 BECK’s Test for T.

spiralis
EXTRAINTESTINAL NEMATODES Treatment
Blood and Tissue Nematodes
 Mebendazole–drug of choice
- 5mg/kg body wtdaily
Trichinella spiralis  Albendazole
“Muscle worm” - 15mg/kg body wtper day in two
divided doses, for 10
Trichinella species: - 15 days
o Children >2 yrs old : 10 mg/kg body wt
1. Trichinella spiralis
 most important cause of trichinellosisin humans A treatment cycle may be repeated 5 days after the
 the species that is most adapted to domestic and initial cycle in cases of severe infection
wild pigs
Prevention and Control
2. Trichinella britovi o Health education
 2nd most common species affecting humans o Meat cooked in at least 77OC
 most widely distributed species among wild o Freezing to kill the larvae
animals in Asia, Europe, Northern Africa, o Storage of meat at –15OCfor 20 days or
Western Africa –30OCfor six days
o Meat inspection
3. Trichinella native o Keeping pigs in rat-free pens
 infects primarily wild carnivores in the frigid zone o Proper disposal of suspected carcasses
of Asia, North America and North Eastern Europe
4. T. murrelli The Filariae
5. T. nelsoni
Filarial Nematodes
6. T. papuae
1. Subcutaneous
7. T. pseudospiralis
o Loa loa(African eye worm)
o Onchocerca volvulus
Trichinella spiralis: o Mansonella streptocerca
ADULT 2. Serous cavity
o Mansonella–serous cavity in abdomen
3. Lymphatic Filariasis
Males : 0.62 –1.58 mm x 0.025 –0.033 mm o Wuchereria bancrofti
•Single testis near the posterior end o Brugia malayi
o Brugia timori
Females: 1.26 –3.35 mm x 0.029 –0.038 mm
•Has a single ovary, oviduct, seminal receptacle, Filarial Parasites
coiled uterus, vagina, and vulva 1. Wuchereria bancrofti
 creamy white, long, and filiform in shape
LARVA  male: 20 –40 mm length
At birth : 80 –120 um x 5.6 um
After it enters the muscle fibers: 0.65 –1.45 mm x 0.026 –  female: 80 –100 mm
0.040 mm 2. Brugia malayi
•Has a spear-like, burrowing anterior tip  male: 13 –23 mm length
•The digestive tract of the a mature larvae encysted  female: 43 –55 mm
in muscle fiber resembles that of the adult worm 1. Wuchereria bancrofti
•Reproductive organs are not yet developbut it is  270 –290 um
already possible to identify the sex of the parasite  Sheathed (hyaline sheath is longer than
microfilaria itself)
Diagnosis:
 Stained blood smear: the central axis
 Muscle biopsy – definitive diagnosis shows dark-staining nuclei (important
 Digestion of muscle with pepsin and HCl to identifying feature). The column of nuclei
determine the number of larvae per gram of is arranged in 2 or 3 rows and distinctly
muscle** conspicuous
 Creatinine phosphokinase, LDH, myokinase  Have several curvatures and a graceful
appearance
 •Total IgE  Minute snake-like organisms constantly
 ELISA –recommended for diagnosis moving along the RBCs is a fresh blood
specimen
 Latex agglutination –may be utilized for rapid (<1 hr) Filarial Parasites
confirmation  111 –230 um
Immunologic tests
 Bentonite flocculation test (T. spiralis, E. granulosus)  Stained blood smear: Sheathed
 Intradermal test: Bachmann -have angular curvatures with secondary kinks
 Xenodiagnosis tests - 2 nuclei at the tip of the tail (indistinct and
 Uses lab animal (T. spiralis, T. cruzi) confluent), composed of 2 rows
 OTHER SPECIES Stage 5
1. Dipetalomena perstans  Swelling not reversible at night
•“Acanthocheilonemaperstans”  Skin folds-Deep
•Habitat: body cavities  Skin: Smooth or Irregular
•Vector: Culicoidesspp
Stage 6
•Specimen: blood
 Swelling not reversible at night
•Microfilariae:  Mossy lesions
•Unsheathed
 Wart-like lesions on foot or top of the toes
•Nuclei up to the tip of the tail
•Non periodic Stage 7
 Swelling not reversible at night
2. Mansonella ozzardi  Skin folds-Deep
•Habitat: body cavities  needs help for daily activities like walking,
•Vector: Culicoidesspp. bathing, using bathrooms, dependent on
•Specimen: blood family or health care systems
•Microfilaria:
•Unsheathed HYDROCELE OR CHYLOCELE FILARIA
Diagnosis:
•Tail is free of nuclei
- Wet smears or thick blood smears
•Non periodic taken between 8pm –4am
- Quantitative Buffy Coat
Filaria Pathogenesis - DEC provocative test (3 mg/kg DEC single
 Lymphedema and elephantiasis dose)
 most common chronic manifestation - Immunochromatographic Card Tests –
 lower limbs commonly affected detects CFA
 upper limbs and genitalia may be involved - Sensitive and specific
 females: breast and genitalia - Molecular xenomonitoring of parasites in
pools of mosquitoes
Prevention
Stages of Chronic Lymphedema •Use of mosquito nets
•Insecticidal residual spraying
 Stage 1 –swelling increases during the day but is •Development of Bacillus sphaericus sprays
reversible once the patient lies flat in bed and n-polysterene beads to seal latrines to
 Stage 2 –swelling is no longer reversible overnight, eliminate or reduce Culex vectors
and the patient may experience acute attacks •Health education

