EXAMPLES LEGEND Diphyllobothrium spp.

(I)
Entamoeba histolytica (l) B= Hymenolepis nana (I)
E. hartmanni (l) Blood Taenia saginata (l)
Class Cestoidea
E. dispar (I) E. coli (I) Dipylidium caninum (l)
Subphylum Sarcodina (tapeworms)
Iodamoeba butschlii (I) C= H. diminuta (l)
(amebae) (8 examples)
Endolimax nana (l) spinal E. multilocularis (H)
(10 examples)
Blastocystis hominis (I) fluid Echinococcus granulosus (H)
Naegleria fowleri (T,C) T. solium (l,T)
Balamuthia mandrillaris (T,C) E= Phylum Clonorchis sinensis (H)
S Acanthamoeba spp. (T,C,E) Platyhelminthes Opisthorchis viverinni (H)
Eye
U Giardia lamblia (l) (flatworms) Fasciola hepatica (H)
B 1 S
Chilomastix mesnili (I) H= Fasciolopsis buski (I)
K Phylum U
Enteromonas hominis (I) liver Metagonimus yokagawai (I)
I Sarcomastigophorea Dientamoeba fragilis (I)
B Class Trematoda (flukes)
Heterophyes heterophyes (I)
N K (12 examples)
Retortamonas intestinalis (I) I= Nanophyetus salmincola (I)
G I Schistosoma haematobium (B)
Trichomonas hominis (I) Intesti
D Subphylum N
T. vaginalis (V) S. japonicum (B)
O Mastigophora(flagellates) ne G
Leishmania tropica (T) S. mansoni (B) S. mekongi (B)
M (16 examples) D
L. major (T) L. mexicana (T) Paragonimus spp. (L)
L= O
L. donovani (T) L. aethiopica (T) Trichinella spiralis (T,I)
P Lung M Class Adenophorea
L. braziliensis (T) Trichuris trichiura (l)
R T. rhodesiense (B,C) (Aphasmidia)
Capillaria philippinensis (I)
O T= M
Trypanosome gambiense (B,C) Enterobius vermicularis (l)
T Tissue E
T. cruzi (B,T) Ancylostoma duodenale (I)
O 2 Phylum Ciliophora T
Balantidium coli (I) A Strongyloides stercoralis (I)
Z (ciliates) V=
Z Anisakis spp. (I)
O Subclass vagina
Babesia spp. (B) O Ascaris lumbricoides (l)
A Piroplasmea
A Necator americanus (l)
Plasmodium falciparum (B) Phylum Nematoda Trichostrongylus spp. (l)
(4)
3 P. ovale (B) P. malariae (B) (roundworms) Class Secernentia Onchocerca volvulus (T)
Class
Phylum Apicomplexa Subclass P. vivax (B) (Phasmidia) Dracunculus medinensis (T)
Sporozoea
(apicomplexans) Coccidia Cryptosporidium parvum (l) (17 examples) Angiostrongylus cantonensis (T)
(8 examples) Isospora belli (I) M. streptocerca (T)
Cyclospora cayetanensis (l) A. costaricensis (T)
Toxoplasma gondii (T) M. ozzardi (T,B)
4 Encephalitozoon spp. (E,H,T) Mansonella perstans (T,B)
Phylum Microspora E. intestinalis (I,T) Wuchereria bancrofti (T,B)
(microsporidia) Enterocytozoon bieneusi (I) Loa loa (T,B)
Brugia malayi (T,B)
 Scientifi
Necatur americanus Ancylostoma
c name Ascaris lumbricoides (1) Trichuris trichiura (2)
(3) duodenale (3)
General Characteristics 
roundworms
Commo HOOKWORMS
they are elongated and cylindrical in shape with Giant round worm Whipworm
n name New world hookworm Old world hookworm
bilateral symmetry
an elastic cuticle covers the body surface of
- most common intestinal
P nematodes
nematode of man which
h generally have complete digestive tract and a - soil-transmitted helminths
occurs most frequently in
y muscular pharynx that is characteristically triradiate the tropics
l provided with separate sexes, although some may be - soil-transmitted helminth
Scientific
u parthenogenetic
Ascaris lumbricoides (1) Trichuris trichiura
- it is estimated that(2)more Necatur americanus (3) Ancylostoma duodenale (3)
name 
m there are sensory organs in the anterior (amphids) than 4 billion individuals are - blood-sucking nematodes that attach to the
Common and posterior (phasmids) ends of the worm infected, 70% of whom are mucosa of the small intestine
HOOKWORMS
those with phasmids areGiant
N name calledround wormnematodes;
phasmids fromWhipworm
Asia New world hookworm Old world hookworm
e those without are called aphasmids nematodes
m Adultonly threeMaleareMorphology
aphasmids worms thar are clinically - have -an
has a so-calledanterior
attenuated - small cylindrical, fusiform, - mostly found
- slightly in tropical
larger than N. countries
americanus where they
a important (Trichuris, Trichinella,
- measures 10-31 cm. in length and Capillaria) three-fifths traversedtype"
"polymyarian of
by a narrow grayish white occur as single or mixed or infections
t mostly found
- haveina the small curved
ventrally and large intestines,
posterior endwhile
with two esophagus somatic muscle a string of
resembling - holomyarian, based on the - single-paired male and female reproductive organs
o some are found outside the intestines
spicules beads arrangement in which cell arrangement
- buccal capsule hasof somatic
a ventral
d muscle arrangement
- have a single, long,
has been tortuous
devisedtubule
based on the Gen. are numerous and project pairmuscles in crosssection
of semilunar cutting plates - head continues in the same direction as the curvature
a number of rows of muscle cells per quadrant Charac- well into
- the robust the body
posterior two-fifths where the cells are small, - of
havethemeromyarian
body type of somatic muscle
Female Morphology
an arrangement of multiple longitudinal rows of teristics
contains the intestine and a - headnumerous,
is curvedand closelyto the
opposite arrangement where the cells are few in number
o muscle cells - measures 22-35 cm.isintermed
in each quadrant length polymyarian, single set of reproductivepinkish
- large, whitish or organs packedof
curvature in the
a narrow
body, zone
which is (2-5
- buccal per dorsal
capsule or ventral
has two half)
pairs of curved ventral teeth
r - tapered
one with no moreendthan
and larger
2 rowsthan males
of cells is called worms with smooth-striated like a hook at the anterior end
- have paired
holomyarian, reproductive
and one with 2 organs
to 5 rows in the
is cuticles
- inhabit the large intestine
N posterior two-thirds
meromyarian - Male: 5-9 mm by 0.30 mm;
- have a terminal mouth
e - Male: measures 30-45 mm long, posterior end has a broad,
with three lips and sensory
m Male nematodes are usually equipped with one or slightly shorter than female; has a membranous caudal bursa with - most adult worms are eliminated in 1 to 2
papillae - therays
third(used
mostfor
common
a more (commonly 2) copulatory spicules (spicules are coiled posterior with a single rib-like copulation) years, but longevity records can reach several
t important during copulation in that they keep the spicule- and
adultsretractile sheath
reside in but do not round worm of humans
years
o female vulva open, thus facilitating the entry of attach to the mucosa of the - Female: 9-11 mm by 0.35 mm
d sperm into the female reproductive tract) - Female:
small measures
intestine35-50 mm (larger than males)
e long; has a bluntly rounded
s Female nematodes are usually didelphic (equipped - infective
posterior stage
end; lays is the fully
approximately
with 2 cylindrical ovaries and uteri) embryonated
3,000 to 10,000 eggsegg per day
The uteri unite to form a common vagina that opens
through a gonopore or vulva, usually located near - females begin to oviposit 60 to
midbody
Oogonia are produced at the proximal end of the
ovary, which is known as the germinal zone
 70 days after infection

NO LARVAE notes (I’ll use the space 4 pics)
- not usually described probably
because soon after the
embryonated eggs are ingested,
Larvae
the larvae escape and penetrate
intestinal villi where they remain
for 3 to 10 days
Scientific
Ascaris lumbricoides (1) Trichuris trichiura (2)
name 
Rhabditiform larvae (see pics above & left of this paper 4 the tables of HookW & S. sterco)
- two spp. are indistinguishable
- resemble rhabditiform larvae of Strongyloides stercorales
Filariform larvae
- buccal spears are conspicuous
and parallel throughout their Filariform larvae
lengths - buccal spears are inconspicuous
- there are conspicuous - there are insconspicuous transverse striations on the
transverse striations present on sheath in the tail region
the sheath in the tail region - infective stage to humans through skin penetration
- infective stage to humans
through skin penetration
Necatur americanus (3) Ancylostoma duodenale (3)

Common HOOKWORMS
Giant round worm Whipworm
name New world hookworm Old world hookworm

A. Infertile egg
- measures 88 to 94 um by 39 to 44 um in length
- narrower than fertile eggs with a thin shell and
irregular mammilated coating filled with
refractive granules
- found not only in the absence of males
B. Fertile egg
Egg - measures 45 to 70 um by 35 to 50 um in length
- has an outer coarsely, mammilated
albuminous covering which may be absent or
lost in “decorticated” eggs
- has a thick, transparent, hyaline shell with a
thick outer layer as a supporting structure and a
delicate vitelline, lipoidal, inner membrane,
which is highly permeable
- will develop into larvae in about 14 days
- 50 to 54 um by 23 um
- lemon-shaped with plug-like translucent polar - difficult to distinguish between the two spp.
prominences
- have bluntly rounded ends and a single thin transparent hyaline
- have a yellowish outer and transparent inner shell
shell
- unsegmented when laid
- fertilized, unsegmented egg when laid
- in the 2-8 cell stages of division in fresh feces
- embryonic development takes place outside the
host when deposited in clayish soil - in the soil, embryo within develops rapidly and hatches 1 to 2
days into the rhabditiform larva
- compared to Ascaris eggs, they are more
susceptible to dessication
L
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F
E

