Intestinal nematodes

as seen in faeces,
and Anisakis spp.
Bethony J. et al. 2006. Lancet 367:1521-1532.

Soil-transmitted helminth infections:

ascariasis, trichuriasis, and
hookworm
 Bethony J. et al. 2006. Lancet 367:1521-1532.

• Ascaris lumbricoides • 807-1221 x 106

• Trichuris trichiura
• Necator americanus and
Ancylostoma duodenale
• Strongyloides stercoralis
• Enterobius vermicularis
• Toxocara canis and
Toxocara cati
• 604-795 x 106
• 576-740 x 106
• 30-100 x 106
• 4-28% of children
• 2-80% of children
Bethony J. et al. 2006. Lancet 367:1521-
1532.

High worldwide prevalence, except

Europe, North America, Australia,
and Japan
 Bethony J. et al. 2006. Lancet 367:1521-1532.

Species Length Daily egg Location in Lifespan

(mm) output host (years)
Ascaris lumbricoides 150- 200000 Small 1
400 intestine

Trichuris trichiura 30-50 3000-5000 Caecum and 1.5-2

colon

Necator americanus 7-13 9000-10000 Upper small 5-7

Ancylostoma duodenale 8-13 25000-30000 intestine
Courtesy J. Vandepitte
Bethony J. et al. 2006. Lancet 367:1521-1532.

• Ascariasis

– Verminous pneumonia (Löffler syndrome)

– Lactose intolerance
– Intestinal obstruction
– Hepatopancreatic ascariasis
Bethony J. et al. 2006. Lancet 367:1521-1532.

• Trichuriasis

– Anterior end embedded in epithelial tunnels

within the intestinal mucosa
– Colitis
– “dysentery syndrome”
– Rectal prolapse
Bethony J. et al. 2006. Lancet 367:1521-1532.

• Hookworm

– Cough
– Intestinal blood loss
– Iron-deficiency anaemia (> 40 adult worms)
– Protein malnutrition
Eosinophilia > 10%
With helminths,
insects (myasis),
not with protozoa excepting
Isospora belli and Dientamoeba
fragilis (with pinworms?)
Charcot-Leyden
Crystals
associated with
eosinophils

found in faeces
or sputum.
Charcot-Leyden
Crystals
associated with
eosinophils

found in faeces
or sputum.
 Auto-infectious
Enterobius vermicularis
Hymenolepis nana
Strongyloides stercoralis
Courtesy CDC
 Ascaris lumbricoides
Adult male worm, with a curved tail (Unstained).
Ascaris lumbricoides
Adult worm (Unstained).
 Ascaris lumbricoides

Several adult worms.

3 cm
 Löffler syndrome
• Second week after ingestion of eggs, larvae
invade lung tissue.
• Immune-mediated hypersensitivity response.
• In severe cases eosinophilic pneumonia
(Löffler syndrome).

Maguire J.H. 2010. In Mandell et al.

Courtesy CDC
 Toxocara canis
Several adult worms, smaller than A. lumbricoides.

1 cm
 Toxocara canis (cati)

• Visceral larva migrans (VLM).

• Children < 6 years.
• Liver, lung, skin, ...
• Ocular larva migrans.
– T. canis
– Unilateral eye involvement
– Albendazole, thiabendazole

Nash T.E. 2010. In Mandell et al.

 Cutaneous larva migrans
• Creeping eruption.
• Serpiginous, reddened, elevated, pruritic
skin lesions.
• Ancylostoma braziliense (dog and cat
hookworm), Ancylostoma caninum, ...
• Eosinophilic inflammatory infiltrate.
• Treatment of choice is ivermectin. An
alternative is albendazole.

Nash T.E. 2010. In Mandell et al.

Courtesy CDC
 Specific gravities
• S.G. of Zn-sulfate 33 %: 1.180
• S.G. of formol-solution 10 %: 1.019
• S.G. of ether: 0.714
• S.G. of parasites: Ancylostoma 1.055; Giardia
1.060; Entamoeba histolytica (coli) and
Endolimax nana 1.065 - 1.070; Ascaris 1.110;
Trichuris 1.150, Chilomastix mesnili 1.180;
Ascaris (unfertilized) 1.200 (Bailenger, 1965).
Ocular micrometer disk
• Each objective must
be calibrated with
reference material.

