Intest|na| Nematodes 1 and 2

Genera| Character|st|cs of Nematodes
Ŧ 8oundţ unsegmenLed worms
2Ŧ fs compleLe dlgesLlve LrfcL
3Ŧ epfrfLe mfle fnd femfle sexes (dloeclous)Ť mfle ls usuflly lfrger Lhfn femfle
4Ŧ overed by Lough coverlng known fs cuLlcle

C|ass|f|cat|on of D|fferent Nematodes
Ŧ 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 loodŴborne or Llssue nemfLodes
V nemfLodes fffecLlng Lhe nervous sysLem

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

lfss Þhfsmldlf (wlLh phfsmlds fnd cfudfl recepLors)
Ascfrls
ookwormsť____________ fnd ____________
LnLeroblus
lllfrlfl wormsť ___________ Ŧ___________ţ____________ fnd __________
AnglosLorngylus
CnfLhosLomf

Intest|na| Nematodes of Med|ca| Importance
Ŧ nemfLode specles fffecLlng Lhe mfll lnLesLlne
fŦ 4scoris /umbricoides*
bŦ necfLor fmerlcfnus**
cŦ AncylosLomf sppŦ**
dŦ Lrongyloldes sLercorflls**
eŦ fplllfrlf phlllpplnensls**
2Ŧ nemfLode specles fffecLlng Lhe Lfrge lnLesLlne
fŦ @richuris trichiuro*
bŦ °terobius vermicu/oris*

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

scar|as|sť Lp|dem|o|ogy
4 1he fnnufl globfl morbldlLy ls esLlmfLed fL bllllon wlLh f morLfllLy of 20ţ000Ŧ
ÞrevflenL ln Lroplcfl counLrles fnd soclo econoŴmlcflly depressed frefs of Luropeţ LfLln
Amerlcfţ Aslf
73Ʒ of fll lnfecLlons ln AslfŤ
4 1he lncldence ls hlgher ln poor rurfl populfLlonsŤ
4 ln Lhe ÞhlllpplnesŴ 80Ŵ90Ʒ fre found ln rurfl frefs fnd slums ln Lhe clLles
ln some frefsţ 00Ʒ of people fre lnfecLed
lghesL lnfecLlon rfLes fre ln chlldren
3Ŧ2Ʒ of chlldren ln ovleL unlon hfd eggs ln nfsfl mucus
ln L uAţ 20Ŵ60Ʒ of chlldren lnfecLed
4 Ascfrlfsls cfn occur fL fll fgesţ buL lL ls more prevflenL ln Lhe 3 Lo 9 yefrs fge groupŦ
4 1hrlves ln counLrles wlLh poor sfnlLfLlon fnd poverLy fnd lgnorfnce
1rfnsmlsslon by lngesLlon of conLfmlnfLed foodţ wfLer/soll
uslng humfn ffeces/ nlghL soll fs ferLlllzer
4 MosL common sourceof lnfecLlonť soll conLfmlnfLed foods esp lf vegeLfbles fre efLen rfw
4 Lggs fre lncredlbly reslsLfnL Lo chemlcflsť
eggŦ reslsLfnL Lo 2Ʒ formflln fnd 30Ʒ lţ nlLrlc/ sulfurlc fcld
O due Lo Lhe llpld lfyer of Lhe eggshell
4 Lggs remfln vlfble for long perlods Lhus long llved ln sollŴ 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
Ŧ AJolt wotms llve lo tbe lomeo of tbe smoll lotestloeŦ
2Ŧ A femole moy ptoJoce opptoxlmotely 200ţ000 eqqs pet Joyţ wblcb ote posseJ wltb tbe feces wblcb coo
eltbet be fettlllzeJ ooJ oofettlllzeJŦ uofettlllzeJ eqqs moy be loqesteJ bot ote oot lofectlveŦ
JŦ o sollţ fettlle eqqs develop lnLo f 2Ŵcell sLfge fnd fdvfnced clefvfge sLfge
4Ŧ @beoţ oftet Joys to sevetol weeks tbey embtyooote wltb tbe lotvol stoqe loslJe ooJ become lofectlve (
JepeoJloq oo tbe optlmom eovltoomeotol cooJltloosť molstţ wotmţ sboJeJ soll)Ŧ
5Ŧ @be lofectlve embtyoooteJ eqqs ote swolloweJ ţ tbe lotvoe botcb lo tbe smoll lotestloeŦ
6Ŧ @be lJ lovoJe tbe lotestlool mocoso ooJ ote cottleJ vlo tbe pottolţ tbeo systemlc cltcolotloo to tbe looqs Ŧ
Aftet two moltloqsţ tbe lJ motote loto l5 lo tbe looqs (0 to 4 Joys)ţ tbeo peoettote tbe olveolot
wollsŦ
7Ŧ l5 osceoJ tbe btoocblol ttee to tbe tbtootţ ooJ ote swolloweJ Ŧ upoo teocbloq tbe smoll lotestloeţ tbey
Jevelop loto oJolt wotms Ŧ 8etweeo 2 ooJ J mootbs ote tepolteJ ftom loqestloo of tbe lofectlve eqqs to
ovlposltloo by tbe oJolt femoleŦ AJolt wotms coo llve to 2 yeotsŦ cuc
scar|as|sť Þatho|ogy and C||n|ca| Þhases
4Ŧ Lu°– phose
Cccurs wlLhln 3Ŵ6 dfys ffLer exposure
uue Lo mlgrfLlon of lfrvfe Lo Lhe lungs
L3 lfrvfe molLed Lwlce Lo form Lhe L3
ln severe lnfecLlonsţ lL cfn lefd Loť
4 emorrhfges fnd desLrucLlon of lung pfrenchymf fs Lhe lfrvfe brefks Lhrough Lhe
cfplllfrles
4 loefflet´s loeomoolo Ŷeoslnophlllc lnfllLrfLlon of Lhe lungs
4 ÞneumonlLls
llnlcfllyť AsLhmfLlc Lype of resplrfLlon
ough wlLh rfles fnd chesL pfln


