesLlve LrfcL
3 epfrfLe mfle fnd femfle sexes (dloeclous) mfle ls usuflly lfrger Lhfn femfle
4 overed by Lough coverlng known fs cuLlcle

C|ass|f|cat|on of D|fferent Nematodes
Accordlng Lo Lhelr orgfn lnvolvemenL
V nemfLodes fffecLlng Lhe skln
V nemfLodes fffecLlng Lhe lungs
V nemfLodes fffecLlng Lhe lymphfLlc sysLem
V nemfLodes fffecLlng Lhe lnLesLlnfl LrfcL
V loodborne or Llssue nemfLodes
V nemfLodes fffecLlng Lhe nervous sysLem

2 Accordlng Lo Lhelr Lfxonomlc clfsslflcfLlon
V hylum AschelmlnLhes ( nemfLhelmlnLhes)
lfss Aphfsmldlf ( wlLhouL phfsmlds fnd cfudfl recepLors)
fplllfrlf
1rlchlnellf
1rlchurls

lfss hfsmldlf (wlLh phfsmlds fnd cfudfl recepLors)
Ascfrls
ookworms____________ fnd ____________
LnLeroblus
lllfrlfl worms ___________ _______________________ fnd __________
AnglosLorngylus
CnfLhosLomf

Intest|na| Nematodes of Med|ca| Importance
nemfLode specles fffecLlng Lhe mfll lnLesLlne
f 4scoris /umbricoides*
b necfLor fmerlcfnus**
c AncylosLomf spp**
d Lrongyloldes sLercorflls**
e fplllfrlf phlllpplnensls**
2 nemfLode specles fffecLlng Lhe Lfrge lnLesLlne
f @richuris trichiuro*
b terobius vermicu/oris*

I scar|as|s
O An lnLesLlnfl pfrfslLlc dlsefse
O fused by Lhe glfnL roundwormAscotls lombtlcolJes
O 1rfnsmlLLed by lngesLlon of embryonfLed eggs
O AdulL worms reslde ln Lhe smfll lnLesLlne
O fuslng fbdomlnfl dlscomforL /or dlfrhhef
O Mfy lefd compllcfLlons
O revenLfble fnd curfble

scar|as|s Lp|dem|o|ogy
4 1he fnnufl globfl morbldlLy ls esLlmfLed fL bllllon wlLh f morLfllLy of 20000
revflenL ln Lroplcfl counLrles fnd soclo economlcflly depressed frefs of Lurope LfLln
Amerlcf Aslf
73 of fll lnfecLlons ln Aslf
4 1he lncldence ls hlgher ln poor rurfl populfLlons
4 ln Lhe hlllpplnes 8090 fre found ln rurfl frefs fnd slums ln Lhe clLles
ln some frefs 00 of people fre lnfecLed
lghesL lnfecLlon rfLes fre ln chlldren
32 of chlldren ln ovleL unlon hfd eggs ln nfsfl mucus
ln L uA 2060 of chlldren lnfecLed
4 Ascfrlfsls cfn occur fL fll fges buL lL ls more prevflenL ln Lhe 3 Lo 9 yefrs fge group
4 1hrlves ln counLrles wlLh poor sfnlLfLlon fnd poverLy fnd lgnorfnce
1rfnsmlsslon by lngesLlon of conLfmlnfLed food wfLer/soll
uslng humfn ffeces/ nlghL soll fs ferLlllzer
4 MosL common sourceof lnfecLlon soll conLfmlnfLed foods esp lf vegeLfbles fre efLen rfw
4 Lggs fre lncredlbly reslsLfnL Lo chemlcfls
egg reslsLfnL Lo 2 formflln fnd 30 l nlLrlc/ sulfurlc fcld
O due Lo Lhe llpld lfyer of Lhe eggshell
4 Lggs remfln vlfble for long perlods Lhus long llved ln soll up Lo 3 yefrs
O eggs fre sLlcky
O eggs found on bfnknoLes / money
eggs cfn be LrfnsmlLLed by wlndborne dusL

L|fe Cyc|e of 4scoris /umbricoides
AJolt wotms llve lo tbe lomeo of tbe smoll lotestloe
2 A femole moy ptoJoce opptoxlmotely 200000 eqqs pet Joy wblcb ote posseJ wltb tbe feces wblcb coo
eltbet be fettlllzeJ ooJ oofettlllzeJ uofettlllzeJ eqqs moy be loqesteJ bot ote oot lofectlve
J o soll fettlle eqqs develop lnLo f 2cell sLfge fnd fdvfnced clefvfge sLfge
4 @beo oftet Joys to sevetol weeks tbey embtyooote wltb tbe lotvol stoqe loslJe ooJ become lofectlve (
JepeoJloq oo tbe optlmom eovltoomeotol cooJltloos molst wotm sboJeJ soll)
5 @be lofectlve embtyoooteJ eqqs ote swolloweJ tbe lotvoe botcb lo tbe smoll lotestloe
6 @be lJ lovoJe tbe lotestlool mocoso ooJ ote cottleJ vlo tbe pottol tbeo systemlc cltcolotloo to tbe looqs
Aftet two moltloqs tbe lJ motote loto l5 lo tbe looqs (0 to 4 Joys) tbeo peoettote tbe olveolot
wolls
7 l5 osceoJ tbe btoocblol ttee to tbe tbtoot ooJ ote swolloweJ upoo teocbloq tbe smoll lotestloe tbey
Jevelop loto oJolt wotms 8etweeo 2 ooJ J mootbs ote tepolteJ ftom loqestloo of tbe lofectlve eqqs to
ovlposltloo by tbe oJolt femole AJolt wotms coo llve to 2 yeots cuc
scar|as|s atho|ogy and C||n|ca| hases
4 Lu phose
Cccurs wlLhln 36 dfys ffLer exposure
uue Lo mlgrfLlon of lfrvfe Lo Lhe lungs
L3 lfrvfe molLed Lwlce Lo form Lhe L3
ln severe lnfecLlons lL cfn lefd Lo
4 emorrhfges fnd desLrucLlon of lung pfrenchymf fs Lhe lfrvfe brefks Lhrough Lhe
cfplllfrles
4 loefflets loeomoolo eoslnophlllc lnfllLrfLlon of Lhe lungs
4 neumonlLls
llnlcflly AsLhmfLlc Lype of resplrfLlon
ough wlLh rfles fnd chesL pfln


ltestio/ Phose
Cccurs 23 monLhs ffLer exposure
uue Lo mfLurfLlon of L3 Lo fdulL worms ln Lhe smfll lnLesLlne
resence of fdulL worms ln Lhe lnLesLlne cfn cfuse
4 uecrefsed ffL fnd nlLrogen fbsorpLlon
4 LfcLose lnLolerfnce
4 LunLed growLh ln chlldren
4 lnLesLlnfl obsLrucLlon due Lo enLfngled Ascotls bolus ln mfsslve lnfecLlon
llnlcfl presenLfLlon vfgue fbdomlnfl pfln ( mosL frequenL complflnL) dlfrrhef fnd loss of
fppeLlLe
4 A cfse of compllcfLed Ascfrlfsls ln1L1lnAL C818u1lCn

