Ascariasis Prof.

Fernando Oliveira Discipline: Clinical Parasitology - UFPI Ascariasis STANDINGS Trematoda Cestoda Plathyhelminthes metazoans Hymenolepis Taenia Echinococcus Enterobius Ascaris Trichuris Strongyloides Toxoc ara Ancylostoma Necator Wuchereria Oncocerca Schistosoma and Fasciola Aschelminthes Nematoda Ascariasis ETIOLOGY: Ascaris lumbricoides (roundworm) FILO: Aschelminthes CLASS: ORDER Nematoda: Secermentea FAMILY: GENDER Ascaridida e Ascaris Ascaris * Suuna Ascariasis Morphology • Male: It is approximately 20-30 cm in length presents rear end stro ngly curved towards the ventral surface • Female: It is approximately 30-40 cm i n length presents rear end Rectilinear Increased intestinal nematode Ascariasis Morphology Eggs large, brown the oval Ascariasis BIOLOGICAL CYCLE Ascariasis BIOLOGICAL CYCLE Ascariasis Ascariasis PATHOGENESIS AND SINTOMATOLOGIA. Larval stage invasion: cough, fever, eosinophil ia, pneumonia. Intestinal Phase: indigestion, abdominal pain, weight loss, irrit ability, vomiting, adult worms in the stool. Bowel obstruction: folding adult wo rm migration of adult worms elsewhere (appendix, liver) - detectable by X-rays. The adult worms may leave the nose and mouth Ascariasis Adult worms removed from the intestine of a patient with massive infection Ascariasis Ascariasis

Massive infection with Ascaris Ascariasis Ascariasis Ascariasis IMMUNE RESPONSE: Predominant TH2 response: TH1 - T cells produce IL1 TH2 T4 - T8 produces IL4 and IL5 Effective for viruses and intracellular bacteria stimulates the production of AC by LB - effective against extracellular bacteria and parasites Cytotoxic - apop tosis Ascariasis EPIDEMIOLOGY. Parasite prevalence worldwide. More frequent human helminthiasis ( approx 30% of world population.) Factors influencing the high prevalence: - Larg e egg production by females (about 200.000/dia/fêmea) - Feasibility of egg infec tive in soil for many months Ascariasis Diagnostic laboratory examination of stools: Macroscopic: Microscopic study of a dult worms: Research Methods eggs: Direct (with Lugol) ® sensitivity> 90% Sedime ntation: Hoffman and Ritchie Kato-Katz (quantitative worm burdens) Ascariasis ENTEROBIOSE OR OXIUROSE ENTEROBIOSE STANDINGS Etiology: Enterobius vermicularis Phylum: Aschelminthes Class: Nematoda Family: Oxyuridae Genus: Enterobius Popularly known as "pinworm" ENTEROBIOSE MORPHOLOGY • Male: Measures 3-5 mm long Presents curvature flow • Female: It measures about 1cm Presents tapered tail Both expansions are called cephalic wings on each side of the end Previous ENTEROBIOSE MORPHOLOGY • Eggs: They are approximately 50-54 μm x 20-27 μm They have thin skin and are c olorless flattened on one side (as in D) Larva developed ENTEROBIOSE ENTEROBIOSE

ENTEROBIOSE MECHANISMS OF TRANSMISSION Heteroinfecção: Eggs (dust or food) → airways or mouth (new host) eggs (anal are a) → mouth (new host) Auto-infection: Eggs (perianal) → mouth or airways Hatchin g (perianal) → → anus cecum → adult worms (retroinfecção) ENTEROBIOSE PATHOGENESIS AND SINTOMATOLOGIA . Many cases are asymptomatic. Rarely cause serious injury. Symptoms associated with migration of pregnant female out of the anus:. Perianal Pruritus night, ins omnia, irritability. Irritation of the vulva in girls Enterobius perianal ENTEROBIOSE EPIDEMIOLOGY . Worldwide distribution. High prevalence in children of school age. Females eli minate large quantities of eggs in the perianal ENTEROBIOSE LABORATORY DIAGNOSIS . Parasitological examination: search of eggs or adult females. Method: gummed t ape or Graham (anal swab) eggs are rarely found in faeces. Sensitivity stool tes t (enrichment methods): <10% ENTEROBIOSE Trichuriasis Trichuriasis Etiology: Trichuris trichiura Phylum: Aschelminthes Class: Nematoda Family: Tric huridae Genus: Trichuris Popularly known as "tricúris or tricocéfalo" Trichuriasis MORPHOLOGY • Adult worms: They measure 3-5 cm in length the anterior portion of both is thin and tapered, while the latter is wider (1 / 3) Trichuriasis Trichuriasis MORPHOLOGY • Worms adults: The male is smaller and has a curved rear end (360 ° C) with copulatory spicule Trichuriasis MORPHOLOGY • Eggs: They measure 50-54 μm x 23 μm were elliptical (barrel-shaped) with protr uding pores and transparent on both ends Trichuriasis

