NEMATODES (ROUND WORMS)

Disease & its Egg Habitat Infective stage & Pathogenesis Clinical manifestation Treatment
causative agent mode of
transmission
Fertilized eggs are Embryonated egg is  Usually mild or Albendazole
bile stained, round ingested  hatch in the asymptomatic  Adult (400mg,
or oval, Small intestine embryonated egg lumen of small intestine,  Pulmonary disease & single dosage)
Ascariasis (Ascaris
surrounded by a containing releasing the larvae  obstruction of the  12-23 months
lumbricoides) thin translucent rhabditiform larva larvae migrate to the intestinal or biliary old children
wall with outer cecum or proximal colon tract (200mg)
-largest nematode mammillated coat where they penetrate the  Fever Mebendazole (500mg
parasite in the containing a large ingestion intestinal wall  larvae  Urticaria single dose)
human intestine unsegmented enter the venules to go to  Granulomatous
ovum. the liver through the disease Pyrantel Pamoate (10
portal vein, on to the  Cough mg/kg (max. 1g)) single
Unfertilized eggs heart, and pulmonary  Dyspnea dose
are elliptical, vessels (4 days to reach  Pulmonary infiltrates
longer with an the lungs)  (10 to 15 on CXR
outer thinner days) they break out of  Blood eosinophilia
irregular capillaries to enter the air  Abdominal cramping
mammillated coat, sacs  in the lungs: (due to heavy
containing a small larvae undergo molting infection)
atrophied ovum before migrating  Vomiting
and refractile (hepatotracheal  Abdominal distention
granules. migration: 14 days) to the Complications
larynx and oropharynx to  Cholecystitis
be swallowed into the  Pancreatitis
digestive tract  Peritonitis
Hookworms (Nector Eggs are oval, Albendazole
americanus & colorless, not bile- Small intestine rd
3 stage Skin penetration of  Ground itch  adult (400mg,
Ancylostoma stained, and float (mostly ileum rhabditiform larvae filariform larvae   Cough single dose)
duodenale) in saturated salt than duodenum) maculopapular lesions
solution and and localized erythema
contain segmented Skin penetration  ground itch 
ovum with 4 papulovesicular eruptions
blastomeres can last for 2 wks 
larval migration to the
lungs  (if abundant)
bronchitis or pneumonitis
 maturation stage of
worm in small intestine
 abdominal pain,
steorrhea, or sometimes
diarrhea with blood and
mucus, eosinophilia
Strongyloides Egg is ovoid, thin
stercolaris walled and Small intestine 3rd stage filariform Filariform larvae hatch
transparent (duodenum and larvae and can do 3 things:
-smallest nematode jejunum) 1. Autoinfection
infecting man Filariform larvae
Skin penetration develop and
penetrate
intestinal wall
2. Direct cycle
Larvae pass out in
stool, penetrate
the next
passerby, and
 Maculopapular rash  over 2yrs old
 Localized erythema (400mg single
 Abdominal pain dose)
 Stetorrhea
 Sometimes diarrhea Mebendazole (adult
with blood and mucus and pedia: 500mg,
 Weight loss single PO)
 Iron deficiency
anemia
 Lung infiltration (CXR)
 Eosinophilia
 Hypoalbuminemia
Other symptoms:
 Dyspnea
 Weakness
 Dizziness
 Lassitude
Other signs
 Rapid pulse
 Edema
 albuminuria
Ivermectin (200mg/kg
 vomiting daily for 2 days)
 abdominal bleeding
 diarrhea
 anemia Albendazole (400mg
 weight loss daily for 3 days)
 pruritic rash
 cough or wheezing
 eosinophilia
Complications
 pneumonia
 ARDS
 migrate to the  Multiple organ failure
lungs  Edema
3. Indirect cycle  Emaciation
Larvae pass out in  Loss of appetite
feces, develop  Ileus
into adults and  GI bleeding
undergo sexual  Malabsorption
reproduction, leading to cachexia
eggs develop into
larvae then into
3rd stage
filariform larvae
 reinfect a
human, moving
to the lung
 Usually asymptomatic Mebendazole (100mg
Egg passed in feces   Chronic dysentery 12 hourly for 3-5 days