C
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C
L
E

Scientific
Ascaris lumbricoides (1) Trichuris trichiura (2) Necatur americanus (3) Ancylostoma duodenale (3)
name à
C.name Giant round worm Whipworm New world hookworm Old world hookworm
Infective
Embryonated egg Embryonated egg Filariform
Stage
Pathoge 1. Reaction of tissue to invading larvae The anterior portions of the worms, which are -pathology of hookworm infection involves:
nesis & 2. Irritation of the intestine by the mechanical and toxic embedded in the mucosa, cause petechial hemorrhages, 1. the skin at the site of entry of the filariform larvae
Clinical action of the adult which may predispose to amebic dysentery presumably 2. the lung during larval migration
Manifest 3. Complications arising from the parasite’s bcs the ulcers provide a suitable site for tissue invasion 3. the small intestine, the habitat of the adult worm
ations extraintestinal migrations by E. histolytica.
Most frequently asymptomatic. Heavy infections, Iron deficiency anemia (caused by blood loss at the
Although infections may cause stunted growth, especially in small children, can cause gastrointestinal site of intestinal attachment of the adult worms) is the
adult worms usually cause no acute symptoms. High problems (abdominal pain, diarrhea, rectal prolapse) and most common symptom of hookworm infection, and can
worm burdens may cause abdominal pain and intestinal possibly growth retardation. be accompanied by cardiac complications. Gastrointestinal
obstruction. Migrating adult worms may cause The mucosa is hyperemic and edematous; and nutritional/metabolic symptoms can also occur.
symptomatic occlusion of the biliary tract or oral enterorrhagia is common & there may even be rectal
expulsion. prolapse among the heavily infected. The lumen of the In addition, local skin manifestations ("ground
During the lung phase of larval migration, appendix may be filled with worms, & consequent itch") can occur during penetration by the filariform (L3)
pulmonary symptoms can occur (cough, dyspnea, irritation and inflammation may lead to appendicitis or larvae, and respiratory symptoms can be observed during
 granulomas.
hemoptysis, eosinophilic pneumonitis – Loeffler’s The prognosis of trichuriasis is very good. Bcs
pulmonary migration of the larvae.
syndrome). there’s no larval migration through the lungs as in Ascaris
& hookworm infections, no lung pathology occurs.
-Microscopic identification of eggs in the stool is the most
common method for diagnosing intestinal ascariasis
Microscopic identification of whipworm eggs in - Microscopic identification of eggs in the stool is the most
A. Direct Fecal Smear
feces is evidence of infection. Because eggs may be common method for diagnosing hookworm infection
B. Kato technique
difficult to find in light infections, a concentration 1. Direct Fecal Smear
C. Kato-Katz technique
procedure is recommended. Because the severity of 2. Kato technique
D. Sedimentation concentration test (recommended
Lab symptoms depend on the worm burden, quantification of 3. Kato-Katz method
instead of flotation)
Diagnosi the latter (e.g. with the Kato-Katz technique) can prove 4. Concentration methods (sedimentation and flotation)
-ELISA serologic test available
s useful.
- Larvae can be identified in sputum or gastric aspirate
1. Direct Fecal Smear - Culture method for the identification of filariform larvae
during the pulmonary migration phase (examine
2. Kato technique 1. Harada-Mori Method - allow hatching of larvae from
formalin-fixed organisms for morphology). Adult worms
3. Kato-Katz technique eggs on strips of filter paper with one end immersed in
are occasionally passed in the stool or through the mouth
4. Concentration methods water for 5 to 7 days
or nose and are recognizable by their macroscopic
characteristics.

S. name Ascaris lumbricoides (1) Trichuris trichiura (2)
C.name Giant round worm Whipworm
The drug of choice in the treatment of
trichuriasis is mebendazole. Albendazole may be
used as an alternative drug. Both are
benzimidazole derivatives and are available
- individual infections are cured by a single dose
locally as chewable tablets.
Treatme any of the broadspectrum antihelmintics such as
A contraindication for albendazole is
nt albendazole, mebendazole, and pyrantel pamoate
pregnancy while, for mebendazole,
- Albendazole, the drug of choice
contraindications are hypersensitivity and early
pregnancy. Adverse effects of these two drugs
are rare and may present as transient
gastrointestinal discomfort and headache.
Necatur americanus (3) Ancylostoma duodenale (3)
New world hookworm Old world hookworm
Broad-spectrum anthelminthics, such as mebendazole and
albendazole, are preferred in areas where nematode infections are
endemic. These drugs are both benzimidazole derivatives that block the
uptake of glucose by most intestinal and tissue nematodes.
Albendazole, the drug of choice, is larvicidal and ovicidal against
N. americanus and A. duodenale. It is given as a 400 mg single dose for
adults and children over two years old. Chewable tablets or suspension
preparations are available. Mebendazole for children and adults is given as
a 500 mg single dose. Hookworms are quite sensitive to albendazole or
mebendazole.
Mebendazole is not recommended for children less than two years
of age. Albendazole is not recommended for pregnant women. Adverse
effects for both drugs are rare, and are usually mild and transient. These
include epigastric pain, diarrhea, headache, and dizziness, among others.
Correction of anemia is achieved by giving adequate diet and iron
supplementation therapy.
 Ascaris has a cosmopolitan distribution.
Over one billion people globally are estimated to
have ascariasis, and of these, at least 20,000 die
annually, mostly young children. The risk of
infection exists wherever fecal disposal is
improper.
The disease remains endemic in many
countries of Southeast Asia, Africa, and Central
and South America. Children are particularly
vulnerable since they are at risk of ingesting
embryonated Ascaris eggs while playing in soil
contaminated with human feces.
Infection rate refers to the presence of
Ascaris eggs in the feces of individuals with or
without signs and symptoms, while disease rate
refers to the people infected with the parasite and
Epidemio show signs and symptoms of the disease probably
logy because of high intensity of infection among
children who are already malnourished.
Ascariasis is one of the soil-transmitted
helminthiases but the level of transmission from
soil to humans depends more on socioeconomic
factors than on physical factors. The main factors
appear to be a high density of human population,
involvement in agriculture (including use of night-
soil as fertilizer), illiteracy, and poor sanitation.
Poor health education on personal, family
and community hygiene are also important factors
contributing to the transmission of ascariasis.
When over 50% of the population is infected, the
disease is considered to be of "high endemicity."
If less than 20% of the population is infected,
most of which are children, the disease is
considered to be of “low endemicity “
Preventi 1. sanitary disposal of human feces
on & 2. health education (personal, family, and
Control community hygiene)
3. mass chemotherapy done periodically, once,
twice, or thrice a year with children as the target
population
Trichuriasis occurs in both temperate
and tropical countries but is more widely
distributed in warm, moist areas of the world.
Hundreds of millions of people are infected.
Prevalence in temperate countries ranges from
20 to 30% while in tropical countries, it ranges
from 60 to 85%. Children 5 to 15 years of age are
more frequently infected than adults.
Factors affecting transmission are the
same as that of ascariasis, namely:
1. indiscriminate defecation of children around
yards
2. frequent contact between fingers and soil
among children at play
3. poor health education,
4. poor personal, family and community hygiene
(unhygienic behavior and eating habits should be
corrected)
Mass treatment may be indicated if infection
rates are greater than 50%. Due to high
incidence of reinfection, periodic mass
treatment may be necessary. Infection in highly
endemic areas may be prevented by:
1) treatment of infected individuals
2) sanitary disposal of human feces by
construction of toilets and their proper use
3) washing of hands with soap and water before
and after meals
4) health education on sanitation and personal
The local distribution of human hookworm infection is greater in
agricultural areas. Farmers are more prone to the infection because they
work in ricefields and vegetable gardens, and they are not properly
protected from contact with infective soil. Prevalence is between 40 to
45% nationwide.
Factors that contribute to the transmission of hookworms are:
1. suitability of the environment for eggs or larvae: damp, sandy or friable
soil with decaying vegetation and temperature of 24 to 32°C
2. mode and extent of fecal pollution of the soil (unsanitary disposal of
human feces or the use of night soil as fertilizer)
3. mode and extent of contact between infected soil and skin or mouth.
Whereas the method of human infection in necatoriasis is purely
percutaneous, in ancylostomiasis it is both percutaneous and through the
oral route. The latter occurs upon eating raw, vegetables contaminated
with infective larvae and probably also through ingestion of raw or
insufficiently cooked infected meat. It is not yet clear whether infection
humans. Transmammary transmission through eating raw meat occurs in
has also been reported.
One big problem in the prevention and control of hookworm
infection is the indiscriminate defecation of children and adults around the
yard or in the vicinity of rice and coffee plantations.
There are also animal hookworms like Ancylostoma braziliense
(cat hookworm; also found in dogs) and Ancylostoma caninum (dog
hookworm) that can infect humans causing "creeping eruption", also
known as cutaneous larva migrans (causing allergic reaction in the
migration tracks).
An itching, red papule is produced at the site of larval entry with
development of serpentine tunnel between the epithelial layers produced
as the larva migrates. The larva moves several millimeters per day and
may survive several weeks or months.
Trapped larvae of A. braziliense may survive for some weeks or
even months, migrating through the subcutaneous tissues, whereas those
of A. caninum encyst and remain dormant in skeletal muscle after a
shorter cutaneous migratory period.
1) sanitary disposal of human feces
2) wearing of shoes, slippers and boots so that skin contact with infective
larvae in contaminated soil is avoided
3) health education on personal, family and community hygiene
4) treatment of infected individuals
5) mass chemotherapy when prevalence is greater than 50%
 6) protection of susceptible individuals by improving household income
hygiene, and consequently, improving the diet to prevent malnutrition.
5) thorough washing and scalding of uncooked
1. Ascaris is the largest intestinal nematode
2. Adults are active migrators provoked by fever, 1. Moist, warm regions and bare-skin contact with sandy soil are optimal
certain drugs, and anesthesia, and may tangle and conditions for contracting heavy infections in areas of poor sanitation.
1. Commonly, double infections occur with
block intestine or migrate through intestine or Often found in same soil conditions as Ascaris and Trichuris.
Ascaris because of the similar method of human
appendix and out of the mouth or anus. Mortality 2. Delayed fecal examination can result in egg hatching and larval
infection, that is, ingestion of eggs from soil. Pica
is due mainly to intestinal complications. development; therefore, Strongyloides larvae must be differentiated from
common in children.
3. Ascaris is the most common infection on a hookworm larvae.
2. Drug treatment may cause production of
worldwide basis. 3. Adults are voracious blood suckers; heavy infection can result in 100 mL
distorted eggs, which will have bizarre shapes
Of note 4. The adult female lays up to 250,000 eggs per of blood loss per day; therefore provide dietary and iron therapy support
when seen in fecal specimen.
day. along with drug treatment as necessary.
3. Zoonosis infection can occur with pig or dog
5. Eggs may remain infective in soil or water for 4. Differentiate adults by buccal capsule and bursa.
whipworm.
years; resistant to chemicals. 5. Ancylostoma filariform larvae can also infect orally and possibly by
4. Examination of the rectal mucosa by
6. Morphologically close to Ascaris suum transmammary or transplacental passage.
proctoscopy (or directly in case of prolapses) can
7. Chickens can serve as paratenic host 6. Some A. duodenale larvae, following penetration of the host skin, can
occasionally demonstrate adult worms.
8. Cockroaches can carry and disseminate the eggs become dormant (in the intestine or muscle)
9. Dogs by coprophagy spread viable eggs in their 7. Pica contributes to infection and is a common symptom.
feces
Scientific
Strongyloides stercoralis (4) Enterobius vermicularis (5) Capillaria philippinensis (6)
name à
C.name Threadworm Pinworm/Seatworm -------------
Gen. tiny nematode residing in the small intestines of humans
causes enterobiasis or oxyuriasis which is characterized
Charac currently considered a parasite of fish eating birds, which
by perianal itching or pruritus ani
seem to be the natural definitive host
characterized by free-living rhabditiform and parasitic
intestinal capillariasis is characterized by abdominal pain,
filariform stages
chronic diarrhea, and gurgling stomach
described in the Philippines in 1963, after the death of
the first human case
not usually fatal, but migrating worms could go beyond
members of the superfamily Trichuroidea, which
the perianal region and thus might cause pathology
characteristically have a thin filamentous anterior end
elsewhere
and a slightly thicker and shorter posterior end
the esophagus has rows of secretory cells called
stichocytes & the entire esophageal structure is called a
stichosome
parasitic form uses the intestine as its habitat meromyarian based on the arrangement of the somatic the anus is subterminal and the vulva in females is
muscles where there are two to five cells per dorsal or located at the junction of anterior and middle thirds

