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MDL 2016

NEMATODES

OVERVIEW

Who are they?

Trichuris trichiura –
Whipworm
Ascaris lumbricoides –
Large Intestinal Roundworm
Necator americanus –
New World Hookworm
Ancylostoma duodenale –
Old World Hookworm
Strongyloides stercoralis –
Threadworm

Intestinal-Tissue
Species

Intestinal Species

Enterobius vermicularis –
Pinworm/ Seat worm/ Society
worm

Trichinella spiralis
– Trichina worm

Terms to Remember
Infective Stage

Stage in the parasitic cycle capable of invading
a definitive host
Auto reinfection Reinfecting oneself
Buccal cavity
Long oral cavity
Corticated
Eggs containing a mammillated albuminous
substance
Decorticated
Eggs lacking a mammillated albuminous
substance
Copulation
Mating of worms
Cuticle
Surface covering present on adult nematodes
Embryonated
Fertilized egg
Unembryonated Unfertilized egg
Larva
Juvenile worms

General Characteristics • Three Basic Morphologic Forms • Vary in size and shape EGGS • Located inside the fertilized eggs. emerge and continue to mature • Develop from the maturing larvae • Sexes separate (females larger than males) • Equipped with a digestive and reproductive system LARVAE ADULT WORMS .

General Characteristics • Free living and parasitic species • Size may range from 2 mm to 1 meter • Two distinct sexes • • Male: smaller. some with copulatory bursa Female: larger and longer • Long-lived . curved or coiled posterior end.

teeth or plates Body is fairly complex Body wall: • • • Cuticle Hypodermis Muscle layer .Morphology • Unsegmented and • • • • bilateral symmetry Long and cylindrical Oral hooks.

Methods of Nourishment

• Sucking with ingestion of blood
• Ingestion of lysed tissues
• Feeding on intestinal contents
• Ingestion of nourishment from body fluids

Nematodes

• Mode of transmission:


Ingestion of infective stage
Larval penetration of skin
Insect bite

• Pathogenicity


Larval migration
Piercing of intestinal wall
Blood sucking

General Life Cycle of Intestinal
Nematodes
 Humans ingest infective eggs
 Larvae hatch in intestine
 Male and female adults develop in the intestine
 Fertilized eggs are produced

 Diagnostic stage – eggs or larvae in feces
 Larvae will develop in warm moist, soil

Ascaris lumbricoides
(Giant Intestinal Roundworm)

Overview • Final Host: Man • Habitat: Small Intestine • Diagnostic Stage: Egg (fertilized or unfertilized) • Infective Stage: Embryonated egg • Mode of Transmission: Ingestion of egg • Portal of Entry: Mouth .

Morphology-Lips • Lips • Tri-radiate or trilobate • Seen at the anterior end • Margin of each lip is lined with minute teeth .

Morphology-Adult • Adults • Creamy white to pinkish yellow • Male: 15-30 cm. straight tails. tapered at both ends . strongly curved tails. a bit “fatter”. with copulatory spicule • Female: 20-35 cm. small and slender.

Morphology-Adult .

Morphology-Egg • Unfertilized egg: • • • • Narrower and longer Thin shell No vitelline layer With coarse lecithin granules • Corticated or decorticated .

Morphology-Egg • Fertilized egg: • Oval or spherical • Thick walled • Inner vitelline layer • Middle glycogen layer • Outer albuminous coat (absent in decorticated egg) • Fertilized and unfertilized eggs: underdeveloped eggs are being passed in the stool .

Morphology-Egg • Embryonated egg: • • Infective stage Embryonation occurs in the soil .

Life Cycle .

worm bolus/obstruction. coughing. appendicitis. pancreatitis .Pathology • Ascariasis • Larva: • • • Ascaris pneumonitis or Loeffler’s Syndrome Difficulty in breathing. fever. malnutrition. lung infiltration May become erratic • Adult: • Diarrhea.

Diagnosis • Direct Fecal Smear • Eggs easily found (240.000 per day) • Kato-Katz Technique • Quantitative • Intensity of infection .

of 1 g) .Treatment • Albendazole • Drug of choice • 400 mg single dose • 200 mg for children under 2 years old • Mebendazole • 500 mg single dose • Pyrantel Pamoate • 10 mg/kg body weight (max.

Enterobius vermicularis (The Pinworm) .

Overview Final host Man Diagnostic stage Egg Infective stage Embryonated egg Mode of transmission Ingestion of inhalation Contact with contaminated lines or clothing Habitat Large intestine Synonym Oxyuris vermicularis Other common names Seatworm or society worm .