woderi worms
Mflnly due Lo errfLlc behfvlor of Lhe fdulL worms mfy lefd Lo
4 erforfLlon of Lhe bowel lefdlng Lo perlLonlLls
4 lnvfslon fnd blockfde of Lhe hollow sLrucLures
Appendlx fcuLe fppendlclLls
ommon blle ducL blllfry fscfrlfsls
LusLfchlfn Lube CLlLls medlf
Lfrynx suffocfLlon
4 lnvfslon of vlLfl orgfns llke llver ( fbscess) fnd gfll blfdder (gfllsLones due Lo Ascotls
eggs)

scar|as|s D|agnos|s
A llndlng Lhe ovf ln feces mosL prfcLlcfl meLhod
ulrecL lecfl mefr
2 1hlck mefr MeLhod
fLo 1echnlque
fLo fLz 1echnlque wlLh 4060 mg feces

AdvfnLfges
lL cfn qufnLlLfLe Lhe number of eggs
2 lL cfn deLermlne Lhe egg reducLlon ffLer LrefLmenL
3 lL cfn deLermlne Lhe lnLenslLy of lnfecLlon
Morpho|ogy of 4scoris Cva
O ert|||zed Cva] Lggs mosLly ovfl or spherlcfl golden brown ln color
fpfble of developmenL ln soll from slngle cell Lo embryonfLed egg
onslsL of Lhree shell lfyers
f lnner nonpermefble llpoldfl vlLelllne mebrfne ( fbsenL ln lnferLlle egg)
b 1hlck LrfnspfrenL mlddle lfyer glycogen membrfne
c CuLermosL cofrsely mfmlllfLed flbumlnold lfyer (fbsenL ln decorLlcfLed
egg)
O Dnfert|||zed Cva] Lggs lfrger ln slze ovold wlLh Lhlnner shell
f wlLh fn lrregulfr cofLlng of flbumln fnd
b hlghly refrfcLlle grfnules lnslde Lhe proLoplfsm
c fnnoL undergo developmenL ln soll
O lLmbryonated Cva]Lggs
f JlLh lfrvf lnslde Lhe shell
easons for Negat|ve Stoo| Lxam|nat|on
Jhen Lhere ls nC helmlnLhlc lnfecLlon
uurlng Lhe perlod of lfrvfl mlgrfLlon ln Lhe lungs fnd oLher orgfns vlf blood sLrefm
Jhen worms fre sLlll sexuflly lmmfLure
Jhen fll mfles fdulL worms fre presenL ln Lhe smfll lnLesLlne

3upper Cl erles for Lhe ouLllne of AdulL worm buL lL ls noL cosL efflclenL

Ident|f|cat|on of 4scoris du|t

Morpho|ogy of du|t worms
refmy whlLe or plnklsh yellow worms
JlLh smooLh flnely sLrlfLed cuLlcle

A lemfle Jorm
O @apered at both ends
O Lfrger Lhfn mfles 2233 cm by 3 cm
O Mfy go up Lo 43 cm
O flred reproducLlve orgfns ln Lhe posLerlor 2/3 of femfle
8 Mfle worm
O Curved poster|or end
O mfller Lhfn femfle 03 cm x 3 cm

@reatment for scar|as|s
peclflc 1refLmenL
V 8rofd specLrum fnLhelmlnLhlc drug
Mechfnlsm of fcLlon neuromusculfr blocklng effecL on pfrfslLe lefdlng Lo pfrflysls of
worms
Albendfzole 400 mg slngle dose
Mebendfzole 300 mg slngle dose
yrfnLel pfmofLe 0 mg/kg fs slngle dose
Ascfrlfsls onLrol Mefsures
V Mfss urug AdmlnlsLrfLlon ln Lhe communlLy 3x f yefr for Lhree yefrs
V MeLhod
elecLlve Mfss urug AdmlnlsLrfLlon for Lhose resldenLs wlLh poslLlve sLool exfmlnfLlon
only
1frgeLed Croup 1refLlng hlldren flone
1refLmenL of choolchlldren 2x f yefr fL fn lnLervfl of 46 monLhs

scar|as|s revent|ve Measures
fnlLfry wfsLe dlsposfl
ersonfl hyglene
Avold use of fresh humfn feces for ferLlllzer
1horough cooklng of food especlflly vegeLfbles
AdequfLe wfshlng of frulLs before efLlng


II @ICnDISIS
O ynonyms Jhlpworm lnfecLlon
O fused by @tlcbotls ttlcbloto f soll LrfnsmlLLed helmlnLh
O lrequenLly lnfecL chlldren 33 yefrs of fge
O revflenL ln hlllpplnes prevflence rfLe ls 8084 frequenLly fssoclfLed wlLh Ascfrls lnfecLlon
O revenLfble fnd curfble

@r|chur|as|s Lp|dem|o|ogy
lghly prevflenL pfrfslLlc lnfecLlon buL lLs lnLenslLy ls llghL
ulsLrlbuLlon ls coexLenslve wlLh Ascfrls lumbrlcoldes
lghesL lncldences found ln frefs wlLh hefvy rflnffll subLroplcfl cllmfLe fnd hlghly polluLed soll
More chlldren fre lnfecLed Lhfn fdulLs
lfcLors fffecLlng Lrfnsmlsslon
V lndlscrlmlnfLe defecfLlon of chlldren ln Lhe yfrd
V oor heflLh educfLlon
V oor personfl ffmlly fnd communlLy hyglene
lemfle worm lfys 30000000 eggs per dfy

L|fe cyc|e of @richuris trichiuro

) lemfle fdulL worms lfld Lhe unembryonfLed eggs whlch fre pfssed wlLh Lhe sLool
2) ln Lhe soll Lhe eggs develop lnLo f 2cell sLfge fnd fdvfnced clefvfge sLfge
3) 1hen Lhey embryonfLe fnd become lnfecLlve ln 3 Lo 30 dfys
4) AfLer lngesLlon (sollconLfmlnfLed hfnds or food) Lhe eggs hfLch ln Lhe smfll lnLesLlne fnd relefse
lfrvfe
3) MfLurfLlon of lfrvfe Lo fdulLs occur ln Lhe colon
6) 1he fdulL worms (fpproxlmfLely 4 cm ln lengLh) llve ln Lhe cecum fnd fscendlng colon 1he fdulL
worms fre flxed ln LhfL locfLlon wlLh Lhe fnLerlor porLlons Lhrefded lnLo Lhe mucosf 1he femfles
begln Lo ovlposlL 60 Lo 70 dfys ffLer lnfecLlon lemfle worms ln Lhe cecum shed beLween 3000 fnd
20000 eggs per dfy 1he llfe spfn of Lhe fdulLs ls fbouL yefr