• Can be roughly
checked with a
counting chamber,
with RBCs ...
Courtesy Ash L.R. & Orihel T.C.
Courtesy CDC
 Estimation of worm burdens
through egg counts
• Direct fecal smear of 2 mg (Beaver)
• Number of adult worms correlated to
number of eggs present
Ascaris lumbricoides 1/2
Trichuris trichiura 10
Ancylostoma duodenale 5
Necator americanus 10 to 20
Courtesy CDC
 Enterobius vermicularis
Tail from a gravid female filled with eggs (Unstained).
 Enterobius vermicularis
Pin-shaped tail from a female pinworm (Unstained).
 Enterobius vermicularis
Front end with alae from a female (Unstained).
 Enterobius vermicularis
Asymmetric embryonated infective egg in faeces with
thin double shell. Contains a folded larva.
Length: 55 μ (Unstained).
 Enterobius vermicularis
Asymmetric embryonated infective egg in faeces with
thin double shell. Contains a folded larva. Length: 55
μ (Unstained).
 Enterobius vermicularis
Asymmetric eggs in faeces with a thin double shell,
containing a folded larva (Unstained).
 Enterobius vermicularis
Asymmetric eggs with a thin double shell in the
female worm (Unstained).
Courtesy CDC
 Trichuris trichiura
Lemon-shaped egg, measuring 50-55 μm, with a
brown-yellowish outer shell and two hyaline polar
plugs in faeces (Unstained).
 Trichuris trichiura
Lemon-shaped egg, measuring 50-55 μm, with a
brown-yellowish outer shell and two hyaline polar
plugs in faeces (Unstained).
 Trichuris trichiura
Lemon-shaped egg, measuring 50-55 μm, with a
brown-yellowish outer shell and two hyaline polar
plugs in faeces (Unstained).
 Trichuris trichiura
Lemon-shaped egg, measuring 50-55 μm, with a
brown-yellowish outer shell and two hyaline polar
plugs in faeces (Unstained).
 Trichuris trichiura
Lemon-shaped egg, measuring 50-55 μm, with a
brown-yellowish outer shell and two hyaline polar
plugs in faeces (Lugol stain ).
Courtesy Peters W. & Gilles H.
 Ascaris lumbricoides
Fertile bile-stained egg with a thick, mammillated
shell, measuring 55-75 μm (Unstained).
 Ascaris lumbricoides
Fertile bile-stained egg with a thick, mammillated
shell, measuring 55-75 μm. The microscope has been
focused on the outer shell (Unstained).
 Ascaris lumbricoides
“Decorticated” fertile egg from a subphrenic abscess.
The mammillated layer is absent (Unstained).
 Ascaris lumbricoides
This infertile egg is elongated and larger (85-95 μm)
than a fertile egg (Unstained).
 Ascaris lumbricoides
This infertile egg is elongated and larger (85-95 μm)
than a fertile egg (Unstained).
 Ascaris lumbricoides
This infertile egg is elongated and larger (85-95 μm)
than a fertile egg (Unstained).
Courtesy CDC
 Hookworm egg
Hookworm egg with four blastomeres. Eggs of
Ancylostoma duodenale and Necator americanus are
indistinguishable (Unstained).
 Hookworm egg
Older hookworm egg with many blastomeres. Eggs of
A. duodenale and N. americanus are indistinguishable
(Lugol stain).
Courtesy CDC
 Strongyloides stercoralis
First stage rhabditiform larva in faeces. The length
varies from 180 to 380 μm (Unstained).
 Strongyloides stercoralis
Rhabditiform larva in faeces. The length varies from
180 to 380 μm (Unstained).
 Strongyloides stercoralis
Rhabditoid larva in faeces with the typical esophagal
bulb (Unstained).
 Strongyloides stercoralis
Infective-stage filariform larva in faeces. The tail has a
typical notched appearance. Length up to 630 μm
(Unstained).
 Strongyloides stercoralis
The free-living (rhabditoid) female (length 1.0 to 1.7
mm) has a short vulva that opens near the middle of
the ventral side (Unstained).
 Trichostrongylus colubriformis
Large egg (75-95 μm) with a thin shell, containing a
morula (Unstained).
Anisakis sp.
Larvae in fish.
• Nematode of crustaceans,
fish, marine mammals
(stomach).
• The Netherlands, Northern
Europe, Japan.
• Linked to the consumption
of raw fish.
• Haringworm (NL) in the
stomach or duodenum of
man (eosinophilic
granuloma).
• Removed by surgery,
mebendazole (?).
Pseudoterranova decipiens
An uninvited dinner
guest
• Home-cooked codfish
dinner on the Good
Friday holiday.
• Gill C. & Hamer D.
• 2005. CID. 1764 & 1810-
1811.
Courtesy CDC