General Characteristics • Cervical or cephalic alae • Wing-like flaps or extensions • Esophageal bulb .

Morphology • Adult Male • Smaller • 2-5 mm in length • Curved. relatively blunt posterior end • Rarely seen .

Morphology • Adult Female • Longer • Long pointed tail • Gravid female lays (11.105 eggs on average/day) .

Morphology .

Morphology • Egg • Colorless and transparent • Thin-shelled • One side is flattened (“D-shaped”) • Content: larva .

Life Cycle .

Pathology • Enterobiasis or oxyularis • • • Itchiness Nocturnal pruritus ani Migration of the gravid females from the anus and deposition of eggs in the perianal folds of the skin .

Diagnosis • Scotch Tape Swab • Eggs and female adults removed from the skin in the perianal regions • Made in the morning before the patient has washed or defecated .

Treatment • Pyrantel pamoate • • Drug of choice 10 mg/kg with a second dose 2 to 4 weeks late • Albendazole • • Alternative drug 400 mg single dose • Mebendazole • 500 mg single dose .

Trichuris trichiura (The Whipworm) .

Overview Final host Man Diagnostic stage Unembryonated egg Infective stage Embryonated egg Mode of transmission Ingestion of egg Portal of entry Mouth Habitat Wall of the cecum (large intestine) .

Morphology-Adult • Adults • Flesh colored or pinkish slender worm • Thick posterior portion and long thin anterior portion • Whip-like appearance .

Morphology-Adult • Male • • • • 30-45 mm Coiled posterior portion Single spicule Refractile sheath • Female • • • 35-50 mm Bluntly rounded posterior end Can produce over 60 million eggs (average life span of 2 years) .

Morphology-Egg • With protuberant bipolar mucus plugs • Thick-shelled • Brown in color • • • • Foot ball-shaped Lemon-shaped Barrel-shaped Japanese lanternshaped .

Life Cycle .

Pathology • Trichuriasis leading to rectal prolapse during heavy infection • Iron Deficiency Anemia • Occurs quite frequently with A. lumbricoides due to similarities in MOT and MOD .

Treatment • Mebendazole • • • • Drug of choice 500 mg single dose (light infections) 2-3 days of consecutive treatment for moderate and heavy infections Contraindications: early pregnancy and hypersensitivity • Albendazole • • 400 mg single dose Contraindicated during pregnancy • Hard to expel because it attaches to the mucosa of the cecum by burying its anterior portion in a pin-fashion manner .

The Hookworms Necator americanus Ancylostoma duodenale .

Overview Final host Man Diagnostic stage Egg Infective stage Filariform larva Mode of transmission Skin penetration of infective larvae .

Non-human hookworms • Causes cutaneous larva migrans or creeping erruptions or ground itch • Ancylostoma braziliense • “cat hookworm” • Ancylostoma caninum • “dog hookworm” .

Comparison of Hookworms Points of differentiation Common name Habitat Ancylostoma duodenale Necator americanus Old world hookworm New world hookworm Small intestine (duodenum) Small intestine (jejunum) .

Comparison of Hookworms Points of differentiation Ancylostoma duodenale Necator americanus Size Body curvature Bigger Smaller “C” shaped “S” shaped .

Comparison of Hookworms Points of differentiation Dental pattern Ancylostoma duodenale Necator americanus 2 pairs of teeth Semi-lunar cutting plates .

Comparison of Hookworms Points of differentiation Ancylostoma duodenale Necator americanus Copulatory bursa of the male Circle (top view) Tridigitate/tripartite With unfused spicules Oval (top view) Bipartite/bidigitate With fused spicules .

Life Cycle .

2-8 cell stage (blastomeres) .Morphology-Egg • Ovoid • Thin-shelled (hyaline) • Bluntly round ends • In the early stage of segmentation.

Comparison of Larvae Rhabditiform larva (L1) Filariform larva (L3) Short Feeding stage larva Open mouth Flask-shaped esophagus Long Non-feeding stage Closed mouth With pointed tail and sheath .

asthma.Pathology • Larval migration • Dermatitis or ground itch (Wakana Disease) o Allergic reaction o Petechiae or papule o Itching and burning sensation • Pneumonitis o Cough. hemoptysis .

Hookworm Rhabditiform Larva .

Hookworm Filariform Larva .