Ŧ l°testi°o/ Phose
Cccurs 2Ŵ3 monLhs ffLer exposure
uue Lo mfLurfLlon of L3 Lo fdulL worms ln Lhe smfll lnLesLlne
Þresence of fdulL worms ln Lhe lnLesLlne cfn cfuseť
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 presenLfLlonť vfgue fbdomlnfl pfln ( mosL frequenL complflnL)ţ dlfrrhef fnd loss of
fppeLlLe
4 A cfse of compllcfLed Ascfrlfsls Ŵ ln1L1lnAL C818u1lCn

Ŧ wo°deri°– worms
Mflnly due Lo errfLlc behfvlor of Lhe fdulL worms mfy lefd Loť
4 ÞerforfLlon of Lhe bowel lefdlng Lo perlLonlLls
4 lnvfslon fnd blockfde of Lhe hollow sLrucLuresť
AppendlxŴ fcuLe fppendlclLls
ommon blle ducL Ŷ blllfry fscfrlfsls
LusLfchlfn Lube Ŷ CLlLls medlf
Lfrynx Ŷ suffocfLlon
4 lnvfslon of vlLfl orgfns llke llver ( fbscess) fnd gfll blfdder (gfllsLones due Lo Ascotls
eggs)

scar|as|sť D|agnos|s
AŦ llndlng Lhe ovf ln feces Ŷ mosL prfcLlcfl meLhod
Ŧ ulrecL lecfl mefr
2Ŧ 1hlck mefr MeLhod
fLo 1echnlque
fLo fLz 1echnlque wlLh 40Ŵ60 mg feces

AdvfnLfgesť
Ŧ lL cfn qufnLlLfLe Lhe number of eggs
2Ŧ lL cfn deLermlne Lhe egg reducLlon ffLer LrefLmenL
3Ŧ lL cfn deLermlne Lhe lnLenslLy of lnfecLlon
Morpho|ogy of 4scoris Cva
O ert|||zed Cva] LggsŴ mosLly ovfl or spherlcflŤ golden brown ln color
fpfble of developmenL ln soll from slngle cell Lo embryonfLed egg
onslsL of Lhree shell lfyersť
fŦ lnner nonpermefble llpoldfl vlLelllne mebrfneŴ ( fbsenL ln lnferLlle egg)
bŦ 1hlck LrfnspfrenL mlddle lfyer glycogen membrfne
cŦ CuLermosL cofrsely mfmlllfLed flbumlnold lfyer Ŷ (fbsenL ln decorLlcfLed
egg)
O Dnfert|||zed Cva] LggsŴ lfrger ln slzeţ ovold wlLh Lhlnner shell
fŦ wlLh fn lrregulfr cofLlng of flbumln fnd
bŦ hlghly refrfcLlle grfnules lnslde Lhe proLoplfsm ť
cŦ fnnoL undergo developmenL ln soll
O lLmbryonated Cva]Lggs
fŦ 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

3Ŧupper Cl erlesŴ for Lhe ouLllne of AdulL worm buL lL ls noL cosL efflclenL

ŦIdent|f|cat|on of 4scoris du|t

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

AŦ lemfle Jormť
O @apered at both ends
O Lfrger Lhfn mflesţ 22Ŵ33 cm by 3 cm
O Mfy go up Lo 43 cm
O Þflred reproducLlve orgfns ln Lhe posLerlor 2/3 of femfle
8Ŧ Mfle wormť
O Curved poster|or end
O mfller Lhfn femfleţ 0Ŵ3 cm x 3 cm

@reatment for scar|as|s
peclflc 1refLmenLť
V 8rofd specLrum fnLhelmlnLhlc drug
Mechfnlsm of fcLlonť neuromusculfr blocklng effecL on pfrfslLe lefdlng Lo pfrflysls of
worms
Albendfzole 400 mg slngle dose
Mebendfzole 300 mg slngle dose
ÞyrfnLel pfmofLe 0 mg/kg fs slngle dose
Ascfrlfslsť onLrol Mefsures
V Mfss urug AdmlnlsLrfLlon ln Lhe communlLyť 3x f yefr for Lhree yefrs
V MeLhodť
elecLlve Mfss urug AdmlnlsLrfLlonť for Lhose resldenLs wlLh poslLlve sLool exfmlnfLlon
only
1frgeLed Croupť 1refLlng hlldren flone
1refLmenL of choolchlldrenť 2x f yefr fL fn lnLervfl of 4Ŵ6 monLhs

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


IIŦ @ICnDISIS
O ynonymsť Jhlpworm lnfecLlon
O fused by @tlcbotls ttlcblotoţ f soll LrfnsmlLLed helmlnLh
O lrequenLly lnfecL chlldren 3Ŵ3 yefrs of fge
O ÞrevflenL ln Þhlllpplnesţ prevflence rfLe ls 80Ŵ84Ʒ frequenLly fssoclfLed wlLh Ascfrls lnfecLlon
O ÞrevenLfble fnd curfble

@r|chur|as|sť 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 rflnffllţ subLroplcfl cllmfLe fnd hlghly polluLed soll
More chlldren fre lnfecLed Lhfn fdulLs
lfcLors fffecLlng Lrfnsmlsslonť
V lndlscrlmlnfLe defecfLlon of chlldren ln Lhe yfrd
V Þoor heflLh educfLlon
V Þoor personflţ ffmlly fnd communlLy hyglene
lemfle worm lfys 3ţ000Ŵ0ţ000 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 sollţ Lhe eggs develop lnLo f 2Ŵcell sLfge fnd fdvfnced clefvfge sLfge
3) 1hen Lhey embryonfLe fnd become lnfecLlve ln 3 Lo 30 dfys
4) AfLer lngesLlon (sollŴconLfmlnfLed hfnds or food)ţ Lhe eggs hfLch ln Lhe smfll lnLesLlneţ 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 colonŦ 1he fdulL
worms fre flxed ln LhfL locfLlonţ wlLh Lhe fnLerlor porLlons Lhrefded lnLo Lhe mucosfŦ 1he femfles
begln Lo ovlposlL 60 Lo 70 dfys ffLer lnfecLlonŦ lemfle worms ln Lhe cecum shed beLween 3ţ000 fnd
20ţ000 eggs per dfyŦ 1he llfe spfn of Lhe fdulLs ls fbouL yefrŦ