@r|chur|as|s atho|ogy Symptomato|ogy
Jorms embedded ln Lhe mucosf cfn cfuse peLechlfl hemorrhfges
LlghL lnfecLlons no cllnlcfl sympLoms
efvy frfslLlsm chronlc lnfecLlons

@r|chur|as|s C||n|ca| features
lrequenL smfll 8loodsLrefked dlfrrhelc sLools
Abdomlnfl pfln fnd Lenderness
nfusef fnd vomlLlng
Anemlf mfybe mfrked wlLh b level of 3 g/00ml
JelghL loss
AcuLe or subfcuLe fppendlclLls lf worms fre fLLfched Lo Lhe fppendlcefl mucosf fnd
encourfge enLry of bfcLerlf Lo Lhe fppendlx
ecta| pro|apse due Lo worms embedded ln Lhe mucosf
4 f condlLlon ln whlch Lhe recLum (Lhe lower end of Lhe colon locfLed [usL fbove Lhe
fnus) Lurns lLself lnslde ouL
@r|chur|as|s D|agnos|s
ln hefvy lnfecLlons cllnlcfl presenLfLlon mfy be relled upon Lo mfke f dlfgnosls plus Lhe
fecflysls resulL
ln llghL lnfecLlon requesL for Lhe sLool exfmlnfLlon uslng
V ulrecL fecfl smefr
V fLo 1hlck smefr
V oncenLrfLlon meLhods
Ident|f|cat|on of @richuris Cva
V llndlng Lhe chfrfcLerlsLlc eggs ln Lhe feces
|emonshaped or barre|shaped eggs wlLh b|po|ar p|ugs ln Lhe feces
lzes 34 um x 23 um
JlLh yellowbrown ouLer fnd f LrfnspfrenL lnner shell
unembronfLed fL ovlposlLlon
Lmbryonlc developmenL Lfkes plfce ln Lhe exLernfl envlronmenL (soll)
Less reslsLfnL Lo desslcfLlon hefL fnd cold Lhfn A lombtlcolJes

Ident|f|cat|on of @richuris du|t
V ALLenufLed whlpllke fnLerlor end 3/3s Lrfversed by f nfrrow esophfgus fnd 2/3s
conLfln Lhe lnLesLlnes fnd f slngle seL of reproducLlve orgfn
V lemfle lfrger 3330 mm wlLh blunLly rounded posLerlor/Lfll wlLh eggs ln uLerus
V Mfle smfller 3043 mm colled posLerlor end wlLh slngle splcule fnd reLrfcLlle shefLh




@r|chur|as|s @reotmet
Spec|f|c treatment
V Mebendfzole 00 mg bld for 3 dfys for hefcy lnfecLlons or
V Mebendfzole 300 mg slngle dose ln llghL lnfecLlons
V Albendfzole 400 mg slngle dose flLernfLlve drug
Nonspec|f|c @reatment
V ympLomfLlc fnd supporLlve mfnfgemenL

@r|chur|as|s revent|on and Contro|
Mfss urug 1refLmenL lf lnfecLlon ln Lhe communlLy ls 30
revenLlve Mefsures ln hlghly endemlc frefs
V Lfrly ulfgnosls fnd LrefLmenL of lnfecLed lndlvldufls
V fnlLfry dlsposfl of humfn feces
V Jfshlng of hfnds before fnd ffLer mefls
V eflLh educfLlon on sfnlLfLlon fnd personfl hyglene
V 1horough wfshlng fnd scfldlng of uncooked vegeLfbles
V Avold uslng nlghL soll fs ferLlllzer


III LN@LCISIS

ynonym humfn plnworm/sefLworm lnfecLlon Cxyurlfsls
fused by LnLeroblus vermlculfrls
hfrfcLerlzed by perlfnfl lLchlng
1rfnsmlLLed by lngesLlon or lnhflfLlon of eggs fnd by fuLo or reLrolnfecLlon
revenLfble fnd curfble

Lnterob|as|s Lp|dem|o|ogy
lnfecLlon occur Lhrough
fndLomouLh Lrfnsmlsslon mosL common rouLe
from lngesLlon of eggs ffLer scrfLchlng Lhe fnfl frefs or from hfndllng conLfmlnfLed
fomlLes
2 lnhflfLlon of flrborne eggs from dusL
3 reLrolnfecLlon Lhrough Lhe fnus
occurs when eggs hfLches ln Lhe fnfl fref fnd lfrvfe mlgrfLe bfck Lo Lhe lfrge lnLesLlne
lL cfnnoL be conLrolled by proper sfnlLfry dlsposfl of humfn feces becfuse eggs fre deposlLed
ln Lhe perlfnfl fref
revflence of lnfecLlon
V Clobflly 2088 M fre lnfecLed
V ommonly fffecLs school chlldren 29 from Lhe prlvfLe schools fnd 36 from Lhe
publlc schools
V Lggs hfve been collecLed under Lhe flngernflls of Lhese chlldren

Anybody cfn be lnfecLed buL more prevflenL ln low socloeconomlc groups menLfl
lnsLlLuLlons orphfnfges
AdulL worms mfy mlgrfLe Lo fnfl frefs durlng dfyLlme buL more commonly observed fL nlghL

L|fe Cyc|e of terobius vermicu/oris
Crfvld femfles mlgrfLe Lo perlfnfl reglon fL nlghL Lggs fre deposlLed on perlfnfl folds Lggs
mfLure ln 46 hours lnLo embryonfLed lnfecLlve sLfge under opLlmum condlLlon
2 1rfnsmlsslon of lnfecLlon occurred fs
f AuLolnfecLlon by Lrfnsferrlng lnfecLlve eggs Lo Lhe mouLh wlLh hfnds LhfL hfve scrfLched
Lhe perlfnfl fref
b ersonLoperson Lrfnsmlsslon cfn flso occur Lhrough
l hfndllng of conLfmlnfLed cloLhes or bed llnens
ll conLfmlnfLed surffces ln Lhe envlronmenL wlLh plnworm eggs (eg curLflns cfrpeLlng)
lll lnhflfLlon ln some smfll number of eggs 1hese would be swfllowed fnd follow Lhe
sfme developmenL fs lngesLed eggs
3 lollowlng lngesLlon of lnfecLlve eggs Lhe lfrvfe hfLch ln Lhe smfll lnLesLlne
4 1he fdulLs developed Lhemselves ln Lhe colon 1he Llme lnLervfl from lngesLlon of lnfecLlve eggs Lo
ovlposlLlon by Lhe fdulL femfles ls fbouL one monLh 1he llfe spfn of Lhe fdulLs ls fbouL Lwo
monLhs
3 Crfvld femfles mlgrfLe nocLurnflly ouLslde Lhe fnus fnd ovlposlL whlle crfwllng on Lhe skln of Lhe
perlfnfl fref 1he lfrvfe fre relefsed when Lhe embryonfLed eggs fre hfLched
6 8eLrolnfecLlon or Lhe mlgrfLlon of newly hfLched lfrvfe from Lhe fnfl skln bfck lnLo Lhe recLum
mfy rfrely occur