Trichuriasis Trichuriasis PATHOGENESIS AND SINTOMATOLOGIA . → mild asymptomatic infections. Symptomatic: nervousness, insomnia,€loss of ap petite, eosinophilia, diarrhea, abdominal pain. heavy infections (500-5000 worms ) → → intestinal inflammation rectal prolapse Trichuriasis Prolapse (exteriorization) rectal Trichuriasis EPIDEMIOLOGY . Prevalence and intensity of infection higher in children. Frequently occurring dual infection with Ascaris Trichuriasis LABORATORY DIAGNOSIS . Examination of stools. Macroscopic examination: survey of adult worm (rare in the stool.) Microscopic examination: detection of eggs in faeces. Methods: Direc t (with Lugol.) Sedimentation (Hoffman and Ritchie). Kato-Katz (parasite load) Trichuriasis Trichuriasis TREATMENT Ascariasis, Enterobiasis, Trichuriasis. Irreversibly inhibits glucose uptake by the worm. It causes paralysis and death phase of the parasite. Elimination passi ve worm until the 3rd day post treatment. The eggs eliminated after treatment ar e impractical. The drug is practically not absorbed and does not interfere with the system for glucose uptake in man Trichuriasis TREATMENT Ascariasis, Enterobiasis, Trichuriasis. Vermont, ovicidal and larvicidal. Promot es the blockade of glucose uptake by the worms. In the initial phase involved th e detention of the musculature of the worm and in the final death from muscle pa ralysis. Age by direct contact in the intestine and is only 0.5% absorbed by hum ans Trichuriasis TREATMENT Other drugs Enterobiasis Ivermectin (associated with Albendazole) trichuriasis P almoato pyrantel Piperazine Levamisole Ivermectin (100% effective) of ascariasis Palmoato pirvínio Thiabendazole ANCYLOSTOMIASIS ANCYLOSTOMIASIS Etiology: Ancylostoma duodenale and Necator americanus Phylum: Aschelminthes Cla ss: Nematoda Family: Ancylostomatidae Genus: Ancylostoma and Necator

Popularly known as "yellowing" ANCYLOSTOMIASIS MORPHOLOGY A. duodenale N. americanus ANCYLOSTOMIASIS MORPHOLOGY Hookworm: rhabditiform larvae Hookworm: egg N. A. americanus duodenale Hookworm: infective larvae (infective) ANCYLOSTOMIASIS MORPHOLOGY Female Male characters SIZE CAPSULE ORAL bursal Adapted EGG SIZE: Rey 9-11 mm 59 mm 1 pair cutting boards The longer that thin 64-76 μm 10-13 mm 9-11 mm 2 pair s of large teeth wider than Long 20 to 30 thousand 56-60 μm Necator americanus A ncylostoma duodenale Oviposition by day 6 to 11 000 ANCYLOSTOMIASIS CYCLE ANCYLOSTOMIASIS PATHOGENESIS AND SINTOMATOLOGIA Larvae: traumatic lesions in the skin, redness, itching, swelling, urticarial de rmatitis (similar allergic reaction), rash (rash) signs like pneumonia and bronc hitis as cough and low fever (early Adults: epigastric pain, flatulence, nausea, vomiting, bloody diarrhea or constipation ANCYLOSTOMIASIS PATHOGENESIS AND SINTOMATOLOGIA Acute phase: migration of larvae in the lung and skin tissue of adults and insta llation ID in chronic phase: the presence of adult worms, theft blood, nutrition al deficiency anemia → Primary - signs associated with the presence of the paras ite Secondary - signs resulting from anemia and hypoproteinemia Signs and sympto ms depend on worm burden and the sensitivity of the patient ANCYLOSTOMIASIS EPIDEMIOLOGY In the past the distribution of hookworm was as follows: A. duodenale: N. Old Wo rld americanus: a new world With the evolution of transport and human migrations , are present worldwide. Occurs preferentially in children over six years, adole