@r|chur|as|sť Þatho|ogy Ǝ Symptomato|ogy
Jorms embedded ln Lhe mucosf cfn cfuse peLechlfl hemorrhfges
LlghL lnfecLlonsť no cllnlcfl sympLoms
efvy ÞfrfslLlsmť chronlc lnfecLlons

@r|chur|as|sť C||n|ca| features
lrequenL smfllŦ 8loodŴsLrefked dlfrrhelc sLools
Abdomlnfl pfln fnd Lenderness
nfusef fnd vomlLlng
Anemlf Ŷ mfybe mfrked wlLh b level of 3 g/00ml
JelghL loss
AcuLe or subfcuLe fppendlclLls Ŷ lf worms fre fLLfched Lo Lhe fppendlcefl mucosf fnd
encourfge enLry of bfcLerlf Lo Lhe fppendlx
ecta| pro|apse Ŷ due Lo worms embedded ln Lhe mucosf
4 f condlLlon ln whlch Lhe recLum (Lhe lower end of Lhe colonţ locfLed [usL fbove Lhe
fnus) Lurns lLself lnslde ouL
@r|chur|as|sť D|agnos|s
ln hefvy lnfecLlonsţ cllnlcfl presenLfLlon mfy be relled upon Lo mfke f dlfgnosls plus Lhe
fecflysls resulL
ln llghL lnfecLlonţ requesL for Lhe sLool exfmlnfLlon uslngť
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
|emonŴshaped or barre|Ŵshaped eggs wlLh b|po|ar p|ugs ln Lhe feces
lzesť 34 um x 23 um
JlLh yellowŴbrown ouLer fnd f LrfnspfrenL lnner shell
unembronfLed fL ovlposlLlon
Lmbryonlc developmenL Lfkes plfce ln Lhe exLernfl envlronmenL (soll)
Less reslsLfnL Lo desslcfLlonţ hefL fnd cold Lhfn AŦ 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 lemfleť lfrger ţ 33Ŵ30 mm wlLh blunLly rounded posLerlor/Lfll wlLh eggs ln uLerus
V Mfleť smfllerţ 30Ŵ43 mmţ colled posLerlor end wlLh slngle splcule fnd reLrfcLlle shefLh




@r|chur|as|sť @reotme°t
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 doseŴ flLernfLlve drug
NonŴspec|f|c @reatment
V ympLomfLlc fnd supporLlve mfnfgemenL

@r|chur|as|sť Þrevent|on and Contro|
Mfss urug 1refLmenL lf lnfecLlon ln Lhe communlLy ls 30Ʒ
ÞrevenLlve Mefsures ln hlghly endemlc frefsť
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


IIIŦ LN@LCISIS

ynonymť humfn plnworm/sefLworm lnfecLlonţ Cxyurlfsls
fused byť LnLeroblus vermlculfrls
hfrfcLerlzed by perlfnfl lLchlng
1rfnsmlLLed by lngesLlon or lnhflfLlon of eggs fnd by fuLoŴ or reLroŴlnfecLlon
ÞrevenLfble fnd curfble

Lnterob|as|s ť Lp|dem|o|ogy
lnfecLlon occur Lhroughť
Ŧ fndŴLoŴmouLh LrfnsmlsslonŴ mosL common rouLe
Ŵ from lngesLlon of eggs ffLer scrfLchlng Lhe fnfl frefs or from hfndllng conLfmlnfLed
fomlLes
2Ŧ lnhflfLlon of flrborne eggs from dusL
3Ŧ reLroŴlnfecLlon Lhrough Lhe fnus
Ŵoccurs 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 frefŦ
Þrevflence of lnfecLlonť
V Clobfllyť 208Ŧ8 M fre lnfecLed
V ommonly fffecLs school chlldrenť 29Ʒ from Lhe prlvfLe schools fnd 36Ʒ from Lhe
publlc schools
V Lggs hfve been collecLed under Lhe flngernflls of Lhese chlldren

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

L|fe Cyc|e of °terobius vermicu/oris
Ŧ Crfvld femfles mlgrfLe Lo perlfnfl reglon fL nlghLŦ Lggs fre deposlLed on perlfnfl foldsŦ Lggs
mfLure ln 4Ŵ6 hours lnLo embryonfLed lnfecLlve sLfge under opLlmum condlLlonŦ
2Ŧ 1rfnsmlsslon of lnfecLlon occurred fsť
fŦ AuLolnfecLlon by Lrfnsferrlng lnfecLlve eggs Lo Lhe mouLh wlLh hfnds LhfL hfve scrfLched
Lhe perlfnfl fref
bŦ ÞersonŴLoŴperson Lrfnsmlsslon cfn flso occur Lhrough
lŦ hfndllng of conLfmlnfLed cloLhes or bed llnens
llŦ conLfmlnfLed surffces ln Lhe envlronmenL wlLh plnworm eggs (eŦgŦţ curLflnsţ cfrpeLlng)
lllŦ lnhflfLlon ln some smfll number of eggsŦ 1hese would be swfllowed fnd follow Lhe
sfme developmenL fs lngesLed eggsŦ
3Ŧ lollowlng lngesLlon of lnfecLlve eggsţ Lhe lfrvfe hfLch ln Lhe smfll lnLesLlne Ŧ
4Ŧ 1he fdulLs developed Lhemselves ln Lhe colonŦ 1he Llme lnLervfl from lngesLlon of lnfecLlve eggs Lo
ovlposlLlon by Lhe fdulL femfles ls fbouL one monLhŦ 1he llfe spfn of Lhe fdulLs ls fbouL Lwo
monLhsŦ
3Ŧ Crfvld femfles mlgrfLe nocLurnflly ouLslde Lhe fnus fnd ovlposlL whlle crfwllng on Lhe skln of Lhe
perlfnfl fref Ŧ 1he lfrvfe fre relefsed when Lhe embryonfLed eggs fre hfLchedŦ
6Ŧ 8eLrolnfecLlonţ or Lhe mlgrfLlon of newly hfLched lfrvfe from Lhe fnfl skln bfck lnLo Lhe recLumţ
mfy rfrely occurŦ