Lnterob|as|s atho|ogy and Symptomato|ogy
l/3 of cfses fre fsympLomfLlc
1hree (3) forms of pfLhologlc flndlngs due Lo
V 4du/t worm ottochmet
MlnuLe ulcerfLlons fnd fbscess ln Lhe cecfl mucosf
V depositio ot the oo/ oreo
fn cfuse severe lLchlng or prurlLus ln Lhe perlenfl reglon
crfLchlng mfy lefd Lo scfrlfled leslon
Pruritus oi hemorrhfges fnd eczemf or bfcLerlfl lnfecLlons of Lhe fnus fnd
perlfnfl fref
4 erlfnfl fnd perlnefl lLchlng especlflly fL nlghL
4 A rfsh coupled wlLh lnsomnlf fre Lhe mosL common complflnLs of
plnworm lnfecLlon
V 4du/t worm mirotio
Mfy lfy eggs ln genlLfl orgfns vulvovfglnlLs
Mfy enLer fflloplfn Lube sflplnglLls

Lnterob|as|s D|agnos|s
lsLory fnd hyslcfl LxfmlnfLlon hlldren wlLh per|ana| |tch|ng lnsomnlf fnd resLlessness
1he presence of plnworms cfn be conflrmed ln one of Lwo wfys
V D|rect observat|on of the adu|t worms fround Lhe fnus perlneum or enLrfnce Lo Lhe
vfglnf 1he opLlmum Llme Lo see Lhe worms ls Lo 2 hours ffLer f chlld hfs gone Lo bed
or upon fwfkenlng ln Lhe mornlng
V Scotch tape swab
MeLhod er|ana| Scoth] Ce||ophane @ape Swab
V wfb for eggs ls preferfbly done ln Lhe mornlng before Lfklng f bfLh or
defecfLlon
V 3 (rfrely) fre seen ln feces becfuse relefse ls exLernfl Lo Lhe lnLesLlne
V Jorms mfy be seen crfwllng ouL of Lhe chlld's fnus fL nlghL

Ident|f|cat|on of terobius Cva Larvae
Morpho|ogy of Cva
V LlongfLed ovold wlLh one convex fnd one flfLLened end produclng a Dshaped ovum
wlLh welldeveloped embryo
V JlLh 2 egg shell lfyers
CuLer Lhlck hyfllne flbumlnold
lnner embryonlc llpoldfl lfyer
V Mefsures 33um x 23 um
Morpho|ogy of |arva
V lolded once lnslde Lhe egg shell
Ident|f|cat|on of terobius du|t
Morpho|ogy of du|t
mfll whlLlsh or brownlsh worm wlLh cuLlculfr flfr expfnslon fL Lhe fnLerlor end
( cepha||c a|ae)
ema|e 83 mm x 04 mm wlLh promlnenL esophfgefl bulb fnd long polnLed Lfll
uLerus mfy hfve eggs
Ma|e 23 mm wlLh curved Lfll fnd slngle copulfLory splcule (rfrely seen)


Lnterob|as|s @reatment
peclflc 1refLmenL
V yrfnLel pfmofLe 0 mg/kg wlLh f second dose 24 weeks lfLer
V Mebendfzole 300 mg slngle dose
V Albendfzole 400 mg slngle dose
nonspeclflc 1refLmenL
V ympLomfLlc LrefLmenL

Lnterob|as|s Contro| and revent|on
ersonfl hyglene flngernflls should be cuL shorL wfsh hfnds Lhoroughly fnd wfsh fnfl reglon upon
rlslng
Cenerfl clefnllness ln Lhe house
1refL Lhe lnfecLed person fnd fll members of Lhe household becfuse eggs fre efslly sprefd ln Lhe
envlronmenL
Lerlllze Lhe bed llnens fnd cloLhlngs of lnfecLed person wlLh hoL wfLer
roLecL foods from dusL fnd from Lhe hfnds of lnfecLed person

IV nCCkWCM DISLSL
D|sease ncy|ostom|as|s
Synonyms nky|ostom|as|s flLernfLlvely spelled anchy|ostom|as|s fnd flso cflled he|m|nth|as|s m|ners
anaem|a tunne| d|sease br|ckmakers anaem|a fnd Lgypt|an ch|oros|s
Iron def|c|ency anem|a ls Lhe dlsefse cfused by hookworms
aras|t|c gent
-ecotor omericous *
4cy/ostomo duodeo/e*
AncylosLomf cfnlnum**
AncylosLomf brfzlllenze**
AncylosLomf ceylfnlcum***
W *oll LrfnsmlLLed helmlnLhs LhfL lnfecL mfn
W ** specles fffecLlng cfL fnd dog cfnnoL mfLure ln mfn
W *** specles ffecLlng cfL fnd dog cfn develop Lo fdulLs ln humfn

L|fe Cyc|e of 2 nookworms |s s|m||ar
Lggs fre pfssed ln Lhe sLool fnd under ffvorfble condlLlons (molsLure wfrmLh shfde) eggs
embryonate
2Lfrvfe hfLch ln Lo 2 dfys fnd relefsed rhabd|t|form |arvae (L1) whlch grow ln Lhe feces fnd/or Lhe
soll
3 L
1
mo|ts tw|ce and Lhey become fllfrlform lfrvfe (L3)LhfL fre lnfecLlve 1hese lnfecLlve lfrvfe cfn
survlve 3 Lo 4 weeks ln ffvorfble envlronmenLfl condlLlons
4 Cn conLfcL wlLh Lhe humfn hosL Lhe lfrvfe peneLrfLe Lhe skln Larvae typ|ca||y penetrate sk|n of
the feet when one wa|ks barefooted through warm so|| @hey fre cfrrled Lhrough Lhe blood vessels Lo
Lhe hefrL fnd Lhen Lo Lhe lungs 1hey peneLrfLe lnLo Lhe pulmonfry flveoll fscend Lhe bronchlfl Lree Lo
Lhe phfrynx fnd fre swfllowed
3 1he lfrvfe refch Lhe smfll lnLesLlne where Lhey reslde fnd mfLure lnLo fdulLs AdulL worms llve ln
Lhe lumen of Lhe smfll lnLesLlne where Lhey fLLfch Lo Lhe lnLesLlnfl wfll wlLh resulLfnL blood loss by Lhe
hosL

du|ts occur |n the human smfll lnLesLlne Mfle fnd femfle fre commonly found ln copu/o 8oLh fre
well fLLfched Lo Lhe lnLesLlnfl mucosf wlLh Lhe buccfl cfpsule lemfle relefses eggs whlch fre pfssed
|n the feces 8oLh specles show hlgh fecundlLy
A JooJeoole produces 23000 Lo 30000 eggs/dfy
N ometlcooos produces 9000 eggs/dfy