Parasitic Female (Adult in Mucosa of Small Intestine)
- 2.2 mm by 2.2 mm by 0.04 mm
- colorless, semi-transparent, with a finely striated cuticle
- has a slender tapering anterior end and a short conical
pointed tail
- the short buccal cavity has four indistinct lips
- the long slender esophagus extends to the anterior
fourth of the body, and the intestine is continuous to the
subterminal anus
- the vulva is located one-third the length of the body
from the posterior end
- the uteri contain a single file of eight to twelve thin-
shelled, transparent, segmented ova, 50 to 58 um by 30
to 34µm
Parasitic Male
- not been reliably identified
Free-living Adults
- found in the soil
- female worm lays embryonated eggs, which develop
Adult into rhabditiform larvae after a few hours (feed on
organic matter and transforms into free-living adults)
- when conditions in the soil become unfavorable,
rhabditiform larvae develop into filariform larvae, which
are infective to humans
Free-living Adult (Female)
- measures I mm by 0.06 mm and is smaller than the
parasitic female
- has a muscular doublebulbed esophagus and the
intestine is a straight cylindrical tube
Free-living Adult (Male)
- measures 0.7 mm by 0.04 mm, is smaller than the
female
- has a ventrally curved tail, two copulatory spicules, a
gubernaculum but no caudal alae
S.name Strongyloides stercoralis (4)
The first generation of female worms produces Iarvae to
build up the population. Subsequent generations
predominantly produce eggs although there are always a
few female worms that produce both larvae and eggs or
larvae only. Some of these larvae are retained in the gut
ventral half
lumen and develop into adults. This leads to
hyperinfection and autoinfection, which result in the
production very large numbers of worms. In one autopsy,
as many as 200,000 worms were recovered from one liter
of bowel fluid.
- have three lips surrounding a mouth followed by
cuticular expansions (cephalic alae) at the anterior end
and a prominent posterior esophageal bulb
- found in the lower ileum and cecum
- Male: 2-5 mm by 0.1 to 0.2 mm has a curved tail and a
single spicule; rarely seen because they usually die after
copulation
- Female: 8-13 mm by 0.4 mm has a long pointed tail;
uteri of gravid females are distended with eggs
Adult (Male)
- range in length from 1.5 to 3.9 mm
- the male spicule is 230 to 300 um long and has an
unspined sheath
Adult (Female)
- range in length from 2.3 to 5.3 mm
- vulva is located at the junction of anterior and middle
thirds
Enterobius vermicularis (5) Capillaria philippinensis (6)
C.name Threadworm Pinworm/Seatworm -------------
Rhabditiform Larva
- measures 225 um by 16 um
- has an elongated esophagus with a pyriform posterior
bulb
- differs from the hookworm in being slightly smaller and
less attenuated posteriorly
- has a shorter buccal capsule and a larger genital
primordium

Larvae

Rhabditiform larva
- measures 140-150 um by 10 um
- has the characteristic esophageal bulb has no cuticular -----------------------------------
Filariform Larvae
expansion on the anterior end
- non-feeding, and slender, about 550 um in length
- similar to the hookworm filariform larva but usually is
smaller
- has a distinct cleft at the tip of the tail
- larvae have been thought to locate their hosts via
chemicals in the skin, predominantly urocanic acid, a
histidine metabolite on the uppermost layer of skin that
is removed by sweat or the daily skin-shedding cycle
(major chemoattractant)

Larvae
S.name Strongyloides stercoralis (4) Enterobius vermicularis (5) Capillaria philippinensis (6)
C.name Threadworm Pinworm/Seatworm -------------
- assymetrical, with one side flattened and the other side
convex - peanut-shaped with striated shells and flattened bipolar
- measures 50-60 um by 20-30 um in size (average : 55 by plugs
36 um) - measure 36 to 45 um by 20 um
have a clear thin shell and are similar to those of - translucent shell consists of an outer, triple albuminous - unembryonated when laid
hookworms except that they measure only about 50 to covering for mechanical protection and an inner - embryonate in the soil or water
58 pm by 30 to 34 um embryonic lipoidal membrane for chemical protection - must reach the water in order to be ingested by small
- embryonated when laid species of freshwater or brackish water fish
- outside the host, becomes infective in four to six hours - embryonated egg hatch in the intestines of the fish and
Egg
(ovum develops into a tadpole-like embryo) grow into the infective larvae (when the fish is eaten
- resistant to disinfectants but succumb to dehydration in uncooked, the larvae escape from the fish intestines and
dry air within a day (in moist conditions, these eggs may develop into adult worms in human intestines)
If the temperature is 340C or higher (unfavorable for remain viable for 13 days)
free-living stages), they become J3 infective juveniles and
will not develop further unless they encounter a potential
host.
If the temperature is less than 340C, they tend to molt to
J4 and become free-living adults.
S.name Strongyloides stercoralis (4) Enterobius vermicularis (5) Capillaria philippinensis (6)
C.name Threadworm Pinworm/Seatworm -------------
 The Strongyloides life cycle is more complex than that of
most nematodes with its alternation between free-living
and parasitic cycles, and its potential for autoinfection
and multiplication within the host. 2 types of cycles exist:
1. Free-living cycle
2. Parasitic cycle
Free-living cycle: The (1) rhabditiform larvae passed in
the stool can either molt twice and become infective (6)
filariform larvae (direct development) or molt four times
and become free living adult males and females (2) that
mate and produce eggs (3) from which rhabditiform
larvae (4) hatch . The latter (5) in turn can either develop
into a new generation of free-living adults (2), or into
infective filariform larvae (6). The filariform larvae
penetrate the human host skin to initiate the parasitic
cycle.
Parasitic cycle: Filariform larvae (6) in contaminated soil
penetrate the human skin, & are transported (7) to the
Life Cycle
lungs where they penetrate the alveolar spaces; they are
carried through the bronchial tree to the pharynx, are
swallowed and then reach the small intestine. In the
small intestine they molt twice and become adult female
worms (8). The females live threaded in the epithelium of
the small intestine and by parthenogenesis produce eggs Typically, unembryonated eggs are passed in the human
(9), which yield rhabditiform larvae (1). The rhabditiform stool and become embryonated in the external
larvae can either be passed in the stool (see Free- living environment; after ingestion by freshwater fish, larvae
cycle), or can cause autoinfection (7). In autoinfection, hatch, penetrate the intestine, and migrate to the tissues.
the rhabditiform larvae become infective filariform larvae Ingestion of raw or undercooked fish results in infection
(7), which can penetrate either the intestinal mucosa of the human host. The adults of Capillaria reside in the
(internal autoinfection) or the skin of the perianal area human small intestine, where they burrow in the
(external autoinfection); in either case, the filariform mucosa. The females deposit unembryonated eggs.
larvae may follow the previously described route, being Some of these become embryonated in the intestine and
carried successively to the lungs, the bronchial tree, the release larvae that can cause autoinfection. This leads to
pharynx, and the small intestine where they mature into hyperinfection (a massive number of adult worms).
adults; or they may disseminate widely in the body.
(See pic under the life cycle of E. vermicularis)
S.name Strongyloides stercoralis (4) Enterobius vermicularis (5) Capillaria philippinensis (6)
C.name Threadworm Pinworm/Seatworm -------------
Infective Filariform Embryonated eggs Infective larvae
 stage
There are three phases of infection in Strongyloidiasis:
1) invasion of the skin by filariform larvae
2) migration of larvae through the body
3) penetration of the intestinal mucosa by adult female
worms
The migration of larvae through the body and
penetration of intestinal mucosa by adult females may
occur simultaneously particularly in hyperinfection.
Frequently asymptomatic. Gastrointestinal symptoms
include abdominal pain and diarrhea. Pulmonary
Abdominal pain and diarrhea are typical manifestations.
symptoms (including Loeffler’s syndrome) can occur Enterobiasis is frequently asymptomatic. The most
If untreated, the disease becomes severe due to
during pulmonary migration of the filariform larvae. typical symptom is perianal pruritus, especially at night,
autoinfection, resulting protein-losing enteropathy and
Dermatologic manifestations include urticarial rashes in which may lead to excoriations and bacterial
dehydration leading to cachexia and death.
the buttocks and waist areas. superinfection. Occasionally, invasion of the female
Disseminated strongyloidiasis occurs in genital tract with vulvovaginitis and pelvic or peritoneal
The large number of worms that develop in humans is
Pathoge immunosuppressed patients, can present with granulomas can occur. Other symptoms include
responsible for the pathology. The parasites do not
nesis & abdominal pain, distension, shock, pulmonary and anorexia, irritability, and abdominal pain. Children
invade intestinal tissue but they are responsible for
Clinical neurologic complications and septicemia, and is infected with this parasite may suffer from insomnia due
micro-ulcers in the epithelium and the compressive
Manifest potentially fatal. Blood eosinophilia is generally present to pruritus.
degeneration and mechanical compression of cells.
ations during the acute and chronic stages, but may be absent
with dissemination. The prognosis of enterobiasis or oxyuriasis is good
The ulcerative and degenerative lesions in the intestinal
Light infection does not cause intestinal symptoms. except that this parasitic disease is easily spread within
mucosa may account for malabsorption of fluid, protein,
Moderate infection causes diarrhea alternating with the family, hence it may be described as a familial
and electrolytes. Histologically, the intestines also show
constipation. Heavy infection produces intractable, disease.
flattened and denuded villi and dilated mucosal glands.
painless, intermittent diarrhea (Cochin China diarrhea)
characterized by numerous episodes of watery and
bloody stools.
Prognosis is good in light infections but moderate and
heavy infections have high mortality rates due to
massive invasion of tissues by adults and larvae.
Disseminated infection occurs among patients with
cancer, malnutrition or those using immunosuppressive
drugs after organ transplantation.
The finding of unexplained eosinophilia in a patient may
be a clue pointing to strongyloidiasis.

