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Classification of Medically Significant Nematodes

Classification of Medically Significant Nematodes

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NEMATODES

Classification of medically significant nematodes
A. Based on the presence of absence of caudal receptor. a. Class Enoplea- with caudal receptor and with caudal glands. - trichuris trichura - trichinella spiralis - capillaria philipinensis

2. Class Rhabditea- with caudal receptor but without caudal glands - ascaris lumbricoides - stronglyloides stercoralis - enterobius vermicularis - filarial worms - hookworms - dracunculus medinensis - anglostrongylus cantonensis

Based of habitat
A.

Intestinal nematodes 1. Small intestine - ascaris lumbricoides - capillaria philipinensis - hookworms - strongyloides stercoralis 2. large intestine - trichuris trichura - enterobius vermicularis

b. Extra intestinal Nematodes 1. Trichinella spiralis- muscle 2. Filarial worms- lymphatic tissue 3. Dracunculus medinensis- tissue 4. Anglostrongylus cantonensis- brain

ASCARIS LUMBRICOIDES
  

Giant intestinal roundworm Disease- human ascariasis Adult - largest and most common - 15-30 cm by 3 mm male - 20-40 cm by 5 mm female - cylindrical, elongated, tapering in the end - containing lateral lines seen as whitish streak along the entire length of the body - terminal mouth with trilobate lips with a small triangular buccal cavity

Ova

Fertilized ova
 

Broadly ovoid, golden brown in color 45-75 by 35-45 micron with 3 thick transparent layers
Vitelline membrane- inner non permeable  Glycogen membrane- thick transparent middle layer  Albuminous/ mammilary coat- outermost layer

Fertilized ova

Decorticated fertilized ova

Unfertilized ova

 

Larger, longer, elongated or sometimes irregular in shape 88-94 microns Two layers
Glycogen membrane  Albuminous layer  * vitelline layer is absent

Unfertilzed Ova

Life cycle
    

 

Adult in small intestine Eggs passes out in the feces Embryonation in 1-2 weeks Fully embryonayed egss ingested by man In the small intestine, larva penetrate the mucosa and enters the blood circulation Heart and lung migration, molt twice Larvae ascend respiratory tree and swallowed, descend to the small intestine to mature

Pathology
Adult  Feeds on intestinal contents  abdominal pain, diarrhea, nausea, loss of appetite  Due to eratic migration might lead to regurgitation and escape through the nostril  Vomited ascaris may pass the larynx and might lead to suffocation or reach the lung producing gangrene  might enter the eustachian tube and provole otitis media

    

Extra intestinal pathology May invade bile duct, gall bladder, appendix May cause hemorrhagic pancreatitis Migration to the peritoneal cavity leads to peritonitis Even the worms cause little or no traumatic damage the by product of living or dead worms may rarely produced toxic manifestation such as edema and urticaria accompanied by loss of appetite and weight

Diagnosis
   

Direct fecal smear Kato-thick Kato- katz Concentration technique

Treatment
   

Piperazine citrate Pyrantel pamoate Mebendazole Albendazole

*piperazine and pyrantel pamoate with neuromuscular blocking effect that paralyses the parasites.

Prevention and control
     

Treatment of infected individual Sanitary waste disposal Hand washing before meals Proper personal hygiene Thorough washing and cooking of food Avoid using human excreta as fertilizer

TRICHURIS TRICHURA
  

Whipworm Trichuriasis Adults
   

Attached to the wall of the caecum Whiplike and posterior end is more robust Female- 3.5- 5 cm Male- 3-4.5 cm and coiled posterior end

Ova

  

Unsegmented, barrel shaped, lemon, football shaped ova Bi-polar plugs With 3 layers Embryonation takes place in the soil where the first stage larvae is formed within 3 weeks

Life cycle

   

Adult worms attached to the wall of the caecum Eggs passes out of the feces Embryonate in 2-3 weeks Embryonated eggs ingested by man Larvae hatch in the intestine

Pathology
     

Small streaked diarrheic stool Abdominal pain and tenderness Nausea and vomiting Hypochromic anemia Weight loss Rectal prolapse

Diagnosis
  

Direct fecal smear analysis Kato-thick or kato Katz Concentration technique

Treatment
  

Albendazole Mebendazole Pyrantel pamoate

Prevention and control
     

Treatment of infected individual Sanitary waste disposal Hand washing before meals Proper personal hygiene Thorough washing and cooking of food Avoid using human excreta as fertilizer

Enterobius vermicularis
  

Pinworm or seatworm Enterobiasis or oxyuriasis Adults
   

Small whitish or brown in color Male- 2-5 mm coiled tail end Female- 8-13mm pointed tail end Diagnostic in the presence of cephalic alae and distinct or prominent esophageal bulb.