MosL fdulL worms fre ellmlnfLed ln Lo 2 yefrs buL Lhe longevlLy mfy refch severfl yefrs
ome A JooJeoole lfrvfe followlng peneLrfLlon of Lhe hosL skln cfn become dormfnL (ln Lhe lnLesLlne
or muscle) ln fddlLlon lnfecLlon by A JooJeoole mfy probfbly flso occur by Lhe orfl fnd
Lrfnsmfmmfry rouLe N ometlcooos however requlres f Lrfnspulmonfry mlgrfLlon phfse

athogenes|s nookworm D|sease
Lxtent of patho|ogy |s assoc|ated w|th the numbers of adu|ts
4 ympLoms fppefr ln lnfecLlons of 00 or more worms
4 A hefvy lnfecLlon lnvolves 300 or more worms
4 ympLoms fre severe fnd Lhe lnfecLlon mfy be llfeLhrefLenlng
4 ookworm lnfecLlon ls rfrely ffLfl buL fnemlf cfn be slgnlflcfnL ln Lhe hefvlly lnfecLed
lndlvldufl

@nLL nSLS C nCCkWCM DISLSL
Cutaneous hase peneLrfLlon of L3 lnLo Lhe skln usuflly Lhe feeL lLchlng fnd reddlsh rfsh
occurs cfuslng ground |tch
Cutaneous |arva m|grans (creep|ng erupt|on) due Lo fnlmfl hookworms (A brfzlllense A
cfnlnum)
fLhogenesls ookworm ulsefse
2 Lung hase due to |ung m|grat|on of L3
S|mp|e Lung Los|noph|||a ( Loeff|er's Syndrome) pneumonlfllke sympLoms occur fs L3 brefk ouL
of Lhe cfplllfrles fnd enLer Lhe flveoll (sympLoms fre noL fs severe fnd fs common fs Ascotls
mlgrfLlon
3 Intest|na| hase fdulLs fLLfch Lo Lhe mucosfl wfll fnd mfy peneLrfLe lnLo Lhe submucosf
where Lhey vorfclously suck blood up Lo 200 ml of blood mfy be losL/dfy
W A JooJeoole Lfkes 026 ml/dfy
W N ometlcooos 003 ml/dfy
W ookworms fre very wfsLeful fs mosL of Lhe blood Lfken slmply pfsses Lhrough lLs lnLesLlne
buL ls losL Lo Lhe hosL
W 8lood loss ls fssoclfLed wlLh ICNDLICILNC NLMI cfused by vorfclously sucklng blood
from Lhe hosLs lnLesLlnfl wflls
W lnfecLed fdulLs become Llred fnd rundown
W MenLfl fnd growLh reLfrdfLlon commonly occurs ln chlldren
W 1he pfLhology fnd sympLomfLology number of worms fnd lron lnLfke of Lhe pfLlenL
W 8ecenL flndlngs lndlcfLe LhfL Lhere ls f reduct|on |n gamma g|obu||ns (prote|ns) wh|ch resu|ts |n
C@LIN MLND@I@ICN predlsposlng Lhem Lo oLher lnfecLlons
W omblnfLlon of Lhese ffcLors can be fata|

D|agnos|s nookworm d|sease
|nd|ng the eggs |n the feces Lhrough
ulrecL fecfl smefr
oncenLrfLlon meLhods
lnc ulffLe enLrlfugfl llofLfLlon
lormflln LLher concenLrfLlon
W All hookworm eggs look Lhe sfme so lu specles could noL be done
W Lggs fre ovold wlLh Lhln smooLh eggshell
W lnLernflly eggs fre flwfys efrly ln mlLosls conLfln 2 Lo 8 cells
W lze 3373 m x 3340 m
2naradaMor| cu|ture f meLhod of lncubfLlng fecfl mfLerlfl on f fllLer pfper sLrlp ln f LesL Lube conLflnlng
wfLer (cover oneLhlrd of Lhe lengLh of Lhe pfper sLrlp)
urpose ulLurlng fnd recoverlng Lrongyloldes fnd hookworm lfrvfe from eggs presenL ln Lhe fecfl
sfmple





Ident|f|cat|on of nookworms
Stage ecator americanus Ancylostoma duodenale
Adult Small,cylindrical, fusiform, gray-white
worm with thick cuticle
Female : 9-13 x 0.35-.6 mm with paired
reproductive organs
Larger, cylindrical worm
Same
Buccal capsule Conspicuous pair of semilunar cutting
plates
Two pairs of large teeth, similar in size
Caudal Bursa In Male: 5-11 by 0.3-0.45 mm
Copulatory bursa contains spicules that
are fused distally.
Same
Copulatory bursa is at posterior end and
contains 2 thin spicules that separate
distally.
Rhabditiform larva
( 1
st
stage)
Larger, more attenuated posterior end,
longer buccal capsule than Strongyloides
Same
Filariform larva
(3
rd
Stage)
Short ,bulbous esophagus Same

Dog and Cat nookworms
V uog hookworm 4cy/ostomo coium ls efslly recognlzed by lLs 3 pa|rs of teeth ln Lhe buccfl
cfpsule
V fL hookworm 4cy/ostomo broti/iese hfs f pa|r of |ong teeth lL does noL mlgrfLe Lo Lhe
lnLesLlne fnd mfLure
V 8oLh specles lnhfblL Lhe smfll lnLesLlne of Lhelr hosLs
V Llfe cycles fnd pfLhology fre slmllfr Lo humfn specles
V uMAn mfy serve fs fccldenLfl hosLs of Lhese hookworms when Lhe fllfrlform lfrvfe (L
3
)
peneLrfLe humfn skln

@wo (2) atho|og|ca| rob|ems |n numans
Cutaneous |arva m|grans ( Creep|ng Lrupt|on)
V L
3
of dog or cfL hookworms enLer humfn skln fnd wfnder fbouL ln epldermls
V A btozllleoze ls Lhe mf[or cfusfLlve fgenL of humfn cuLfneous lfrvf mlgrfns lL does noL
mlgrfLe Lo Lhe lnLesLlne fnd mfLure
V L
3
fre unfble Lo peneLrfLe lnLo Lhe dermls fnd fre evenLuflly kllled by our lmmune sysLem
V Jfnderlng L
3
cfuse f red lLchy lrrlLfLlon
V 1refLed wlLh Lhlfbendfzole olnLmenL or LfbleL
V AnoLher refson Lo clefn up dog fnd cfL feces!