Lnterob|as|sť Þatho|ogy and Symptomato|ogy
l/3 of cfses fre fsympLomfLlc
1hree (3) forms of pfLhologlc flndlngs due Loť
V 4du/t worm ottochme°t
MlnuLe ulcerfLlons fnd fbscess ln Lhe cecfl mucosf
V –– depositio° ot the o°o/ oreo
fn cfuse severe lLchlng or prurlLus ln Lhe perlenfl reglon
crfLchlng mfy lefd Lo scfrlfled leslon
Pruritus o°iŴ hemorrhfges fnd eczemf or bfcLerlfl lnfecLlons of Lhe fnus fnd
perlfnfl fref
4 Þerlfnfl fnd perlnefl lLchlngţ especlflly fL nlghLţ
4 A rfsh coupled wlLh lnsomnlf fre Lhe mosL common complflnLs of
plnworm lnfecLlonŦ
V 4du/t worm mi–rotio°
Mfy lfy eggs ln genlLfl orgfns vulvovfglnlLs
Mfy enLer fflloplfn Lube sflplnglLls

Lnterob|as|sť D|agnos|s
lsLory fnd Þhyslcfl LxfmlnfLlonť hlldren wlLh per|ana| |tch|ngţ lnsomnlf fnd resLlessness
1he presence of plnworms cfn be conflrmed ln one of Lwo wfysŦ
V D|rect observat|on of the adu|t worms fround Lhe fnusţ perlneumţ or enLrfnce Lo Lhe
vfglnfŦ 1he opLlmum Llme Lo see Lhe worms ls Lo 2 hours ffLer f chlld hfs gone Lo bed
or upon fwfkenlng ln Lhe mornlngŦ
V Scotch tape swab
MeLhodť Þer|ana| Scoth] Ce||ophane @ape Swab
V wfb for eggs ls preferfbly done ln Lhe mornlng before Lfklng f bfLh or
defecfLlon
V 3Ʒ (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 Ǝ Larvae
Morpho|ogy of Cva
V ŴLlongfLed ţ ovold wlLh one convex fnd one flfLLened end produclng a DŴshaped ovum
wlLh wellŴdeveloped embryo
V JlLh 2 egg shell lfyersť
CuLer Lhlck hyfllne flbumlnold Ǝ
lnner embryonlc llpoldfl lfyer
V Mefsures 33um x 23 um
Morpho|ogy of |arvať
V lolded once lnslde Lhe egg shell
Ident|f|cat|on of °terobius du|t
Morpho|ogy of du|t
Ŵmfll whlLlsh or brownlsh worm wlLh cuLlculfr flfr expfnslon fL Lhe fnLerlor end
( cepha||c a|ae)
Ŵ ema|eť 8Ŵ3 mm x 0Ŧ4 mm wlLh promlnenL esophfgefl bulb fnd long polnLed LfllŤ
uLerus mfy hfve eggs
Ŵ Ma|eť 2Ŵ3 mm wlLh curved Lfll fnd slngle copulfLory splcule (rfrely seen)


Lnterob|as|sť @reatment
peclflc 1refLmenL
V ÞyrfnLel pfmofLe 0 mg/kg wlLh f second dose 2Ŵ4 weeks lfLer
V Mebendfzole 300 mg slngle dose
V Albendfzole 400 mg slngle dose
nonŴspeclflc 1refLmenL
V ympLomfLlc LrefLmenL

Lnterob|as|sť Contro| and Þrevent|on
Þersonfl hygleneť flngernflls should be cuL shorLŤ 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
ÞroLecL foods from dusL fnd from Lhe hfnds of lnfecLed person

IVŦ nCCkWCM DISLSL
D|seaseť ncy|ostom|as|s
Synonymsť nky|ostom|as|sţ flLernfLlvely spelled anchy|ostom|as|s fnd flso cflled he|m|nth|as|sţ ƍm|nersƌ
anaem|aƍţ ƍtunne| d|seaseƍţ ƍbr|ckmakerƌs anaem|aƍ fnd ƍLgypt|an ch|oros|sƍţ
Iron def|c|ency anem|a ls Lhe dlsefse cfused by hookworms
Þaras|t|c gentť
-ecotor omerico°us *
4°cy/ostomo duode°o/e*
AncylosLomf cfnlnum**
AncylosLomf brfzlllenze**
AncylosLomf ceylfnlcum***
W *oll Ŷ LrfnsmlLLed helmlnLhs LhfL lnfecL mfn
W ** specles fffecLlng cfL fnd dogŤ cfnnoL mfLure ln mfn
W *** specles ffecLlng cfL fnd dog Ť cfn develop Lo fdulLs ln humfn

L|fe Cyc|e of 2 nookworms |s s|m||ar
ŦLggs fre pfssed ln Lhe sLool fnd under ffvorfble condlLlons (molsLureţ wfrmLhţ shfde)ţ eggs
embryonate Ŧ
2ŦLfrvfe hfLch ln Lo 2 dfys fnd relefsed rhabd|t|form |arvae (L1) whlch grow ln Lhe feces fnd/or Lhe
sollŦ
3Ŧ L
1
mo|ts tw|ce and Lhey become fllfrlform lfrvfe (L3)LhfL fre lnfecLlve Ŧ 1hese lnfecLlve lfrvfe cfn
survlve 3 Lo 4 weeks ln ffvorfble envlronmenLfl condlLlonsŦ
4Ŧ Cn conLfcL wlLh Lhe humfn hosLţ Lhe lfrvfe peneLrfLe Lhe sklnŦ Larvae typ|ca||y penetrate sk|n of
the feet when one wa|ks barefooted through warm so||Ŧ @hey fre cfrrled Lhrough Lhe blood vessels Lo
Lhe hefrL fnd Lhen Lo Lhe lungsŦ 1hey peneLrfLe lnLo Lhe pulmonfry flveollţ fscend Lhe bronchlfl Lree Lo
Lhe phfrynxţ fnd fre swfllowed Ŧ
3Ŧ 1he lfrvfe refch Lhe smfll lnLesLlneţ where Lhey reslde fnd mfLure lnLo fdulLsŦ AdulL worms llve ln
Lhe lumen of Lhe smfll lnLesLlneţ where Lhey fLLfch Lo Lhe lnLesLlnfl wfll wlLh resulLfnL blood loss by Lhe
hosLŦ

du|ts occur |n the human smfll lnLesLlneŦ Mfle fnd femfle fre commonly found ln copu/oŦ 8oLh fre
well fLLfched Lo Lhe lnLesLlnfl mucosf wlLh Lhe buccfl cfpsuleŦ lemfle relefses eggs whlch fre pfssed
|n the fecesŦ 8oLh specles show hlgh fecundlLyť
AŦ JooJeoole produces 23ţ000 Lo 30ţ000 eggs/dfyŦ
NŦ ometlcooos produces 9ţ000 eggs/dfyŦ