Diagnosis • Harada-Mori Technique • Allowing hatching of larvae from eggs on strips of filter paper • Direct Fecal Smear • For heavy infections • Kato Katz Method • Quantitative diagnosis .

Treatment • Albendazole • Drug of choice • 400 mg single dose in adults and children over 2 years old • Mebendazole • 500 mg single dose in adults and children • Not recommended for children below 2 years old .

Strongyloides stercoralis (The Threadworm) .

Overview Final host Man Diagnostic stage Rhabditiform larva Infective stage Filariform larva Habitat Small intestine Facultative parasite Free living (soil) Parasitic (human body) Reproduction without fertilization Parthenogenic females .

stouter. spindle-shaped Short buccal cavity and a muscular esophagus • Filariform • • Long esophagus Forked or notched tail without a sheath .Morphology-Larva • Rhabditiform • • Smaller.

Strongyloides Rhabditiform Larva .

Strongyloides Filariform Larva .

stercoralis Long Small Short Prominent Shorter Pointed Yes Longer Notched Yes .Comparison of Larva L1 Rhabditiform Buccal capsule Genital primordium L3 Filariform Esophagus Tail end Sheath Hookworm S.

Life Cycle .

Pathology • Strongyloidiasis producing Cochin China Diarrhea or Honey Comb Ulcers • Invasion of skin by filariform • Migration of larva inside the body • Penetration of intestinal mucosa by female worms .

Diagnosis • • • • Eosinophilia Duodenal Aspiration Small bowel biopsy Concentration techniques • Harada Mori culture • Mode of transmission: skin penetration • Larvae penetrate skin and migrate to the lungs .

of 3 g/day) in 2 divided doses daily for 2 consecutive days after meals • Contraindicated in pregnant women and those with hypersensitivity to the drugs .Treatment • Albendazole • Drug of choice • 400 mg single dose for adults and children over 2 years of age • Eradicate up to 80% of infection • Thiabendazole • 500 mg/kg (max.

Capillaria philippinensis (The Pudoc Worm) .

Morphology-Adult • Female • Eggs in utero arranged in single or multiple rows • Male • Chitinized spicule • Long sheath extending beyond the length of the worm .

Morphology-Adult • • • Habitat: small intestine Female: 2.2-3.2 mm.4 mm Male: 2. with chitinized spicule and a long spicule sheath .5-4.

Morphology-Egg • Moderately thick striated egg sheath • Flattened bipolar plugs • Peanut-shaped • Guitar-shaped • Mistaken for Trichuris egg .

Life Cycle .

Capillariasis • • • • Borborygmi (gurgling stomach) Abdominal pain and diarrhea Weight loss Malabsorption • Mode of transmission • Eating raw freshwater fish • Intermediate hosts • • Brackish water fish: “bagsit” Fresh water fishes: ipon.Pathology . birot. bagsing or bagtu .

Treatment • Albendazole • 400 mg once a day for 20 days • Drug of choice • Destroys larval stages • Mebendazole • 200 mg 2x a day for 20 days .

Trichinella spiralis (The Trichina or Muscle Worm) .

Overview Habitat Small intestine (adults) Encysted in muscles of pigs (larva) Mode of transmission Ingestion of raw/undercooked meat containing encysted larva Portal entry Mouth Diagnostic specimen Skeletal muscle biopsy .

5 mm by 0.04 mm Pair of papillae to hold the female during copulation • Encysted Larva • • Spear-like burrowing anterior tip Infective stage .06 mm Club-shaped uterus Viviparous • Male • • 1.5 mm by 0.Morphology • Female • • • 3.

Encysted Larva .

Life Cycle .

carnivores or omnivores . bears. pigs. foxes.Life Cycle • Needs two hosts for the completion of life cycle • Serve both as final and intermediate hosts • Each hosts harbors both the adult and larval stages • Hosts: humans. rats. dogs. cats.

abdominal cramps. nausea • Larval migration and muscle invasion • Myalgia. eosinophilia • Complications: splenomegaly.Pathology • Trichinosis • Intestinal invasion • Diarrhea or constipation • Vomiting. cerebral lesions • Encystment .

twice a day for 7 days during the first week of infection expels the adult worm from the GI tract • No effect on migrating larvae and infections detected 2 weeks after exposure • Mebendazole • Larvicidal • 20 mg/kg body weight 6-hourly for 10 to 14 days .Treatment • Thiabendazole • 25 mg/kg body weight.

” -END OF PRESENTATION- .“Nothing worth having comes easy.