2 Los|noph|||c enter|t|s caused by 4cy/ostomo coium
4 A few L
3
fre fble Lo peneLrfLe skln Lo enLer clrculfLlon fnd fre cfrrled Lo smfll lnLesLlne
4 Aokylostomo cooloom ls noL fssoclfLed wlLh chronlc blood loss fnd fnemlf buL rfLher wlLh
eoslnophlllc enLerlLls
4 8emfrkfble 43 (86) of 30 dogs exfmlned fL f veLerlnfry hosplLfl were found lnfecLed mfklng
Lhe poLenLlfl for humfn exposure Lo Lhls hookworm very hlgh
4 MeLhod of lnfecLlon uog defecfLes on lfwn fnd Lhen person mows lfwn bfrefooLed fnd L
3

peneLrfLe skln

@reatment of nookworm D|sease
SLCIIC @L@MLN@
urug of holce |bendazo|e 400 mg slngle dose ls effecLlve ln LrefLlng boLh specles
or Mebendfzole or yrfnLel fmofLe
NCNSLCIIC @L@MLN@
ympLomfLlc upporLlve 1refLmenL
lerrous ulffLe 1fbleLs Lo correcL fnemlf
Contro| and revent|on of nookworm D|sease
LVLN@ICN
uo noL use humfn excremenL or rfw sewfge or unLrefLed nlghL soll fs mfnure/ferLlllzer ln
fgrlculLure sLop polluLlon of soll wlLh lnfecLed feces
2 uo noL defecfLe ln plfces oLher Lhfn lfLrlnes LolleLs Lhls hfs ellmlnfLed much of Lhe problem
3 Jefrlng of shoes or sllppers prevenL peneLrfLlon of L
3

4 1refL lnfecLed dogs fnd cfLs wlLh fnLhelmlnLhlcs Lo prevenL soll conLfmlnfLlon
CCN@CL

Mfss LrefLmenL of lnfecLed lndlvldufls (Jhen 30 of Lhe resldenLs ln Lhe communlLy ls lnfecLed) fnd educfLlon
of Lhe publlc

I 5@-Llul45l5
W A humfn pfrfslLlc dlsefse cfused mflnly by Lhe nemfLode ttooqylolJes stetcotolls
W CLher Lrongyloldes lnclude follebotol whlch lnfecLs Afrlcfn prlmfLes esp chlmpfnzees fnd bfboons
fnd mfy produce llmlLed lnfecLlons ln humfns
W 1rfnsmlLLed by skln peneLrfLlon of fllfrlform lfrvfe (L3)
W fblLfL Sma|| |ntest|ne of man
W Cosmopo||tan ln dlsLrlbuLlon buL ls mosL common ln wfrm molsL cllmfLes

L|fe Cyc|e of 5troy/oides stercoro/is
W aras|t|c adu|ts ||ve |n the sma|| |ntest|ne of humfns fnd oLher mfmmfls
W lemfles produce eggs by parthenogenes|s f form of fsexufl reproducLlon found ln femfles where
growLh fnd developmenL of embryos occurs wlLhouL ferLlllzfLlon by f mfle
W Dnfert|||zed eggs g|ve r|se to offspr|ng
W frfslLlc femfles burrow lnLo Lhe mucosf Lo relefse Lhelr ovf
W Jhen Lhe eggs refch Lhe lumen of Lhe smfll lnLesLlne Lhe eggs hfLch fnd Lhe L1 ( rhabd|t|form
|arvae) are re|eased |nto the |umen
W 1he L1 ( rhabd|t|form |arvae) are re|eased |nto the |umen and pfssed ln Lhe sLool
W 18LL (3) posslble pfLhwfys LhfL cfn be followed ln Lhe llfe cycle

aras|t|c Cyc|e or D|rect Deve|opment ( nomogon|c Cyc|e)
responslble prlmfrlly for lnfecLlon ln mfn

L

fre pfssed ln Lhe feces onLo wfrm molsL soll

2 ln Lhe soll Lhe L

molL 2x Lo L
3
(fllfrlform lfrvfe)
3 L
3
peneLrfLe Lhe skln (llke hookworm lfrvfe) fnd enLer Lhe clrculfLlon
4 Co Lhrough lung mlgrfLlon L3 molL 2x Lo L3
3 wfllowed fnd develop Lo pfrfslLlc fema|es ln Lhe smfll lnLesLlne

ree||v|ng or Ind|rect Deve|opment ( neterogon|c Cyc|e)

L

rhfbdlLlform lfrvfe fre pfssed ln Lhe feces
2 MolL 4x Lo develop d|rect|y lnLo freellvlng mfles fnd femfles
3 1hese fdulLs copulfLe fnd eggs fre relefsed ln Lhe soll
4 L

(rhfbdlLlform lfrvfe) hfLch from Lhe eggs

3 MolL 4x fgfln fnd develop lnLo freellvlng fdulLs C
6 Mfy molL 2x Lo become lnfecLlve L
3
LhfL peneLrfLe skln Lo sLfrL f new pfrfslLlc cycle

Cuto|nfect|on

L
1
molL Lwlce Lo form L
3
sLfge ( f||ar|form |arvae) fs Lhey pfss Lhrough Lhe lfrge lnLesLlne
2 L3 peneLrfLe Lhe wfll of Lhe lfrge lnLesLlne
3 LnLer Lhe clrculfLlon mlgrfLe Lhrough Lhe lungs enLer resplrfLory Lree
4 wfllowed fnd lfrvfe molL Lwlce ln smfll lnLesLlne fnd become pfrfslLlc
parthernogenet|c femfles cfuslng hyper|nfect|on syndrome and pers|stent |nfect|on |n
endem|c area
3 Lggs are |a|d by the fema|e worm

atho|ogy and Symptomato|ogy of 5troy/oides stercoro/is
LlghL lnfecLlon ls longlfsLlng (up Lo 40 yefrs ) fnd ls generflly fsympLomfLlc
18LL (3) AL Cl A1CLCC?
Cutaneous hase skln peneLrfLlon of L
3

ln cute |nfect|on cuLfneous flndlngs usuflly occurs on Lhe fooL fL Lhe peneLrfLlon slLe
1hls erupLlon mfy conslsL of eryLhemfLous mfcules fnd pfpules or fcuLe urLlcfrlf fnd lL ls
ofLen fccompfnled by excorlfLlon

Larva currens f recurrenL cuLfneous flndlngs ln hronlc lnfecLlon
f fn lnLensely prurlLlc llnefr or serplglnous urLlcfrlfl leslon whlch Lyplcflly beglns wlLhln 2 cm of
Lhe fnus 1he leslons mfy conslsL of or more such bfnds whlch mlgrfLe lnLermlLLenLly fnd
rfpldly fL f rfLe fs ffsL fs 3 cm/h
b mfy flso occur on Lhe groln fnd Lrunk fnd frefs of lnvolvemenL on Lhe Lhlghs fnd upper body
hfve been descrlbed fs well
c excorlfLlon fnd lmpeLlglnlzfLlon fre common