MosL fdulL worms fre ellmlnfLed ln Lo 2 yefrsţ buL Lhe longevlLy mfy refch severfl yefrsŦ
ome AŦ JooJeoole lfrvfeţ followlng peneLrfLlon of Lhe hosL sklnţ cfn become dormfnL (ln Lhe lnLesLlne
or muscle)Ŧ ln fddlLlonţ lnfecLlon by AŦ JooJeoole mfy probfbly flso occur by Lhe orfl fnd
Lrfnsmfmmfry rouLeŦ NŦ ometlcooosţ howeverţ requlres f Lrfnspulmonfry mlgrfLlon phfseŦ

Þathogenes|s ť 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 wormsŦ
4 A hefvy lnfecLlon lnvolves 300 or more wormsŦ
4 ympLoms fre severe fnd Lhe lnfecLlon mfy be llfeŴLhrefLenlngŦ
4 ookworm lnfecLlon ls rfrely ffLflţ buL fnemlf cfn be slgnlflcfnL ln Lhe hefvlly lnfecLed
lndlvlduflŦ

@nLL ÞnSLS C nCCkWCM DISLSL
Ŧ Cutaneous Þhase Ŵ peneLrfLlon of L3 lnLo Lhe sklnţ usuflly Lhe feeLŤ lLchlng fnd reddlsh rfsh
occurs cfuslng ground |tchŦ
Cutaneous |arva m|grans (creep|ng erupt|on) Ŷ due Lo fnlmfl hookworms (AŦ brfzlllense ƽ AŦ
cfnlnum)
ÞfLhogeneslsť ookworm ulsefse
2Ŧ Lung Þhase Ŵ due to |ung m|grat|on of L3
S|mp|e Lung Los|noph|||a ( Loeff|er's Syndrome) Ŵ pneumonlfŴllke sympLoms occur fs L3 brefk ouL
of Lhe cfplllfrles fnd enLer Lhe flveoll (sympLoms fre noL fs severe fnd fs common fs Ascotls
mlgrfLlon
3Ŧ Intest|na| Þhase Ŵ fdulLs fLLfch Lo Lhe mucosfl wfll fnd mfy peneLrfLe lnLo Lhe submucosf
where Lhey vorfclously suck blood Ŵ up Lo 200 ml of blood mfy be losL/dfy
W AŦ JooJeoole Lfkes 0Ŧ26 ml/dfyŤ
W NŦ ometlcooos 0Ŧ03 ml/dfy
W ookworms fre very wfsLefulţ fs mosL of Lhe blood Lfken slmply pfsses Lhrough lLs lnLesLlne
buL ls losL Lo Lhe hosLŦ
W 8lood loss ls fssoclfLed wlLh ICNŴDLICILNC¥ NLMI cfused by vorfclously sucklng blood
from Lhe hosLƌs lnLesLlnfl wflls
W lnfecLed fdulLs become Llred fnd rundown
W MenLfl fnd growLh reLfrdfLlon commonly occurs ln chlldrenŦ
W 1he pfLhology fnd sympLomfLology Ƌ number of worms fnd lron lnLfke of Lhe pfLlenLŦ
W 8ecenL flndlngs lndlcfLe LhfL Lhere ls f reduct|on |n gamma g|obu||ns (prote|ns) wh|ch resu|ts |n
ÞC@LIN MLND@I@ICN predlsposlng Lhem Lo oLher lnfecLlonsŦ
W omblnfLlon of Lhese ffcLors can be fata|Ŧ

D|agnos|sť nookworm d|sease
Ŧ |nd|ng the eggs |n the feces Lhroughť
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 Lhlnţ smooLh eggshellŦ
W lnLernfllyţ eggs fre flwfys efrly ln mlLosls Ŵ conLfln 2 Lo 8 cellsŦ
W lzeť 33Ŵ73 DŽm x 33Ŵ40 DŽm
2ŦnaradaŴMor| cu|ture Ŷ f meLhod of lncubfLlng fecfl mfLerlfl on f fllLer pfper sLrlp ln f LesL Lube conLflnlng
wfLer (cover oneŴLhlrd of Lhe lengLh of Lhe pfper sLrlp)
Þurposeť ulLurlng fnd recoverlng Lrongyloldes fnd hookworm lfrvfe from eggs presenL ln Lhe fecfl
sfmpleŦ





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 Ŵ 4°cy/ostomo co°i°um Ŵ ls efslly recognlzed by lLs 3 pa|rs of teeth ln Lhe buccfl
cfpsuleŦ
V fL hookworm Ŵ 4°cy/ostomo broti/ie°se Ŵ hfs f pa|r of |ong teethŦ lL does noL mlgrfLe Lo Lhe
lnLesLlne fnd mfLureŦ
V 8oLh specles lnhfblL Lhe smfll lnLesLlne of Lhelr hosLsŦ
V Llfe cycles fnd pfLhology fre slmllfr Lo humfn speclesŦ
V uMAn mfy serve fs fccldenLfl hosLs of Lhese hookworms when Lhe fllfrlform lfrvfe (L
3
)
peneLrfLe humfn sklnŦ

@wo (2) Þatho|og|ca| Þrob|ems |n numansť
Ŧ Cutaneous |arva m|grans (ƹ Creep|ng Lrupt|on)
V L
3
of dog or cfL hookworms enLer humfn skln fnd wfnder fbouL ln epldermlsŦ
V AŦ btozllleoze ls Lhe mf[or cfusfLlve fgenL of humfn cuLfneous lfrvf mlgrfnsŦ 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 redţ lLchy lrrlLfLlon
V 1refLed wlLh Lhlfbendfzole olnLmenL or LfbleL
V AnoLher refson Lo clefn up dog fnd cfL feces!