S.name Strongyloides stercoralis (4) Enterobius vermicularis (5) Capillaria philippinensis (6)
C.name Threadworm Pinworm/Seatworm -------------
 Diagnosis rests on the microscopic identification of
larvae (rhabditiform and occasionally filariform) in the
stool or duodenal fluid. Examination of serial samples
may be necessary, and not always sufficient, because
stool examination is relatively insensitive.
The stool can be examined in wet mounts:
1. directly
2. after concentration (formalin-ethyl acetate)
3. after recovery of the larvae by the Baermann funnel
technique
4. after culture by the Harada-Mori filter paper
technique
Lab
5. after culture in agar plates
Diagnosi
The duodenal fluid can be examined using techniques
s
such as the Enterotest string or duodenal aspiration.
Larvae may be detected in sputum or urine from
patients with disseminated strongyloidiasis. Small bowel
biopsy can be done. Serology may not be useful in filaria
endemic areas since there are cross-reactions between
Strongyloides and filarial worm antigens.
Enterotest
A capsulated yarn is swallowed by the patient; the yarn
is expected to reach the duodenum; after about 4 hours,
the yarn is retrieved and the mucoidal material clinging
to the yarn is examined for the presence of the parasite.
All infected individuals should be treated. The drug of
choice is albendazole, 400 mg administered for three
consecutive days. The drug is well tolerated by both
adults and children over two years old. Albendazole
Treatme
appears to eradicate up to 80% of infections. It is more
nt
effective and better tolerated than thiabendazole, which
is given at 50 mg per kg (max. 3 grams per day) in 2
divided doses daily for 2 consecutive days after meals.
Higher doses given for longer periods may be necessary.
S.name Strongyloides stercoralis (4)
Microscopic identification of eggs collected in the
perianal area is the method of choice for diagnosing
enterobiasis. This must be done in the morning, before
defecation and washing, by pressing transparent The specific diagnosis of C. philippinensis is established
adhesive tape ("Scotch test", cellulose-tape slide test) on by finding eggs, larvae and/or adult worms in the stool,
the perianal skin and then examining the tape placed on or in intestinal biopsies. Unembryonated eggs are the
a slide. Alternatively, anal swabs or "Swube tubes" (a typical stage found in the feces. In severe infections,
paddle coated with adhesive material) can also be used. embryonated eggs, larvae, and even adult worms can be
found in the feces. The parasites can also be recovered
Eggs can also be found, but less frequently, in the stool, from the small intestines by duodenal aspiration.
and occasionally are encountered in the urine or vaginal
smears. Adult worms are also diagnostic, when found in
the perianal area, or during ano-rectal or vaginal
examinations.
The drug of choice is pyrantel pamoate (10 mg/kg with a
second dose 2 to 4 weeks later). Alternative drugs
include albendazole (400 mg chewable tablets single The antihelmintics recommended are mebendazole or
dose) and mebendazole (500 mg chewable tablets single albendazole. Albendazole is considered the drug of
dose). E. vermicularis is quite susceptible to these drugs. choice as it destroys larval stages more readily than
However, due to high reinfection rates, a second dose mebendazole. Relapses may occur if the treatment
maybe necessary. Cure maybe considered only after regimen is not followed.
seven perianal smears using the scotch-tape swab
method are all found to be negative.
Enterobius vermicularis (5) Capillaria philippinensis (6)
C.name Threadworm
Strongyloides is more of a fecally-transmitted worm
than a soiltransmitted helminth because it is infective
shortly after passage with the feces.
Egg reduction rate (ERR) cannot be determined because
eggs are not passed out in the feces but are oviposited
in the intestine and other tissues of the host.
Reinfection rate is difficult to calculate because of auto
Epidemio
infection.
logy
The factors that affect transmission include poor
sanitation and indiscriminate disposal of human feces,
which contain Strongyloides larvae. Autoinfection
explains how some people remain infected for more
than 30 years even after leaving the endemic area. This
was seen in Vietnam war veterans who returned to the
United States (Cochin-China diarrhea).
Prevention and control measures for this disease are
similar to those for hookworm infection. Both worms
use the soil for further development and maintain their
endemicity in areas where environmental sanitation is
poor and human feces is deposited indiscriminately in
Preventi soil by people who usually walk barefoot.
on & People with cancer, debilitating diseases like pulmonary
Control tuberculosis, and malnutrition, and those about to
undergo organ transplantation should be cleared of
Strongyloides infection. This important step is taken to
prevent the occurrence of disseminated strongyloidiasis,
which is almost always fatal because adults and larvae
invade practically all tissues of the human body.
Pinworm/Seatworm
Enterobiasis occurs in both temperate and tropical
regions of the world and has a high prevalence in both
developed and underdeveloped countries. It is the only
intestinal nematode infection that cannot be controlled
through sanitary disposal of human feces because eggs
are deposited in the perianal region instead of the
intestinal lumen.
Eggs usually contaminate underwear and beddings. The
route of infection is through the mouth, the respiratory
system (by inhalation of dust containing Enterobius eggs)
and finally through the anus (wherein the hatched larvae
enter the anus and cause retroinfection when they go
back into the large intestine).
In the Philippine studies, eggs were collected from
fingertips and under fingernails of schoolchildren.
Apparently, adult female worms migrate to the perianal
area even during daytime but more migration occurs in
the evening hours.
Personal cleanliness and personal hygiene are essential.
Fingernails should be cut short and hand washing should
be done after using the toilet, as well as before and after
meals. The use of showers rather than bathtubs is
suggested and infected persons should sleep alone.
Underwear, night clothes, blankets, and bedsheets
should be handled with care, boiled, and laundered.
Being a familial disease, chemotherapy of the entire
family is suggested and will help in the control of the
disease.
-------------
Capillaria philippinensis is endemic in the Philippines. It
is also known as ‘Pudoc worm’ in the Philippines, based
on the name of the location where the disease and the
associated worm were first discovered in 1963.
Outbreak of this disease first found in northern Luzon,
Philippines in 1963. Subsequently human cases were
found in Thailand in the 1970s, then in Japan, Taiwan,
Egypt, in the 1980s. Further expansion was noted in
Korea and Indonesia in the 1990s. The latest record of
new endemic area is Lao PDR. Migration of
ichthyophagous(meaning fish-eating) birds and/or humans
are considered to be responsible for the transmission of
this parasite.
Cases have been documented from the Northern Luzon
provinces, Zambales, and Southern Leyte. Infections are
acquired by eating uncooked small freshwater/brackish
water fish. Ilocano people enjoy eating "hagsit/bagsit"
and other fishes found in the lagoons.
More recently described endemic areas in the
Philippines include Compostela Valley Province and
Zamboanga del Norte. In Monkayo, Compostela Valley,
Province, an outbreak described as “mystery disease” in
1998 resulted in the death of villagers due to
misdiagnosis. Intestinal capillariasis was diagnosed in
17% of the cases presenting with chronic diarrhea.
Infections can be prevented by discouraging people in
endemic areas from eating raw fish. Good sanitary
practices should be followed. It is believed that the 1967
to 1968 Philippine epidemic was due to washing of
fecally contaminated bed sheets in lagoons in the
Tagudin area of Ilocos Sur. All infected persons should
be treated quickly and their feces disposed of in a
sanitary manner. Educational programs should be
implemented to inform populations at risk about the
hazards of eating uncooked fish.
 S.name Strongyloides stercoralis (4)
C.name Threadworm
1. Parasitic female is parthenogenic (capable of
unisexual reproduction; no fertilization is required)
2. Internal infection can continue for years because of
maintenance of autoinfection.
3. Strongyloidiasis is difficult to treat
4. Often defective T-lymphocyte function
5. Strongyloides larvae do not float in saturated salt
solutions; sedimentation concentration preferred.
6. Infects other primates besides humans as well as
Of note
dogs, cats and other mammals
7. If the temperature is 34◦C or higher (unfavorable for
free-living stages), they become J3 infective juveniles
(filariform) and will not develop further unless they
encounter a potential host.
8. If the ambient temperature is less than 34◦C, they
tend to molt to J4 and become free-living females.
9. Urocanic acid in mammalian skin is a specific
attractant for S. stercoralis
Enterobius vermicularis (5) Capillaria philippinensis (6)
Pinworm/Seatworm -------------
1. Humans are the only known host. Infection is
generally self-limiting. 2. Each female produces an
average of 11, 105 eggs per day. 3. Cleaning eggs from
the environment and treating all persons in the
household are important in order to break the life cycle.
4. Eggs are rarely found in fecal samples because release
-------------------------------
is external to the intestine. Adult females can be
recovered occasionally on cellophane tape preparation
used to find eggs on perianal area. 5. Hatched larvae on
perianal area may migrate back into rectum and large
intestine and develop into adults (retroinfection), or
autoinfection (ingestion of eggs) can occur.