2 Lung hase due Lo lung mlgrfLlon of L
3

pneumonlfllke sympLoms slmllfr Lo Ascotls hookworms cfuslng Loeffler's syndrome
u|monary Strongy|o|d|as|s f sysLemlc lnfecLlon ln dlssemlnfLed sLrongyloldlfsls ls
fssoclfLed wlLh flndlngs LhfL mfy be observed wlLh flveolfr or lnLersLlLlfl lnfllLrfLes wlLh /
wlLhouL pulmonfry effuslon
3 Intest|na| hase pfrfslLlc femfles burrow lnLo Lhe mucosf fnd submucosf of Lhe smfll lnLesLlne
cfuslng ulcerfLlon of Llssue fnd sloughlng of lnLesLlnfl cells
ulcerfLlon cfuses secondfry bfcLerlfl lnfecLlons
ompllcfLlons of lnLesLlnfl Lrongyloldlfsls ulcerfLlon cfuses secondfry bfcLerlfl lnfecLlons
atho|ogy of 5troy/oides stercoro/is
lrequenLly fsympLomfLlc fnd uncompllcfLed
mfll lnLesLlnfl dfmfge ln lmmunocompeLenL persons cfuses fbdomlnfl pfln fnd dlfrrhef
Alu pfLlenLs ulssemlnfLed sLrongyloldlfsls (hyperlnfecLlon syndrome) occurs ln
lmmunosuppressed pfLlenLs cfn presenL wlLh fbdomlnfl pfln dlsLenslon shock pulmonfry fnd
neurologlc compllcfLlons fnd sepLlcemlf fnd ls poLenLlflly ffLfl
@h|s |s the on|y he|m|nth that causes greater patho|ogy |n IDS pat|ents
nLINLC@ICN SNDCML
flso cflled dlssemlnfLed sLrongyloldlfsls
due Lo Lhe reproducLlve cfpfclLy of Lhe femfle pfrfslLe lnslde Lhe hosL Mfy lefd Lo
dlssemlnfLlon of lfrvfe beyond Lhe guL
nyper|nfect|on syndrome ls esLlmfLed Lo hfppen ln 3 Lo 23 of Lhe pfLlenLs wlLh
sLrongyloldlfsls (Mllder !L eL fl 98)
1he lnLesLlnfl mfnlfesLfLlons lnclude severe crfmplng fbdomlnfl pfln wfLery dlfrrhef welghL
loss nfusef vomlLlng fnd occfslonflly gfsLrolnLesLlnfl bleedlng
ubfcuLe lnLesLlnfl obsLrucLlon cfn flso be cfused by sLrongyloldlfsls
1he exLrflnLesLlnfl mfnlfesLfLlons lnclude mflnly fsLhmfllke sympLoms such fs cough fnd
wheezlng fnd oLhers such fs pneumonlf fnd pulmonfry hemorrhfge wlLh dlffuse bllfLerfl
lnfllLrfLes on Lhe chesL x rfy
D|agnos|s 5troy/oides stercoro/is
() Mlcroscoplc ldenLlflcfLlon of lfrvfe (rhfbdlLlform fnd occfslonflly fllfrlform) ln Lhe sLool or duodenfl
fluld
(2) AnLlbody deLecLlon LesLs
uLlllze fnLlgens derlved from ttooqylolJes stetcotolls fllfrlform lfrvfe for Lhe hlghesL senslLlvlLy fnd
speclflclLy
AlLhough lndlrecL fluorescenL fnLlbody (llA) fnd lndlrecL hemfggluLlnfLlon (lA) LesLs hfve been used
enzyme lmmunofssfy (LlA) ls currenLly recommended becfuse of lLs grefLer senslLlvlLy (90)

@reatment 5troy/oides stercoro/is

urug of cholce lvermecLln buL hfs serlous slde effecLs
AlLernfLlve drug Albendfzole

revent|on 5troy/oides stercoro/is
lmproved sfnlLfLlon (proper dlsposfl of feces)
rfcLlclng good hyglene (wfshlng of hfnds)
4Pl@DL4@l-
Genus and Spec|es Necator amer|canus ncy|ostoma duodena|e
Common Name new world hookworm Cld world hookworm
Lt|o|og|c gent of necfLorlfsls AncylosLomlfsls
unclnlfsls Jfkfnf ulsefse

Infect|ve stage lllfrlform lfrvf lllfrlform lfrvf
Def|n|t|ve nost Mfn Mfn
orta| of Lntry usuflly vlf skln usuflly vlf lngesLlon
peneLrfLlon rfLher rfLher Lhfn skln Lhfn
lngesLlon peneLrfLlon

Mode of @ransm|ss|on kln MouLh MouLh kln
nab|tat
73
mfll lnLesLlne mfll lnLesLlne
([e[unum lleum) (duodenum [e[unum)

athogen|c Stage L3 Lfrvf L3 Lfrvf

Maturat|on t|me 4936 33
|n host (days)
73









Il l-@5@l-4L 4PlLL4l45l5
ynonyms JfsLlng ulsefse udoc's MysLery ulsefse
f flshborne zoonoLlc dlsefse
cfused by fplllfrlf phlllpplnensls
AffecLlng Lhe smfll lnLesLlne
Lefdlng Lo enLeropfLhy or mflfbsorpLlon syndrome
1rfnsmllLed by efLlng rfw lnfecLed flsh
Lp|dem|o|ogy
1he flrsL humfn cfse of lnLesLlnfl cfplllfrlfsls wfs descrlbed ln 963 ln whlch f mfn from norLhwesLern
Luzon fell lll wlLh severe fbdomlnfl sympLoms fnd Llssue wfsLlng 1he dlfgnosls of lnLesLlnfl fplllfrlfsls
wfs mfde upon presenLfLlon of c pblllpploeosls eggs ln Lhe mfns sLool
ln less Lhfn flve yefrs more Lhfn 000 new cfses of lnLesLlnfl cfplllfrlfsls hfd been reporLed uurlng
Lhls perlod Lhe morLfllLy of Lhe dlsefse wfs fpproxlmfLely 0
mosL commonly ln men beLween 20 fnd 43 yefrs of fge buL Lhe dlsefse occurs ln boLh sexes fnd fll fge
groups
lL cfuses f severe proLelnloslng enLeropfLhy fnd mflfbsorpLlon syndrome wlLh f relfLlvely hlgh
morLfllLy unless fpproprlfLe Lherfpy ls lnsLlLuLed
Lndemlc ln Lhe hllllpplnes fnd ln pfrLs of 1hfllfnd
fses hfve flso been documenLed ln humfns oref !fpfn 1flwfn lndoneslf lrfn LgypL lLfly pfln
fnd olomblf
lnce 973 Lhe lncldence of lnLesLlnfl cfplllfrlfsls hfs decrefsed subsLfnLlflly lnce Lhe flrsL reporLed
cfse ln 963 f LoLfl of fpproxlmfLely 300 cfses of lnLesLlnfl cfplllfrlfsls hfve been reporLed

nosts of phi/ippiesis

resh and rack|sh Water |sh fre Lhe lnLermedlfLe hosLs of coplllotlo pblllpploesls
|shLat|ng |rds ln endemlc frefs fre consldered Lhe deflnlLlve hosLs for Lhe coplllotlo pblllpploesls
pfrfslLe