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

peneLrfLe sklnŦ

@reatment of nookworm D|sease
SÞLCIIC @L@MLN@ť
urug of holce Ŷ |bendazo|e 400 mg slngle dose ls effecLlve ln LrefLlng boLh specles
or Mebendfzole or ÞyrfnLel ÞfmofLe
NCNŴSÞLCIIC @L@MLN@ť
ympLomfLlc Ǝ upporLlve 1refLmenLť
lerrous ulffLe 1fbleLs Lo correcL fnemlfŦ
Contro| and Þrevent|on of nookworm D|sease
ÞLVLN@ICNť
Ŧ uo noL use humfn excremenL or rfw sewfge or unLrefLed ƌnlghL sollƌ fs mfnure/ferLlllzer ln
fgrlculLure ŴŴŴŴsLop polluLlon of soll wlLh lnfecLed feces
2Ŧ uo noL defecfLe ln plfces oLher Lhfn lfLrlnesţ LolleLs Ŵ Lhls hfs ellmlnfLed much of Lhe problem
3Ŧ Jefrlng of shoes or sllppers Ŵ prevenL peneLrfLlon of L
3

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

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

IŦ 5@-Llul45l5
W A humfn pfrfslLlc dlsefse cfused mflnly by Lhe nemfLodeţ ttooqylolJes stetcotolls
W CLher Lrongyloldes lnclude Ŧ follebotolţ whlch lnfecLs Afrlcfn prlmfLes espŦ chlmpfnzees fnd bfboons
fnd mfy produce llmlLed lnfecLlons ln humfnsŦ
W 1rfnsmlLLed by skln peneLrfLlon of fllfrlform lfrvfe (L3)
W fblLfLť Sma|| |ntest|ne of manŦ
W Cosmopo||tan ln dlsLrlbuLlon buL ls mosL common ln wfrmţ molsL cllmfLesŦ

L|fe Cyc|e of 5tro°–y/oides stercoro/is
W Þaras|t|c adu|ts ||ve |n the sma|| |ntest|ne of humfns fnd oLher mfmmflsŦ
W lemfles produce eggs by parthenogenes|sŴ f form of fsexufl reproducLlon found ln femflesţ where
growLh fnd developmenL of embryos occurs wlLhouL ferLlllzfLlon by f mfleŦ
W Dnfert|||zed eggs g|ve r|se to offspr|ngŦ
W ÞfrfslLlc femfles burrow lnLo Lhe mucosf Lo relefse Lhelr ovfŦ
W Jhen Lhe eggs refch Lhe lumen of Lhe smfll lnLesLlneţ Lhe eggs hfLch fnd Lhe L1 (ƹ rhabd|t|form
|arvae) are re|eased |nto the |umenŦ
W 1he L1 (ƹ 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

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

Ŧ L

fre pfssed ln Lhe feces onLo wfrmţ molsL sollŦ
2Ŧ ln Lhe sollţ Lhe L

molL 2x Lo L
3
(fllfrlform lfrvfe)
3Ŧ L
3
peneLrfLe Lhe skln (llke hookworm lfrvfe) fnd enLer Lhe clrculfLlonŦ
4Ŧ Co Lhrough lung mlgrfLlonţ L3 molL 2x Lo L3Ŧ
3Ŧ wfllowed fnd develop Lo pfrfslLlc fema|es ln Lhe smfll lnLesLlneŦ

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

Ŧ L

rhfbdlLlform lfrvfe fre pfssed ln Lhe feces
2Ŧ MolL 4x Lo develop d|rect|y lnLo freeŴllvlng mfles fnd femflesŦ
3Ŧ 1hese fdulLs copulfLe fnd eggs fre relefsed ln Lhe sollŦ
4ţ L

(rhfbdlLlform lfrvfe) hfLch from Lhe eggs
3Ŧ MolL 4x fgfln fnd develop lnLo freeŴllvlng fdulLs C
6Ŧ Mfy molL 2x Lo become lnfecLlve L
3
LhfL peneLrfLe skln Lo sLfrL f new pfrfslLlc cycleŦ

CŦuto|nfect|on

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

Þatho|ogy and Symptomato|ogy of 5tro°–y/oides stercoro/is
LlghL lnfecLlon ls longŴlfsLlng (up Lo 40 yefrs ) fnd ls generflly fsympLomfLlcŦ
18LL (3) ÞAL Cl ÞA1CLCC?ť
Ŧ Cutaneous ÞhaseŴ skln peneLrfLlon of L
3

Ŵ ln cute |nfect|onţ cuLfneous flndlngs usuflly occurs on Lhe fooL fL Lhe peneLrfLlon slLeŦ
Ŵ 1hls erupLlon mfy conslsL of eryLhemfLous mfcules fnd pfpules or fcuLe urLlcfrlfţ fnd lL ls
ofLen fccompfnled by excorlfLlonŦ

Larva currens Ŵ f recurrenL cuLfneous flndlngs ln hronlc lnfecLlon ť
fŦ fn lnLensely prurlLlc llnefr or serplglnous urLlcfrlfl leslonţ whlch Lyplcflly beglns wlLhln 2 cm of
Lhe fnusŦ 1he leslons mfy conslsL of or more such bfndsţ whlch mlgrfLe lnLermlLLenLly fnd
rfpldly fL f rfLe fs ffsL fs 3 cm/hŦ
bŦ mfy flso occur on Lhe groln fnd Lrunkţ fnd frefs of lnvolvemenL on Lhe Lhlghs fnd upper body
hfve been descrlbed fs wellŦ
cŦ excorlfLlon fnd lmpeLlglnlzfLlon fre commonŦ