scents and elderly (parasite survives for more than 18 years) ANCYLOSTOMIASIS EPIDEMIOLOGY Daily production of eggs: A. duodenale eggs = 22 000 N. americanus = 9000 eggs I deal conditions for egg development:. Permeable sandy soil rich in organic matte r. L3 can remain viable for several weeks (outside the home) Low prevalence in s emi-arid climate ANCYLOSTOMIASIS EPIDEMIOLOGY The presence of the parasite does not indicate disease → need for stool examinat ion and blood test and serologic testing in Brazil is more common hookworm N. am ericanus ANCYLOSTOMIASIS CONTROL In endemic areas:. Sanitation. Health education. Supplementation with iron (ferr roso sulfate and proteins. Anthelmintics (reinfection after treatment). Research on vaccines. Destination suited to human feces. Measures of personal hygiene (w ashing hands, washing raw food before consumption, filtered water or boiled wate r) measures serve other parasitic diseases. ANCYLOSTOMIASIS TREATMENT Only subjects with positive parasitological Anthelmintics broad spectr um: Pyrimidines (Pyrantel) and Benzimidazoles (Mebendazole and Albendazole) Pyri midines - kills for neuromuscular blockade, leads to muscle paralysis (cholinerg ic antagonism) Benzimidazoles - mostly used, interfere with protein synthesis,€c ause cellular degeneration of the tegument and intestinal parasite. Contraindica ted in pregnancy (embryotoxic and teratogenic in rats and mice) ANCYLOSTOMIASIS TREATMENT Treatment of anemia depends on the susceptibility of the population: .50 to 500 EPG is recommended to treat. Georgia (USA) 13 000 population with OPG (500 N. am ericanus) - normal Hb levels. Mississippi (USA) - 25 worms have caused anemia. I ndia - mixed infection (two 40 N. americanus and A. duodenale, with OPG 1000 - a nemia. anemia depends on the absorption of Fe and reserve the same day. ANCYLOSTOMIASIS Cutaneous larva migrans ANCYLOSTOMIASIS ETIOLOGY Larvae of Ancylostoma caninum and A. brasiliensis Parasites of dogs and cats ID ANCYLOSTOMIASIS CYCLE Dogs and cats shed eggs in feces → L1 in the egg and ground → L2 and L3 (s even days) → infection via oral, dermal and transplacental → L3 to adult in abou t four weeks. Men are accidental hosts. Larvae do not develop> ANCYLOSTOMIASIS

ANCYLOSTOMIASIS PATHOGENESIS L3 actively penetrate the skin of man → migrate through the subcutaneous tissue for weeks or months and then die → leave trail winding. The larvae may reach the circulation are the pulmonary cycle → → can be found in sputum If swallowed can reach the L3 ID → migrate through human intestines and cause VLM or OLM (Toxoca ra canis, T. cati and A. caninum) ANCYLOSTOMIASIS SYMPTOMS Reach the feet, legs, buttocks and forearms Pruritus in places of migration may be pulmonary ANCYLOSTOMIASIS DIAGNOSIS Clinical - clinical history and appearance of the lesion TREATMENT Thiabendazole ointment Frío - 4 times a day - healing from seven to 14 days LMC - oral thiabendazole, 25 mg / kg x 2 days, 3 days ANCYLOSTOMIASIS EPIDEMIOLOGY AND CONTROL Larva migrans is associated with the presence of cats and dogs on beaches, plaza s, parks Fecal examination and treatment of dogs and cats