Scientific
Capillaria hepatica (7) Capillaria aerophila (8)
name à
C.name ------------------ ------------------
Gen. Capillaria hepatica causes human hepatic capillariasis. The adult worms reside in the
Characte liver of various animals, especially rats. The females produce eggs that are retained in
Capillaria aerophila causes human pulmonary capillariasis. The adult worms reside in
ristics the liver parenchyma. When the infected animal is eaten by another animal, the eggs
the epithelium of the tracheo-bronchial tract of various animals. Eggs are produced,
are released by digestion, excreted in the feces of the second animal, and become
coughed up, swallowed by the animal, and excreted in its feces. The eggs become
embryonated in the soil.
embryonated in the soil. Ingestion of infective eggs completes the cycle. Transport or
Alternately, the eggs can be released following the death and decomposition of the
paratenic hosts may also intervene in the cycle.
first animal, and mature in the soil. Following ingestion by a subsequent host, these
infective eggs release larvae in the intestine that migrate through the portal
circulation to the liver, where they develop into adults.
The specific diagnosis of C. hepatica infection is based on demonstrating the adult
Lab
worms and/or eggs in liver tissue at biopsy or necropsy. (Note: identification of C. The specific diagnosis of C. aerophila is based on demonstrating eggs in stool or in lung
Diagnosi
hepatica eggs in the stool is a spurious finding, which does not result from infection of biopsy.
s
the human host, but from ingestion by that host of livers from infected animals.
Infective
Embryonated egg Embryonated egg
stage
 1. Fresh and Brackish Water Fish are the intermediate hosts of
Capillaria philippinesis.
Capillariasis
2. Fish-Eating Birds in endemic areas are considered the natural
definitive hosts for the Capillaria philippinesis parasite.
Of Note
Life Cycle
3. Humans are considered the accidental hosts or reservoir for
of
Capillaria philippinesis.
Capillari
a
4. In the USA, documented hosts of C. philippinensis include the
Hepatica NOTE: not
mouse, rat, vole, chipmunk, groundhog, squirrel, mole, shrew,
(7) under sa C.
opossum, weasel, fox, skunk, and raccoon.
aerophila
but
5. There exists no vector for the Capillaria philippinesis parasite.
Capillariasis
as a whole
6. Rodents are the reservoirs for C. hepatica.

7. Cats and dogs are the reservoirs for C. aerophila.

Scientific
Trichostrongylus spp. (meaning of spp is species) (9) Anisakiasis (disease) or Anisakis spp. (parasites) (10)
name à
C.name ------------------------- -------------------------
Anisakiasis is a parasitic infection caused by larval intestinal nematodes of the family
Trichostrongylus contains a number of species that are primarily parasites of
Anisakidae. It is characterized by the burrowing of the worms into the digestive tract
herbivores and are found throughout the world. Human infections have been
of the host organism, causing the attraction of eosinophils to the site and the
reported on occasion from many regions and are accidental. Although primarily
formation of a granuloma.
parasites of animals, several species of Trichostrongylus have been known to infect
Causal Agents
humans, including T. orientalis, T. colubriformis, and T. axei.
Gen. 1. Anisakis simplex (herring worm)
Trichostrongylus are related to the hookworms, and the adults are rather similar in
Character 2. Pseudoterranova (Phocanema) decipiens (cod or seal worm)
appearance. The various species reported from humans are smaller than the
istics 3. Contracaecum spp.
hookworms, but their eggs are larger. Identification of the various species of
4. Hysterothylasium spp. (ang correct spelling is Hysterothylacium but idk ano
Trichostrongylus from the eggs is difficult, but differentiation of the eggs from those
gamiton)
of hookworm can be readily accomplished.
Geographic Distribution
Trichostrongyle eggs are symmetrical and thin shelled and differ from hookworm
Worldwide, with higher incidence in areas where raw fish is eaten (e.g., Japan, Pacific
eggs in their size and their more pointed ends.
coast of South America, the Netherlands).
 S.name Trichostrongylus spp. (meaning of spp is species) (9) Anisakiasis (disease) or Anisakis spp. (parasites) (10)

Life Cycle

Eggs are passed in the stool of the definitive host (usually a herbivorous
mammal), and under favorable conditions (moisture, warmth, shade),
larvae hatch within several days. The released rhabditiform larvae grow in
the soil or on vegetation, and after 5 to 10 days (and two molts) they
become filariform (third-stage) larvae that are infective. Infection of the
human host occurs upon ingestion of these filariform larvae. The larvae
reach the small intestine, where they reside and mature into adults. Adult
worms inhabit the digestive tract of their definitive hosts and may occur
as incidental infections in humans.

Infective
Filariform (third-stage larvae) Filariform (third-stage larvae)
Stage
Pathogen Symptoms and Pathogenesis Clinical Features
esis & Eggs hatch in the soil and if the hatched larvae contaminate foodstuffs Within hours after ingestion of infected larvae, violent abdominal pain, nausea, and vomiting
Clinical they may be ingested. The larvae do not undergo a pulmonary migration may occur. Occasionally the larvae are coughed up. If the larvae pass into the bowel, a severe
Manifest but when swallowed attach themselves to the intestinal mucosa and grow eosinophilic granulomatous response may also occur 1 to 2 weeks following infection, causing
ations to adulthood in 3 to 4 weeks. They ingest blood; only in rather heavy symptoms mimicking Crohn's disease.
infections is the blood loss clinically significant. Heavily infected patients Clinical Presentation
may become emaciated (very thin). Anisakiasis can be classified into four clinical presentations depending on where the larvae is
 found: 1. Luminal form 2. Gastric form 3. Intestinal form 4. Intraperitoneal form