Ova
   

Elongated 50-80 by 20-30 microns Flattened lateral side, lopsided D Two egg-shell layer
    

Albuminous layer- outer Embryonic or lipoidal membrane- inner Embryonated when laid Resistant to disinfectant Under favorable condition, it remains viable for 13 days

Life cycle
 

   

Adults in the caecum Gravid females migrate to the perianal area to deposit embryonated egg Ova are infective to man 6hrs after deposition Ova are ingest of inhaled by man Larvae hatch in the duodenum Migrate to its final habitat in the large intestine

Pathology
       

Poor appetite Insomia Weight loss Irritability Grinding of teeth Nausea Vomiting Pruritus ani

Diagnosis

Scotch tape swab

Treatment
  

Albendazole Mebendazole Pyrantel pamoate

Transmission
  

Hand to mouth Inhalation autoinfection

Trichinella spiralis
  

Trichina worm Trichinosis Adult
Minute  Male-1.5 by 0.04 mm with single testis near the posterior end  Female- 3.6 by 0.06 mm with single ovary  The female is viviparous or larviparous capable of producing 1,500 larvae

Larvae
  

80-120 micron by 5.6 microns at birth 900-1300 micron by 35-40 microns Spear like burrowing anterior

Life cycle
 

 

  

Encysted larvae in pig muscle Ingestion of improperly cooked pork Infected flesh is digested by gastric juice Adults in the duodenum Larviparous female burrows into mucosa and deposit larvae Larvae enters the circulation Encyst in striated muscle Dead end cycle

Pathology

Incubation and intestinal invasion

Includes diarrhrea, constipation, vomiting abdominal cramps, nausea Fever, facial edema, urticaria, pain and swelling weakness Splenomegaly, gastric and intestinal hemorrhages Fever, weak, pain

Larval migration muscle invasion
 

Encysment and encapsulation

Diagnosis
 

Muscle biopsy Serological- ELISA

Treatment
 

Thiabendazole during the first week Mebedazole larvicidal

Prevention and control
 

Cook meat 77 C 177 F Freezing- - 15C for 20 days or -30 C for 6 days Smoking, salting, or drying is not effective

Hookworms
   

Necator americanus- New World Hookworm Ancylostoma duodenale- old world hookworm Ancylostoma braziliense- cat hookworm Ancylostoma caninum- dog hookworm

Necator americanus
 

S-shaped Buccal capsule id provided with semilunar cutting plate With amphidial gland that secretes anticoagulant Copulatory bursa is longer than broad with bipartite dorsal ray and a long slender copulatory spicules that is fused at the tip forming a delicate barb.

Necator americanus

Adult necator

Tail- end

Necator Ova

Ancylostoma duodenale
  

Stout, body contour into letter c 2 pairs of ventral teeth With copulatory bursa characterized as bristle like with tridigitate dorsal ray

Ancylostoma duodenale

Ova

Ancylostoma brazilienze

With a pair of teeth and a pair o f inconspicuous median teeth in the buccal capsule Broad and long copulatory bursa with short lateral rays

Filariform, rhabditiform

Ova

Ancylostoma caninum
 

With 3 pair of ventral teeth Secretes anticoagulant that delays the coagulation of blood.

Ancylostoma caninum

Ova

Larval stage

Rhabditiform
    

Long narrow buccal cavity Flask shaped esophagus With inconspicuous genital primordium Open mouth Feeding stage

Filariform
   

Longer and slender with pointed posterior end Closed mouth with protective covering Non feeding stage Infective stage

Life cycle
         

Adults in the small intestine Ova in feces Rhabditiform larvae 1-2 days Filariform 5-8 days Filariform penetrate the skin Enters the circulation Lungs Trachea Swallowed Esophagus

Pathology

 

 

Ground itch- pruritus, secondary bacterial infection Pulmonary lesion- Wakana disease Creeping eruption- dermatitis characterized by intracutaneous lesion Hookwrom anemia- microcytic hypochromic Albuminea- low level of albumin due to combined loss of blood, lymph and protein

Diagnosis
 

Direct fecal smear Harada-mori

Treatment
  

Mebendazole Albendazole Thiabendazole

Strongyloides stercoralis
    

Threadworm Cochin-china diarrhea Capable of both free living and parasitic 2-7 mm and 30-40um in width Colorless, semitransparent nematode