2Ŧ Ŧ Lung Þhase Ŵ due Lo lung mlgrfLlon of L
3

Ŵ pneumonlfŴllke sympLoms slmllfr Lo Ascotls Ǝ hookworms cfuslng Loeffler's syndrome
Þu|monary Strongy|o|d|as|s Ŷ f sysLemlc lnfecLlon ln dlssemlnfLed sLrongyloldlfsls ls
fssoclfLed wlLh flndlngs LhfL mfy be observed wlLh flveolfr or lnLersLlLlfl lnfllLrfLes wlLh /
wlLhouL pulmonfry effuslon Ŧ
3Ŧ Intest|na| Þhase Ŵ pfrfslLlc femfles burrow lnLo Lhe mucosf fnd submucosf of Lhe smfll lnLesLlne
cfuslng ulcerfLlon of Llssue fnd sloughlng of lnLesLlnfl cellsŦ
Ŵ ulcerfLlon cfuses secondfry bfcLerlfl lnfecLlons
ompllcfLlons of lnLesLlnfl Lrongyloldlfsls Ŵ ulcerfLlon cfuses secondfry bfcLerlfl lnfecLlons
Þatho|ogy of 5tro°–y/oides stercoro/is
lrequenLly fsympLomfLlc fnd uncompllcfLedŦ
mfll lnLesLlnfl dfmfge ln lmmunocompeLenL persons cfuses fbdomlnfl pfln fnd dlfrrhef
Alu pfLlenLsť ulssemlnfLed sLrongyloldlfsls (hyperlnfecLlon syndrome) occurs ln
lmmunosuppressed pfLlenLsţ cfn presenL wlLh fbdomlnfl pflnţ dlsLenslonţ shockţ pulmonfry fnd
neurologlc compllcfLlons fnd sepLlcemlfţ fnd ls poLenLlflly ffLflŦ
@h|s |s the on|y he|m|nth that causes greater patho|ogy |n IDS pat|ents
n¥ÞLINLC@ICN S¥NDCML
flso cflled dlssemlnfLed sLrongyloldlfsls
due Lo Lhe reproducLlve cfpfclLy of Lhe femfle pfrfslLe lnslde Lhe hosL Mfy lefd Lo
dlssemlnfLlon of lfrvfe beyond Lhe guLŦ
nyper|nfect|on syndrome ls esLlmfLed Lo hfppen ln Ŧ3 Lo 2Ŧ3Ʒ of Lhe pfLlenLs wlLh
sLrongyloldlfsls (Mllder !Lţ eL flţ 98)
1he lnLesLlnfl mfnlfesLfLlons lnclude severe crfmplng fbdomlnfl pflnţ wfLery dlfrrhefţ welghL
lossţ nfusefţ vomlLlng fnd occfslonflly gfsLrolnLesLlnfl bleedlngŦ
ubfcuLe lnLesLlnfl obsLrucLlon cfn flso be cfused by sLrongyloldlfslsŦ
1he exLrflnLesLlnfl mfnlfesLfLlons lnclude mflnly fsLhmfŴllke sympLoms such fs cough fnd
wheezlngţ fnd oLhers such fs pneumonlf fnd pulmonfry hemorrhfge wlLh dlffuse bllfLerfl
lnfllLrfLes on Lhe chesL x rfyŦ
D|agnos|sť 5tro°–y/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
speclflclLyŦ
AlLhough lndlrecL fluorescenL fnLlbody (llA) fnd lndlrecL hemfggluLlnfLlon (lA) LesLs hfve been usedţ
enzyme lmmunofssfy (LlA) ls currenLly recommended becfuse of lLs grefLer senslLlvlLy (90Ʒ)Ŧ

@reatmentť 5tro°–y/oides stercoro/is

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

Þrevent|onť 5tro°–y/oides stercoro/is
lmproved sfnlLfLlon (proper dlsposfl of feces)
ÞrfcLlclng 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 ofť necfLorlfslsţ AncylosLomlfslsţ
unclnlfsls Jfkfnf ulsefse

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

Mode of @ransm|ss|on kln ƽ MouLh MouLh ƽ kln
nab|tat
ż73Ž
mfll lnLesLlne mfll lnLesLlne
([e[unumţ lleum) (duodenumţ [e[unum)

Þathogen|c Stage L3 Lfrvf L3 Lfrvf

Maturat|on t|me 49Ŵ36 33
|n host (days)
ż73Ž









Il Ŧ l-@5@l-4L 4PlLL4l45l5
ynonymsť JfsLlng ulsefseţ Þudoc's MysLery ulsefse
f flshŴborne 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|ogyť
1he flrsL humfn cfse of lnLesLlnfl cfplllfrlfsls wfs descrlbed ln 963ţ ln whlch f mfn from norLhwesLern
Luzon fell lll wlLh severe fbdomlnfl sympLoms fnd Llssue wfsLlngŦ 1he dlfgnosls of lnLesLlnfl fplllfrlfsls
wfs mfde upon presenLfLlon of cŦ pblllpploeosls eggs ln Lhe mfnƌs sLoolŦ
ln less Lhfn flve yefrsţ more Lhfn ţ000 new cfses of lnLesLlnfl cfplllfrlfsls hfd been reporLedŦ uurlng
Lhls perlodţ Lhe morLfllLy of Lhe dlsefse wfs fpproxlmfLely 0ƷŦ
mosL commonly ln men beLween 20 fnd 43 yefrs of fgeţ buL Lhe dlsefse occurs ln boLh sexes fnd fll fge
groupsŦ
lL cfuses f severe proLelnŴloslng enLeropfLhy fnd mflfbsorpLlon syndromeţ wlLh f relfLlvely hlgh
morLfllLy unless fpproprlfLe Lherfpy ls lnsLlLuLed
Lndemlc ln Lhe Þhllllpplnes fnd ln pfrLs of 1hfllfndŦ
fses hfve flso been documenLed ln humfns orefţ !fpfnţ 1flwfnţ lndoneslfţ lrfnţ LgypLţ lLflyţ pflnţ
fnd olomblfŦ
lnce 973ţ Lhe lncldence of lnLesLlnfl cfplllfrlfsls hfs decrefsed subsLfnLlfllyŦ lnce Lhe flrsL reporLed
cfse ln 963 f LoLfl of fpproxlmfLely 300 cfses of lnLesLlnfl cfplllfrlfsls hfve been reporLedŦ