L|fe Cyc|e Cap|||ar|a ph|||pp|nens|s
lnfecLed humfn or fvlfn hosL expelled unembryonfLed eggs ln sLool lnLo Lhe exLernfl (usuflly fqueous)
envlronmenL
2 1he unembryonfLed eggs mfLure Lo embryonfLed eggs ln Lhe exLernfl envlronmenL
3 1he embryonfLed eggs fre lngesLed by fresh or brfcklshwfLer flsh whlch when hfLch relefse Lhe flrsL
lfrvfe (L) lnLo Lhe flsh lnLesLlnfl lumen
1he L molL Lwlce Lo L3 fnd burrow Lhrough Lhe lnLesLlnfl mucosf fnd peneLrfLe Lhe flshs mesenLerlc
fnd perlpherfl Llssues
4 umfn fnd fvlfn Lrfnsmlsslon occur when Lhe L3 fre lngesLed from rfw or undercooked lnfecLed flsh
3 L3 mfLure lnLo Lhe fdulL worms ln Lhe hosL's lnLesLlnfl lumen (mosL Lyplcflly of Lhe [e[unum)
6 lnslde Lhe humfn or fvlfn hosL lnLesLlne Lhe femfle worms deposlL unembryonfLed eggs whlch fre
subsequenLly expelled ln Lhe hosLs feces

D@CINLC@ICN
Cccur when Lhe egg lfld by Lhe femfle worm mfLure lnLo lnfecLlve lfrvfe fnd relnfecL Lhe sfme hosL
1hls fllow Lhe lnfecLlon Lo mulLlply wlLhln f slngle hosL lefdlng Lo hyperlnfecLlon

Cap|||ar|as|s atho|ogy and Symptomato|ogy

1he sympLoms resulLed from Lhe progresslve dfmfge Lo Lhe lnLesLlnfl eplLhellum fnd
submucosf cfused by Lhe fdulL worms whlch conLlnuflly Lrfverse fnd burrow lnLo Lhe
lnLesLlnfl mucosf
lsLologlc exfmlnfLlon of Lhe lnLesLlne revefls
V f reducLlon ln Lhe Lhlckness of Lhe lnLesLlnfl mucosf
V flfLLenlng or compleLe desLrucLlon of Lhe lnLesLlnfl vllll
V deepenlng of Lhe crypLs of Llberkuhn fnd
V locfllzed lnflfmmfLlon
1hls mechfnlcfl eroslon of Lhe smfll lnLesLlne ls responslble for Lhe physlologlcfl chfnges
fssoclfLed wlLh coplllotlosls pblllpploeosls lnfecLlon
1hese chfnges lnclude generfllzed mflfbsorpLlon hypoproLelnemlf low blood cflclum low
poLfsslum fnd hypocholesLerolemlf
ln conLrfsL wlLh mfny oLher pfrfslLlc lnfecLlons pronounced eoslnophlllf does noL conslsLenLly
fccompfny lnLesLlnfl cfplllfrlfsls

C||n|ca| features Intest|na| Cap|||ar|as|s

CfLen fsympLomfLlc or only mlldly sympLomfLlc
Lfrly sympLoms of lnLesLlnfl cfplllfrlfsls lnclude fbdomlnfl pfln dlfrrhef fnd borborygmus
1he syndrome resembles dlssemlnfLed sLrongyloldlfsls wlLh fuLolnfecLlon
1he lnlLlfl sympLoms of Lhe dlsefse fre mlld fnd conslsL of borborygml (gurgllng nolses ln Lhe guL)fnd
vfgue fbdomlnfl pfln
ulfrrhef develops wlLhln 26 weeks fL flrsL lL ls lnLermlLLenL buL lL Lhen becomes perslsLenL wlLh
pfssfge of flve Lo Len or more wfLery volumlnous spruellke sLools per dfy
llnlcfl fefLures lnLesLlnfl fplllfrlfsls
1here ls fssoclfLed welghL loss mflflse fnorexlf nfusef fnd vomlLlng
fLlenLs wlLh more fdvfnced dlsefse show cfchexlf fnd wefkness wlLh fbsenL or dlmlnlshed reflexes
profound muscle wfsLlng fnd loss of subcuLfneous ffL fnfsfrcf fnd dehydrfLlon
1he pfLlenL mfy hfve wefk hefrL sounds hypoLenslon fnd gfllop rhyLhm suggesLlng f
myocfrdlopfLhy
1he fbdomen ls dlsLended fnd Lhere ls eplgfsLrlc Lenderness
1he proLelnloslng enLeropfLhy resulLs ln severe hypoproLelnemlf fnd perlpherfl edemf
LxLreme welghL loss emfclfLlon fnd defLh mfy follow rfpldly ln severely lnfecLed lndlvldufls

D|agnos|s Cap|||ar|a ph|||pp|nens|s
llndlng Lhe ovf ln feces
Morphology
pefnuLshfped ovf wlLh sLrlfLed shell fnd flfLLened blpolfr plug
MeLhod ulrecL lecfl mefr or oncenLrfLlon MeLhod
2 llndlng Lhe AdulL ln feces
Morphology
mfll slender nemfLode wlLh
Llchosome ln Lhe fnLerlor pfrL
ema|e Ave 36 mm ln lengLh wlLh nfrrow fnLerlor fnd wlder posLerlor porLlons wlLh eggs ln Lhe
uLerus
Ma|e Ave 26 mm ln lengLh
wlLh cfudfl flfe ln Lhe posLerlor end

@reatment phi/ippieesis
peclflc 1refLmenL
urug of holce Mebendazo|e whlch ls fdmlnlsLered fs f Lwlce dflly dosfge of 200 mg for 20 dfys
AlLernfLlve urug |bendazo|e mfy be fdmlnlsLered ln f 400 mg dflly dose for Len dfys
2 nonspeclflc 1refLmenL
1refLmenL of Lhe sympLoms such
f ulfrrhef Clve fluld fnd elecLrolyLe supplemenLfLlon
b hypoproLelnemlf Clve hlgh proLeln dleL

revent|on and Contro| Cap|||ar|a ph|||pp|nens|s

Avold efLlng rfw or lnfdequfLely cooked flsh
2 fnlLfry dlsposfl of humfn wfsLe
3 eflLh educfLlon