S.name Trichostrongylus spp. (meaning of spp is species) (9) Anisakiasis (disease) or Anisakis spp. (parasites) (10)
Epidemiology LUMINAL FORM
Trichostrongyle eggs passed in the feces of infected herbivores or humans hatch and The larvae that cause luminal anisakiasis are incapable of penetrating the mucosal
develop in the soil in much the same manner as hookworm eggs do. Although surface of the digestive tract, and are accompanied by a tingling, tickling throat until
Trichostrongylus worms are principally zoonotic, the use of human feces for fertilizer the patient actually coughs up or can otherwise extract a nematode. Symptoms occur
facilitates human to human spread of the infection. one hour to two weeks after consumption, and usually only one nematode is
recovered. Most cases in the U.S. are of this form.
Treatment GASTRIC FORM
Mebendazole, 100 mg twice daily for 3 days, has been considered the treatment of The symptoms of this form is usually caused by the Anisakis species, and symptoms
choice for both adults and children. mimic gastritis or an ulcer, accompanied by nausea, vomiting, and abdominal pain.
Under this arrow is for Anisakis spp. Symptoms first occur 12 hours after consumption of the larvae.
Laboratory Diagnosis INTESTINAL FORM
Diagnosis can be made by gastroscopic examination during which the 2 cm larvae are All intestinal cases are caused by the Anisakis species, and are characterized by the
visualized and removed, or by histopathologic examination of tissue removed at burrowing of the larval nematodes into the wall of the intestines, possibly even
Mixed biopsy or during surgery. burrowing through to the cavity, causing intraperitoneal anisakiasis . Any portion of
the intestines may be invaded, but the terminal ileum is the most common site. The
Epidemiology and Prevention larvae produce a substance that recruits eosinophils to the site, causing the formation
Larvae may be found in the gut, the visceral cavity, and the flesh of fish. In some of a granuloma around the worm in the tissue.
species, such as herring, few or none are found in the flesh during life and if the fish INTRAPERITONEAL FORM
are cleaned promptly the flesh will be free of larvae. Even though the organism can In severe cases, the larvae may completely penetrate the intestinal wall and migrate
survive in the muscle tissue of the dead marine species, it cannot survive extreme to the liver, gallbladder, lymph nodes, and mesenteries of the host. Often, symptoms
cold. mimic gastric cancer, appendicitis, pancreatic cancer, or peritonitis. The prognosis of
Human infection results from the consumption of raw or insufficiently smoked or this form of anisakiasis is the worst.
salted or marinated fish. Fish kept frozen at -20 ◦C for at least 7 days are considered
safe for consumption in dishes such as sashimi, sushi, ceviche, and poisson cru.
Smoking fish kills the parasites only if the temperature of the flesh reaches 65 ◦C
during the process. Salting or marinating fish cannot be depended on to kill the
parasites. When fish are iced (but not frozen) for transportation to harbor processing
plants, larvae tend to migrate from the gut into the muscles.
1. Cutaneous Larva Migrans An itching,
(Causal red papule is produced
Agents) 3. Angiostrongylus
at the site of larval
cantonensis
entry with
1. Ancylostoma caninum (dog hookworm)
development of serpentine tunnel between 4. Dracunculus
the epithelialmedinensis
layers produced as
BLOOD & (only in dogs)
the larva migrates. The larva moves several mm per day & may survive
TISSUE 2. Ancylostoma braziliense (cat hookworm) 5. Trichinella spiralis
several weeks or months. 1. Ancylostoma caninum
NEMA- (both dogs & cats)
TODES 2. Visceral Larva Migrans (Causal Agents) 2. Ancylostoma braziliense
Trapped larvae of A. braziliense may survive for some weeks or even
1. Toxocara canis (causing allergic reaction in the
months, migrating through the subcutaneous tissues, whereas those of A.
2. Toxocara cati migration tracks or "creeping
caninum encyst and remain dormant in skeletal muscle after a shorter
eruption"
cutaneous migratory period.
Scientific Toxocara canis & Toxocara cati Angiostrongylus cantonensis Dracunculus medinensis Trichinella spiralis
name à (11) under Visceral Larva Migrans (12) (13) (14)
C.name dog roundworm & cat roundworm Rat lungworm Guinea worm Trichina worm
Trichinellosis (trichinosis) is caused by
-Toxocariasis is caused by larvae of nematodes (roundworms) of the genus
Toxocara canis (dog roundworm) and less The nematode (roundworm) Trichinella. In addition to the classical
frequently of T. cati (cat roundworm), two Angiostrongylus cantonensis, the rat agent T. spiralis (found worldwide in
nematode parasites of animals. lungworm, is the most common cause of many carnivorous and omnivorous
-The adult worms, similar to Ascaris Dracunculiasis (guinea worm disease) is
human eosinophilic meningitis. In animals), several other species of
lumbricoides in appearance but a quarter addition, Angiostrongylus caused by the nematode (roundworm)
Trichinella are now recognized, including
to half its size, live in the small intestines Dracunculus medinensis.
(Parastrongylus) costaricensis is the T. pseudospiralis (mammals and birds
of dogs and cats. Their eggs which require causal agent of abdominal, or intestinal, worldwide), T. nativa (Arctic bears), T.
a period of maturation outside the hosts angiostrongyliasis. nelsoni (African predators and
are infective for dogs, cats, and humans. scavengers), and T. britovi (carnivores of
Causal continuation of vlm below
Europe and western Asia).
Agents
-Toxocara canis accomplishes its life cycle in dogs, with humans acquiring the infection as accidental hosts. Unembryonated eggs are shed in the feces of the definitive host.
Eggs embryonate and become infective in the environment. Following ingestion by dogs, the infective eggs hatch and larvae penetrate the gut wall. In younger dogs, the larvae
migrate through the lungs, bronchial tree, and esophagus; adult worms develop and oviposit in the small intestine. In older dogs, patent infections can also occur, but larval
encystment in tissues is more common. Encysted stages are reactivated in female dogs during late pregnancy and infect by the transplacental and transmammary routes the
puppies, in whose small intestine adult worms become established. Puppies are a major source of environmental egg contamination. Toxocara canis can also be transmitted
through ingestion of paratenic hosts: eggs ingested by small mammals (e.g. rabbits) hatch and larvae penetrate the gut wall and migrate into various tissues where they encyst.
The life cycle is completed when dogs eat these hosts and the larvae develop into egg-laying adult worms in the small intestine. Humans are accidental hosts who become
infected by ingesting infective eggs in contaminated soil or infected paratenic hosts. After ingestion, the eggs hatch and larvae penetrate the intestinal wall and are carried by
the circulation to a wide variety of tissues (liver, heart, lungs, brain, muscle, eyes). While the larvae do not undergo any further development in these sites, they can cause severe
local reactions that are the basis of toxocariasis. The two main clinical presentations of toxocariasis are visceral larva migrans and ocular larva migrans. Diagnosis is usually
made by serology or the finding of larvae in biopsy or autopsy specimens.
S.name Dracunculus medinensis (13) Trichinella spiralis (14)
Life This worm is the largest of the tissue parasites affecting human. The parasite migrates Trichinellosis is acquired by ingesting meat containing cysts (encysted larvae) of Trichinella. After
Cycle through the victim's subcutaneous tissues causing severe pain especially when it occurs in the exposure to gastric acid & pepsin, the larvae are released from the cysts & invade the small
joints. The worm eventually emerges (from the feet in 90% of the cases), causing an intensely bowel mucosa where they develop into adult worms (female 2.2 mm in length, males 1.2 mm;
For painful edema, a blister & an ulcer accompanied by fever, nausea & vomiting. People get life span in the small bowel: 4 weeks). After 1 week, the females release larvae that migrate to
11-14 infected with Guinea worm disease by drinking water contaminated w/ Dracunculus larvae. In the striated muscles where they encyst. Trichinella pseudospiralis, however, does not encyst.
see the water, the larvae are swallowed by small copepods ("water fleas"). The worms mature Encystment is completed in 4- 5 weeks & the encysted larvae may remain viable for several
pics inside the water flea & become infective in about 10 days. Once the worms have matured years. Ingestion of the encysted larvae perpetuates the cycle. Rats & rodents are primarily
after inside the water flea, any person who swallows contaminated water becomes infected. Once responsible for maintaining the endemicity of this infection. Carnivorous/omnivorous animals,
this inside the body, the stomach acid digests the water flea, but not the Guinea worm. During the such as pigs/ bears, feed on infected rodents/meat from other animals. Different animal hosts
page next year, the Guinea worm grows to a full-size adult. Adult worms are up to 3 feet long and are implicated in the life cycle of the different species of Trichinella. Humans are accidentally
are as wide as a spaghetti noodle. After a year, the worm will migrate to the surface of the infected when eating improperly processed meat of these carnivorous animals (or eating food
body. As the worm migrates, a blister develops on the skin where the worm will emerge. This contaminated w/ such meat).
blister will eventually rupture, causing a very painful burning sensation. For relief, persons will
immerse the affected skin into water. The temperature change causes the blister to erupt,
exposing the worm. When someone with a Guinea worm ulcer enters the water, the adult
female emerges from the wound and releases a milky white liquid containing millions of
immature worms into the water, thus contaminating the water supply.
 S. name Toxocara canis & Toxocara cati (11)
C.name dog roundworm & cat roundworm
Infective
Embryonated egg
stage
Geograp
hic
----------------------------
Distributi
on
Clinical Many human infections are
Features asymptomatic, with only eosinophilia and
positive serology. The two main clinical
presentations of toxocariasis are visceral
larva migrans (VLM) and ocular larva
migrans (OLM).
In VLM, which occurs mostly in preschool
children, the larvae invade multiple
tissues (liver, heart, lungs, brain, muscle)
and cause various symptoms including
fever, anorexia, weight loss, cough,
wheezing, rashes, hepatosplenomegaly,
and hypereosinophilia. Death can occur
Angiostrongylus cantonensis (12)
Rat lungworm
For intermediate hosts: first-stage larvae
For human &def. hosts: Third-stage larvae
----------------------------
Clinical symptoms of eosinophilic
meningitis are caused by the presence of
larvae in the brain and by local host
reactions. Symptoms include severe
headaches, nausea, vomiting, neck
stiffness, seizures, and neurologic
abnormalities. Occasionally, ocular
invasion occurs. Eosinophilia is present in
most of cases. Most patients recover fully.
Abdominal angiostrongyliasis mimics
appendicitis, with eosinophilia.
Dracunculus medinensis (13)
Guinea worm
Ingestion of third-stage larvae in copepods
An ongoing eradication campaign has
dramatically reduced the incidence of
dracunculiasis, which are now restricted
to rural, isolated areas in a narrow belt of
African countries.
The clinical manifestations are localized
but incapacitating. The worm emerges as
a whitish filament (duration of
emergence: 1 to 3 weeks) in the center of
a painful ulcer, accompanied by
inflammation and frequently by secondary
bacterial infection. The female guinea
worm induces a painful blister (A); after
Trichinella spiralis (14)
Trichina worm
Encysted larva
Worldwide. Most common in parts of
Europe and the United States.
Light infections may be asymptomatic.
Intestinal invasion can be accompanied by
gastrointestinal symptoms (diarrhea,
abdominal pain, vomiting). Larval
migration into muscle tissues (one week
after infection) can cause periorbital and
facial edema, conjunctivitis, fever,
myalgias, splinter hemorrhages, rashes,
and blood eosinophilia.
 rarely, by severe cardiac, pulmonary or
neurologic involvement.
In OLM, the larvae produce various
ophthalmologic lesions, which in some
cases have been misdiagnosed as
retinoblastoma, resulting in surgical
enucleation. OLM often occurs in older
children or young adults, with only rare
eosinophilia or visceral manifestations.
In this parasitic disease the diagnosis does
not rest on identification of the parasite.
Since the larvae do not develop into
adults in humans, a stool examination
would not detect any Toxocara eggs.
However, the presence of Ascaris and
Trichuris eggs in feces, indicating fecal
exposure, increases the probability of
Toxocara in the tissues.
For both VLM and OLM, a presumptive
diagnosis rests on clinical signs, history of
exposure to puppies, laboratory findings
(including eosinophilia), and the detection
of antibodies to Toxocara.
Lab
Diagnosis
Treatmen VLM is treated with antiparasitic drugs,
t usually in combination with
rupture of the blister, the worm emerges Occasional life-threatening manifestations
as a whitish filament (B) in the center of a include myocarditis, central nervous
painful ulcer which is often secondarily system involvement, and pneumonitis.
infected. Larval encystment in the muscles causes
myalgia and weakness, followed by
subsidence of symptoms.
The clinical presentation of dracunculiasis The suspicion of trichinellosis (trichinosis),
is so typical, and well known to the local based on clinical symptoms and
population, that it does not need eosinophilia, can be confirmed by specific
laboratory confirmation. In addition, the diagnostic tests, including antibody
disease occurs in areas where such detection, muscle biopsy, and microscopy.
confirmation is unlikely to be available.
In eosinophilic meningitis the
Examination of the fluid discharged by the Diagnostic findings
cerebrospinal fluid (CSF) is abnormal
worm can show rhabditiform larvae. No Microscopy
(elevated pressure, proteins, and
serologic test is available. Antibody detection
leukocytes; eosinophilia). On rare
occasions, larvae have been found in the
CSF. In abdominal angiostrongyliasis, eggs
and larvae can be identified in the tissues
removed at surgery.
In humans, eggs and larvae are not
normally excreted, but remain
sequestered in tissues. Both eggs and
larvae (occasionally adult worms) of A.
costaricensis can be identified in biopsy or
surgical specimens of intestinal tissue. The
larvae need to be distinguished from
larvae of Strongyloides stercoralis;
however, the presence of granulomas
containing thin shelled eggs and/or larvae
serve to distinguish A. costaricensis
infections.
Several safe and effective prescription
Local cleansing of the lesion and local drugs are available to treat trichinellosis.
application of antibiotics, if indicated Treatment should begin as soon as
because of bacterial superinfection. possible and the decision to treat is based
No drug has proven to be effective for the Mechanical, progressive extraction of the upon symptoms, exposure to raw or
treatment of A. cantonensis or A. worm over a period of several days. The undercooked meat, and laboratory test
 costaricensis infections. Relief of long, painful process often takes up to one results. Steroids are used for infections
antiinflammatory medications. The symptoms for A. cantonensis infections month. There is no vaccine or medicine to with severe symptoms, plus mebendazole,
antiparasitic drug recommended in is can be achieved by the use of analgesics, treat or prevent Guinea worm disease. with albendazole as an alternative.
albendazole, with mebendazole as an corticosteroids, and careful removal of
alternative. the cerebral spinal fluid at frequent 1. Health education and low-technology 1. Cooking meat to a uniform temperature
intervals. measures to promote behavioral change. of 70 degrees Celsius or higher for at least
2. Filter the tiny water fleas out of a few minutes to kill encysted larvae.
drinking water. 2. Freezing of pork meat to a temperature
- fine-mesh filter cloths that fit over clay of -30 degrees Celsius for one week
pots used to hold water reportedly kills the encysted larvae (may
- pipe filters, which are small straw-like not be effective for wild game meat).
Preventio
------------------- ------------------- personal filters that can be worn around 3. Other cooking methods such as
n
the neck (enable people to drink water microwaving, smoking, or salting meat
safely no matter where they are) often fail to kill the encysted larvae and
3. treating ponds with a safe chemical thus the risk of getting trichinosis from
larvicide called ABATE meat treated by these methods is
4. constructing boreholes or deep wells increased.
General Characteristics
-The filariae are long, threadlike nematodes, various species of which inhabit portions of the human lymphatic system, and others the subcutaneous and deep connective tissues. The
adults of all species of filariae are parasites of vertebrate hosts.
-The female worms produce eggs that during their development become elongate and wormlike in appearance, a modification that adapts them for life within the vascular system or for
migration through the tissues. These highly modified eggs, referred to as microfilariae, are generally capable of living for a long period within the vertebrate host but not of developing
T further until ingested by their intermediate host and vector, an insect.
h - In the insect, the microfilariae molt and grow, transforming into infective larvae, which are deposited on the skin when the insect next takes blood from a suitable host.
e Causal Agents
Filariasis is caused by nematodes (roundworms) that inhabit the lymphatics and subcutaneous tissues. Eight main species infect humans.
F 1. Lymphatics (reside in lymphatic vessels and lymph nodes) 2. Subcutaneous tissues
i Wuchereria bancrofti Onchocerca volvulus - nodules in subcutaneous tissues
l Brugia malayi Loa loa - subcutaneous tissues, where it migrates active
a Brugia timori Mansonella streptocerca - dermis and subcutaneous tissue
r Mansonella ozzardi
i Mansonella perstans - body cavities and the surrounding tissues
a Life Cycles
e -Infective larvae are transmitted by infected biting arthropods during a blood meal. The larvae migrate to the appropriate site of the host's body, where they develop into microfilariae-
producing adults. The adults dwell in various human tissues where they can live for several years.
-The female worms produce microfilariae which circulate in the blood, except for those of Onchocerca volvulus and Mansonella streptocerca, which are found in the skin, and O. volvulus
which invade the eye.
-Inside the arthropod, the microfilariae develop in 1 to 2 weeks into infective filariform (third-stage) larvae. During a subsequent blood meal by the insect, the larvae infect the vertebrate
host. They migrate to the appropriate site of the host's body, where they develop into adults, a slow process that can require up to 18 months in the case of Onchocerca.
 Arthropod Vectors
1. mosquitoes [Culex spp. ; Anopheles spp. ; Aedes spp. Mansonia spp.; and Coquillettidia spp.] for the agents of lymphatic filariasis
2. blackflies [Simulium] for Onchocerca volvulus
3. midges for Mansonella perstans , M. streptocerca, and M. ozzardi
4. blackflies for Mansonella ozzardi
5. deerflies [Chrysops] for Loa loa
Geographic Distribution
1. Wuchereria bancrofti - tropical areas worldwide
2. Brugia malayi - limited to Asia
3. Brugia timori - restricted to some islands of Indonesia
4. Onchocerca volvulus - mainly in Africa, with additional foci in Latin America and the Middle East
5. Loa loa - Africa
6. Mansonella streptocerca - Africa
7. Mansonella perstans - occurs in both Africa and South America
8. Mansonella ozzardi - occurs only in the American continent