Larvae

Rhabditiform- short buccal cavity, elongated esophagus with pyriform posterior bulb and conspicuous genital primodium Filariform- long delicate larvae with long esophagus and forked or notched tail

Life cycle
         

Small intestine Ova in feces Rhabditiform larvae-------------filariform—adult free living--Filariform --ova---rhabditiform---filariform-----host Skin ----adult Circulation Heart Lungs Trachea esophagus

Prevention
  

Proper waste disposal Personal hygiene Avoid being barefooted on suspected infected area medication

Treatment
  

Mebendazole Albendazole thiabendazole

Precaution

Administration of ORS to prevent dehydration and loss of electrolytes

Filarial worms
 

  

 

Arthropod transmitted Invades circulatory system, muscle, serous cavities, lymphatic system 2-50cm with inconspicuous buccal cavity Males with two copulatory spicule Viviparous females gives birth to prelarval microfilaria Microfilaria is motile , snakelike with dark staining nuclei occupying most of the entire body Sheathed ( with embryonic sheath ) Unsheated ( with no embryonic sheath )

Periodicity
    

Noctunal Diurnal Subperiodic Subpeiodic diurnal Subperiodic nocturnal

Wuchereria Bancrofti
    

 

Bancroft’s filarial worm elephantiasis Males- 2-4 cm Females- 8-10 cm Microfilaria is nocturnal with curvatures and graceful appearance, tapering tail with no terminal nuclei Lower lmphatics Elephantiasis

Microfilaria ( wuchereria bancrofti )

Pathology
  

Tropical pumonary eosinophilia Granuloma of the spleen In the lymph nodes they promote pseudotubercular granulomatous reactions, leads to edema, vascular and lymphatic hyperplasia, fibrosis and caesation Elephantiasis- scrotum, vulva, enlargement of the genitals and lower lymphatics

Diagnosis and treatment
 

Blood smear ( check periodicity ) Treatment

DEC- Diethyl carbamazine

Aedes

Anopheles

Brugia malayi
    

Malayan filarial worm Malayan filariasis Male- 13-23 mm Female- 43-55 mm With two distinct or discrete nuclei at the tip of the tail

Vector Mansonia uniformis

Treatment

DEC

Loa Loa
    

African Eye worm Calabar swelling Sheathed microfilaria Subcutaneous tissue ( Habitat ) Vector- chrysops

Disease
   

Calabar swelling Conjunctiva granuloma Bug eye- painless edema of the eyelids Protopsis- bug eye

Calabar swelling

Treatment and control
  

Protection from the bite of the vectors Control of the vector Chemotherapy with diethylcarbamazine

Onchocerca volvulus
     

Convoluted filaria River blindness Nodules in the subcutaneous tissue Males- 19-42 mm Females- 33.5-50mm Vector simulium

Pathology
      

Fever Eosinophilia Urticaria Blindness Pruritus Hyperkeratosis Hanging groin

Diagnosis and treatment
 

  

Skin snip of the subcutaneous nodules Not found on the blood but can be found on the urine Surgical removal of the nodule DEC followed by suramin Mebendazole as an alternate drug of choice

Toxocara canis and Cati
   

Dog and cat ascaris Normal habitat- cats and dogs, human accidental host Visceral larval migrans Life cycle- same as humans

Pathology
      

Visceral larval migration Hemorrhage Necrosis and granuloma Eosinophilia Liver damage Pulmonary inflammation Ocular problems

Diagnosis and Treatment
    

Marked eosinophilia Hepatomegaly Hyperglobulinemia Direct fecal smear Tx

Thiabendazole

Prevention and control
 

Avoid contact with infected animals Animal under 6 mos. Should be dewormed with piperazine Proper waste disposal of animal droppings

Toxocara canis ova

Toxocara cati

Toxocara canis ova

Capillaria philipinensis
   

Pudoc worm Borborygamy Diarrheal disease dehydration

Capillaria ova

Other nematodes

Angiostrongylus cantonensis
 

 

Rat lungworm Pila, planaria, fresh water prawns are intermediate host Infection to rats involves lungs for development In humans stays in the brain

Pila Africana

Planaria

Dracunculus medinensis

 

Guinea worm, dragon worm, fiery serpent worm of the israelites Inhabits the tissue Female 70-120cm

Life cycle
       

Adults in the cutaneous tissue Larva escapes from skin blister 1st stage Free swimming ( rhabditiform ) Ingested by cyclops, copepods Body cavity of cyclops or copepods Infective stage ( filariform ) Ingested by man Adults in the tissue

Diagnosis includes flooding of the ulceration on the skin Treatment- niridazole, metronidazole and thiabendazole

Copepods

Cyclops

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