nosts of Ŧ phi/ippi°e°sis

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

L|fe Cyc|eť Cap|||ar|a ph|||pp|nens|s
Ŧ lnfecLed humfn or fvlfn hosL expelled unembryonfLed eggs ln sLool lnLo Lhe exLernfl (usuflly fqueous)
envlronmenLŦ
2Ŧ 1he unembryonfLed eggs mfLure Lo embryonfLed eggs ln Lhe exLernfl envlronmenLŦ
3Ŧ 1he embryonfLed eggs fre lngesLed by freshŴ or brfcklshŴwfLer flsh whlch when hfLch relefse Lhe flrsL
lfrvfe (L) lnLo Lhe flsh lnLesLlnfl lumenŦ
1he L molL Lwlce Lo L3 fnd burrow Lhrough Lhe lnLesLlnfl mucosfţ fnd peneLrfLe Lhe flshƌs mesenLerlc
fnd perlpherfl LlssuesŦ
4Ŧ umfn fnd fvlfn Lrfnsmlsslon occur when Lhe L3 fre lngesLed from rfw or undercooked lnfecLed flshŦ
3Ŧ L3 mfLure lnLo Lhe fdulL worms ln Lhe hosL's lnLesLlnfl lumen (mosL Lyplcflly of Lhe [e[unum)Ŧ
6Ŧ lnslde Lhe humfn or fvlfn hosL lnLesLlneţ Lhe femfle worms deposlL unembryonfLed eggsţ whlch fre
subsequenLly expelled ln Lhe hosLƌs fecesŦ

D@CŴINLC@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 hyperlnfecLlonŦ

Cap|||ar|as|sť Þatho|ogy and Symptomato|ogy

1he sympLoms resulLed from Lhe progresslve dfmfge Lo Lhe lnLesLlnfl eplLhellum fnd
submucosf cfused by Lhe fdulL wormsţ whlch conLlnuflly Lrfverse fnd burrow lnLo Lhe
lnLesLlnfl mucosfŦ
lsLologlc exfmlnfLlon of Lhe lnLesLlne reveflsť
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 LlberkuhnŤ fnd
V locfllzed lnflfmmfLlonŦ
1hls mechfnlcfl eroslon of Lhe smfll lnLesLlne ls responslble for Lhe physlologlcfl chfnges
fssoclfLed wlLh coplllotlosls pblllpploeosls lnfecLlonŦ
1hese chfnges lnclude generfllzed mflfbsorpLlonţ hypoproLelnemlfţ low blood cflclumţ low
poLfsslumţ fnd hypocholesLerolemlfŦ
ln conLrfsL wlLh mfny oLher pfrfslLlc lnfecLlonsţ pronounced eoslnophlllfţ does noL conslsLenLly
fccompfny lnLesLlnfl cfplllfrlfslsŦ

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

CfLen fsympLomfLlc or only mlldly sympLomfLlc
Lfrly sympLoms of lnLesLlnfl cfplllfrlfsls lnclude fbdomlnfl pflnţ dlfrrhefţ fnd borborygmusŦ
1he syndrome resembles dlssemlnfLed sLrongyloldlfsls wlLh fuLolnfecLlonŦ
1he lnlLlfl sympLoms of Lhe dlsefse fre mlld fnd conslsL of borborygml (gurgllng nolses ln Lhe guL)fnd
vfgue fbdomlnfl pflnŦ
ulfrrhef develops wlLhln 2Ŵ6 weeksŤ fL flrsL lL ls lnLermlLLenL buL lL Lhen becomes perslsLenL wlLh
pfssfge of flve Lo Len or more wfLeryţ volumlnousţ sprueŴllke sLools per dfyŦ
llnlcfl fefLuresť lnLesLlnfl fplllfrlfsls
1here ls fssoclfLed welghL lossţ mflflseţ fnorexlfţ nfusefţ fnd vomlLlngŦ
ÞfLlenLs wlLh more fdvfnced dlsefse show cfchexlf fnd wefknessţ wlLh fbsenL or dlmlnlshed reflexesţ
profound muscle wfsLlngţ fnd loss of subcuLfneous ffLţ fnfsfrcfţ fnd dehydrfLlonŦ
1he pfLlenL mfy hfve wefk hefrL soundsţ hypoLenslonţ fnd gfllop rhyLhm suggesLlng f
myocfrdlopfLhyŦ
1he fbdomen ls dlsLended fnd Lhere ls eplgfsLrlc LendernessŦ
1he proLelnŴloslng enLeropfLhy resulLs ln severe hypoproLelnemlf fnd perlpherfl edemfŦ
LxLreme welghL lossţ emfclfLlon fnd defLh mfy follow rfpldly ln severely lnfecLed lndlvlduflsŦ

D|agnos|sť Cap|||ar|a ph|||pp|nens|s
Ŧ llndlng Lhe ovf ln feces
Morphologyť
pefnuLŴshfped ovf wlLh sLrlfLed shell fnd flfLLened blpolfr plug
MeLhodť ulrecL lecfl mefr or oncenLrfLlon MeLhod
2Ŧ llndlng Lhe AdulL ln feces
Morphologyť
mfllţ slender nemfLode wlLh
Llchosome ln Lhe fnLerlor pfrL
ema|eť AveŴ 3Ŧ6 mm ln lengLh wlLh nfrrow fnLerlor fnd wlder posLerlor porLlons wlLh eggs ln Lhe
uLerus
Ma|eť AveŴ 2Ŧ6 mm ln lengLh
wlLh cfudfl flfe ln Lhe posLerlor end

@reatmentť Ŧ phi/ippi°e°esis
Ŧ peclflc 1refLmenLť
urug of holceť Mebendazo|eţ whlch ls fdmlnlsLered fs f Lwlce dflly dosfge of 200 mg for 20 dfysŦ
AlLernfLlve urugť |bendazo|e mfy be fdmlnlsLered ln f 400 mg dflly dose for Len dfysŦ
2Ŧ nonŴspeclflc 1refLmenLť
1refLmenL of Lhe sympLoms such
fŦ ulfrrhefŴ Clve fluld fnd elecLrolyLe supplemenLfLlon
bŦ hypoproLelnemlf Ŷ Clve hlgh proLeln dleLŦ

Þrevent|on and Contro|ť Cap|||ar|a ph|||pp|nens|s

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