 Stage 3 –presence of shallow skin folds Parastrongylus catonensis

 Stage 4 –knobs present in the affected area; these
 Pale and filiform
are lumps or protrusions in the skin that
 male: 16 –22 mm x 0.25 –0.35 mm
predispose the area to trauma  have well-developed caudal bursa
 Stage 5 –skin folds where the base can no longer (kidney-shaped and single-lobed)
be seen; folds are actively“opened” by hand  female: 19 –33 mm x 0.28 –0.50 mm
 have uterine tubules that are wound
 Stage 6–mossy lesions are present which leak
spirally around the intestine (“barber’s
translucent fluids
pole” pattern) Parastrongylus
 Stage 7 –patient is unable to adequately or cantonensis
independently perform daily activities; foul-  Ovoidal with delicate hyaline shells
smelling  46 –48 um x 68 –74 um
 Unembryonated when oviposited
Stage 1
 Swelling reverses at night  1st stage larva: found in the lungs of rats
 Skin folds-Absent o has a distinct small knob near the tip
 Skin: Smooth, Normal of the tail
 3rd stage larva:
Stage 2
o Has two (2) well-developed
 Swelling not reversible at night
chitinousrods below its buccal
 Skin folds-Absent
cavity
 Skin : Smooth, Normal Pathogenesis
Stage 3  Acute, severe, intermittent
 Swelling not reversible at night occipital or bitemporal
 Skin folds-Shallow headache
 Skin:Smooth, Normal  Stiffness of the neck, paresthesia,
Stage 4 vomiting, fever, nausea, blurred
 Swelling not reversible at night
vision, diplopia
 Skin folds-Shallow
 skin : Irregular,  Intraocular hemorrhage
 Knobs, Nodules  Retinal detachment
 Diagnosis:
 Increase Eosinophil (7 –36% of the wbc count)
 CSF eosinophilia >10%
 Mild increase CSF protein; glucose normal
 CT scan: cerebral edema
 MRI: lesions
 Dot-blot ELISA (100% sensitive and specific)
 PCR: detect Ag
Prevention
 Health education
 Awareness and education of proper eating habits
and safe food preparation
 Handwashing
 Avoid eating raw or poorly cooked mollusks or
unwashed vegetables
 Use of molluscicides