Scientific
Wuchereria bancrofti (15)
name à
C.name Bancroft’s filarial (Lymphatics)
General - Adult Wuchereria worms are creamy white,
Character long, and filiform in shape. The male worm
istics measures 2 to 4 cm length, while the female
measures 8 to 10 cm.
-Microfilariae in fresh specimens appear as
minute snake-like organisms constantly
moving among the red blood cells. A
microfilaria measures 270 to 290 um and is
enclosed in a high hyaline sheath which is
much longer than the microfilaria itself.
-The sheath is actually the egg shell, which is
very thin and delicate and surrounds the
embryo as it circulates in the blood; it is not
lost until it is digested away in the stomach of
the mosquito.
-A large number of distinct nuclei can be seen
in the body of a well-stained specimen, as
well as the rudiments of some organs of the
adult worm. There is no alimentary canal.
Brugia malayi (16)
Malayan filarial (Lymphatics)
-The typical vector for Brugia malayi
filariasis are mosquito species from the
genera Mansonia and Aedes. During a
blood meal, an infected mosquito
introduces third-stage filarial larvae onto
the skin of the human host, where they
penetrate into the bite wound . They
develop into adults that commonly reside
in the lymphatics . The adult worms
resemble those of Wuchereria bancrofti
but are smaller.
-Macaques (Macaca spp) and leaf
monkeys (Presbytis spp) are important
reservoirs of at least certain strains of B.
malayi, which can also be transmitted to
cats and civet cats.
-The microfilariae are sheathed and
average 200 to 275 um in length; body
Brugia timori (17)
Timoran filaria (Lymphatics)
-Microfilariae of a new type were first
reported from the island of Timor in
1964. Subsequently they were found in
persons from surrounding islands of the
Lesser Sunda group in Indonesia, where
prevalence rates for this parasite are
quite high.
- The disease closely resembles
bancroftian filariasis in its clinical
expression, though the rate of abscess
formation seems higher; however there is
a preponderance of elephantiasis of the
legs, as in B. malayi infection. Subsequent
scaring over thick hard, cord like
lymphatics are a hallmark of the disease.
Elephantiasis resulting from timorian
infection is rare.
- Microfilariae of B. timori can be readily
Loa loa (18)
Eye worm (Subcutaneous tissues)
- The African eye worm, Loa loa is found
throughout the rain forest areas of the
Sudan, the basin of the Congo, and West
Africa. The adult Loa loa migrates actively
throughout the subcutaneous tissues of
the body and derives its popular name
from the fact that it is most conspicuous
and irritating when crossing the
conjunctiva. The scientific name comes
from a native term for the worm.
- Adult males of L. loa are 2 to 3.5 cm
long, and females generally 5 to 7 cm;
neither is more than 0.5 mm wide. The
microfilariae which are 250 to 300 um
long and sheathed, differ from the
microfilariae of Wuchereria and Brugia in
having body nuclei that are continuous to
the tip of the tail.
 The cylindrical body is bluntly rounded
anteriorly; posteriorly it tapers to a point.
-Nuclei are not seen in the terminal portion
of the tail, and this characteristic serves to
differentiate microfilariae of this species from
other sheathed microfilariae.
-Microfilariae, present in very small numbers
in the circulating blood during the daytime
hours and often virtually undetectable, they
appear at their greatest density at night,
generally between the hours of 8 PM and 2
to 4 AM. The basis of filarial periodicity
remains largely unknown.
-When absent from the peripheral circulation,
the microfilariae are found primarily in the
capillaries and small vessels of the lungs.
Some of the factors that influence migration
of microfilariae to the lungs are increased
pulmonary pO2 and increased exertion.
S. name Wuchereria bancrofti (15)
C.name Bancroft’s filarial (Lymphatics)
nuclei extend almost to the tip of the tail,
whereas the tail of W. bancrofti
microfilariae contains no nuclei. Two
terminal nuclei are distinctly separate
from the others in the tail.
-Different species of the following genera of
mosquitoes are vectors of W. bancrofti
filariasis depending on geographical
distribution. Among them are: Culex spp.;
Anopheles spp. ; Aedes spp. Mansonia spp.;
and Coquillettidia spp. During a blood meal,
an infected mosquito introduces third-stage
filarial larvae onto the skin of the human host,
where they penetrate into the bite wound
Brugia malayi (16)
Malayan filarial (Lymphatics)
distinguished from those of B. malayi.
They are somewhat longer than those of
B. malayi, averaging 310 um. The cephalic
space (the part of the microfilariae
anterior to the body nuclei) has a length-
width ratio of approximately 2:1 in B.
malayi but 3:1 in B. timori.
- The sheath of B. malayi stains deeply
with Giemsa stain, whereas that of B.
timori does not. In microfilariae of Brugia,
unlike those of Wuchereria, nuclei extend
to the tip of the tail.
-The microfilariae exhibit a nocturnal
periodicity. The vector is Anopheles
barbirostris which breeds in rice fields,
and as far as is known, humans are the
only definitive host.
Brugia timori (17)
Timoran filaria (Lymphatics)
- While adult worms migrate through the
subcutaneous and deeper connective
tissues, the microfilariae make their way
into the blood stream, where they
circulate, having a diurnal periodicity, and
may be ingested by any of the several
species of mango fly. The mango fly,
Chrysops, is large, with mouth parts that
can produce a painful bite (possibly due
to the laceration style employed).
Loa loa (18)
Eye worm (Subcutaneous tissues)
 No pic
of Life
Cycle
and no
sympto
ms &
pathog
enesis
in sir’s
Life Cycle
pdf