Trichuriasis (Trichuris Egg is triple- Large intestine Embryonated egg embryonated egg with  Rectal prolapse
trichiura) [whipworm] shelled, barrel- (Cecum and containing filariform larva is ingested  Anemia (due to blood Albendazole (400mg,
shaped with a ascending colon) rhabditiform larva  larva liberated through loss (0.005gml per single dose for 3 days)
mucus plug at each one of the poles of egg in worm per day))
pole; it is bile- small intestine  passed  Poor growth Ivermectin (300ug/kg
stained and Ingestion down to cecum   Abdominal pain PO for 3 days)
contains an develops into adult  Weight loss
unsegmented worms  adult worms in  Mucus diarrhea HIGHEST CURE RATE:
ovum; egg floats in the large intestine  egg  Acute appendicitis Oxantel pamoate
saturated salt passed in feces (mechanical blockage (20mg/kg) +
solution of the appendical Albendazole (400mg)
luman by masses of
whipworms)
Enterobiasis Freshly laid egg in feces
(Enterobius Eggs are colorless,  embryonated egg with
vermicularis) not bile-stained; Cecum, appendix, Embryonated eggs infective larva in soil is
planoconvex in and adjacent ingested  egg shell is
[pinworm] shape portion of dissolved by the digestive
ascending colon Ingestion juices and larva liberated
in small intestine 
liberated larva migrate
towards cecum 
develops into adult
worms  mild catarrhal
inflammation of the
intestinal mucosa 
migration of egg-laying
female to the anus causes
irritation of the perianal
region  eggs laid at the
perianal skin by the
gravid female  a) egg in
feces, or b) scratching will
lead to autoinfection
 Itching
 Restless sleep Mebendazole (100mg
secondary to PO, single dose)
nocturnal perianal or
perineal pruritus Albendazole (400mg
 Poor appetite PO, single dose)
 Weight loss
 Irritability Pyrantel pamoate
 Grinding of teeth (11mg/kg once, PO,
single dose) (max of
Complications 1g)
 Abdominal pain
 Appendicitis
 Peritonitis
 Hepatitis
 Ulcerative lesions
 Vaginitis
 TISSUE NEMATODE

Parasite infection Egg Habitat Infective stage & Pathogenesis Clinical manifestations Treatment
mode of transmission
Trichinosis or Infective form: Infective encysted Enteric phase (onset Mild cases:
Trichinellosis Striated muscles Encysted larvae in the larvae ingested  within 2-30 hours of Supportive treatment
(Trichinella spiralis) striated muscles in cysts are digested in ingestion of infective food) (bed rest, analgesics,
human body the stomach  larvae  Watery diarrhea and antipyretics)
excyst either in the  Abdominal
Muscles commonly stomach or in the discomfort Moderate cases:
involved: small intestine   Vomiting Albendazole (400mg
Diaphragm, pectoralis, larvae burrow into the  Nausea twice a day for 8 days)
deltoid, biceps, and sub-epithelium of the  Malaise Pedia (>2yrs):
gastrocnemius villi where they  Abdominal cramps (10mg/kg body
undergo four molts  Invasion phase (1-4 weeks weight)
Optimum host: Pig maturation (2 days): after infection)
Alternate host: adult worms begin to  Fever Mebendazole (200-
human mate 5-7 days post-  Myalgia 400mg twice a day for
infection  female  Preorbital edema 3 days, then 400mg
Man acquires produces eggs that  Weakness of twice a day for 8 days)
infection by eating grow into larvae in its affected muscle
raw or undercooked uterus  deposits  Eosinophilia Severe cases:
pork or inadequately larvae in the mucosa (constant feature) Add
processed sausages or  penetrate the  Subconjunctiva glucocorticosteroids
other meat products mucosa, pass through and new beds like prednisolone to
containing the viable the lymphatic system hemorrhage albendazole or
larvae into the circulation   Myocarditis mebendazole
into the striated  Encephalitis
muscle  grow & Encystation stage
develop All symptoms subside