Infective
Third-stage filarial larvae Third-stage filarial larvae Third-stage filarial larvae Third-stage filarial larvae
Stage
Pathogenesis & Clinical Symptoms & Pathogenesis (B. malayi) Symptoms (Loa loa)
Manifestation (W. bancrofti) -Clinical features are generally similar to -Migration of the adult worms through the tissues is not painful and seldom is noticed unless they happen to pass the
Sym
-Lymphatic filariasis is those in bancroftian infections. over the bridge of the nose or through the conjunctival tissue across the eyeball. While they migrate rapidly, they can
pto
characterized by a wide Lymphadenitis occurs most frequently in often be immobilized with a few drops of 10 percent cocaine instilled into the eye and excised while passing through
ms the conjunctiva.
spectrum of clinical the inguinal area, & may be followed by a
manifestations with signs and retrograde lymphangitis, often -At other times, patches of localized subcutaneous edema (Calabar swellings) may appear anywhere in the body. The
Path symptoms different from one swellings may be several inches in diameter and are often preceded by localized pain and pruritus. They last several
accompanied by lymphedema of the foot
ogen another. The infection is and ankle. Occasionally (& more commonly days to weeks and subside slowly. It is thought that Calabar swellings are a type of allergic reaction to the metabolic
esis usually acquired in childhood than in bancroftian filariasis) there’s products of the worms or to dead worms. A worm is not necessarily present in the area of a Calabar swelling when it
and but may take years to manifest appears.
ulceration of the affected node.
Clini -Loa in ectopic sites may provoke unusual reactions. Clinical features that have been described are hydrocele and
itself. The clinical course may -Involvement of the genitalia (funiculitis,
cal orchitis in patients with adult Loa in the tunica vaginalis or spermatic cord, a colonic lesion causing obstruction in a
be divided into asymptomatic, orchitis, epididymitis, hydrocele) & chyluria
patient with an adult Loa in the bowel wall, and membranous glomerulonephritis.
Mani acute, and chronic stages, are not characteristic. When elephantiasis Pathogenesis
festa generally progressing in that occurs, it involves the leg below the knee -There is little to suggest that the adult Loa produces any lasting damage to its host during life. Its quite rapid migration
tion order. or, less commonly, the arm below the through the subcutaneous tissue (about 1 cm per minute) may be completely painless in areas other than the face.
elbow. Eosinophilia of 50 to 70 per cent is frequently noted, especially when Calabar swellings are present.
S. name Wuchereria bancrofti (15) Brugia malayi (16) Brugia timori (17) Loa loa (18)
C.name Bancroft’s filarial (Lymphatics) Malayan filarial (Lymphatics) Timoran filaria (Lymphatics) Eye worm (Subcutaneous tissues)
 -Diethylcarbamazine (DEC) has been the drug
of choice for the treatment of lymphatic
filariasis since its discovery in 1948. It is Surgical removal of the migrating adult
effective against both microfilaria and adult worms most readily effected when they
worms; however, some strains of adult worms are found crossing the bridge of the nose
may not be sensitive to the drug. It markedly or in the conjunctiva, is a relatively simple
lowers blood microfilaria even in single once- matter.
a-year doses of 6 mg/kg.
A single optimum dose of DEC does not clear
all microfilariae and does not kill all adult
DEC treatment is effective, but not
worms. A regimen of 6 mg/kg for 12 DEC has been used for mass treatment, without risk, as it readily penetrates the
consecutive days is better than the single and it seems probable that Timoran blood-brain barrier and in heavily
dose, and can be given to individuals if filariasis responds better to drug therapy infected persons may cause a fatal
Treatmen supervised by a medical practitioner, than the other lymphatic filariases, encephalitis. Use of DEC is
same as for filariasis bancrofti
t preferably in divided doses after meals. though the long-term aspects of their contraindicated in persons with blood
reported programs may also be a factor. microfilaria counts of 500 or more per uL.
-Ivermectin: Used in LF, it is highly effective No studies of the use of ivermectin in the
and well tolerated at doses of 100 to 200 brugian filariases have been published. Ivermectin is also an effective
µg/kg for the reduction of microfilaremia for
microfilaricide in loiasis. Its onset of
up to 1 year. Ivermectin leads to
hyperpolarization of glutamate-sensitive action is slower than that of DEC, and the
channels and immobilization of microfilaria. severe reactions resulting from a massive
destruction of these organisms generally
- Albendazole: A low dose of 400 mg used for are not seen with its use. Side effects of
the treatment of most intestinal helminth treatment are mild; pruritus is the most
infections decreases W. bancrofti common one
microfilaremia progressively for 6 to 12
months.
Diagnosis (page 192 sa book)
-The microscopic finding of characteristic microfilaria in the blood is the traditionally accepted procedure.
Diagnosis -bcs of nocturnal periodicity: wet smears or thick blood smears are taken between 8 p.m. and 4 a.m
& - If low intensity infections, filtration using a nucleopore filter or the Knott’s method for concentration may be used.
- The DEC provocative test (3 mg /kg DEC single dose) stimulates microfilariae into coming out to the peripheral circulation, allowing blood smear collection even during daytime.
Epidemio
- Detection of circulating filarial antigens (CFA) is now the preferred method since it also detects latent infections. This is mainly done with immunochromatographic card tests. These simple
logy of
card tests that detect CFAs are very sensitive and specific, thus eliminating the need for laboratory facilities.
W. - Other diagnostic approaches include molecular xenomonitoring of parasites in pools of mosquitoes, and detection of exposure to transmission in children with antibody detection.
bancrofti Epidemiology
(15) About 120 million people worldwide are affected by the disease, and more than 1 billion people are at risk (one-fifth of the world’s population), mostly in the poorest areas. Bancroftian filariasis
accounts for 90% of cases in 83 endemic countries while the Malayan filarial worm (and B. timori) causes the remainder. W. bancrofti affects more than l00 million people in the tropical areas of
India, Southeast Asia, the Pacific Islands, Africa, and South and Central America. India has the largest number of cases.

Staging system for chronic lymphedema (UNDER Wuchereria Bancrofti)(15)

 Stage 1: the swelling increases during the day but is reversible once the patient lies flat in bed
Stage 2: the swelling is no longer reversible overnight, and the patient may still experience acute attacks.
Stage 3: main feature is the presence of shallow skin folds, these are folds where the base can still be seen when the patient moves the leg or foot and the fold “opens up.” Lines or creases
not seen in the normal leg are already considered shallow folds
Stage 4: there are knobs present in the affected area; these are lumps or protrusions in the skin that predispose the area to trauma
Stage 5: patient has deep skin folds, where the base can no longer be seen when the patient moves the leg, but only when the folds are actively “opened” by hand
Stage 6: mossy lesions are present, brought about by the clustering of small elongated or rounded growths. These usually leak translucent fluid, putting the area at risk for secondary
bacterial infection
Stage 7: the patient is unable to adequately or independently perform activities of daily living due to the extent of the pathology. The infected area is foul-smelling and the affected
individual frequently experiences acute attacks
Prevention & Control (UNDER Wuchereria bancrofti)(15)
The Global Programme to Eliminate Lymphatic Filariasis (GPELF) has two major goals: to interrupt transmission of the parasite via preventive chemotherapy, and to provide care for those
who suffer from the clinical manifestations of LF through hygiene education programs. The development of safe, effective, and welltolerated single dose microfilaricidal regimens has
resulted in effective and sustainable drug delivery in endemic areas. DEC-medicated table or cooking salt has been used successfully in eliminating LF in some endemic areas. Besides the
z
commonly used filaricidal drugs, drug development is continuously being undertaken. Moxidectin has been proven in recent animal trials to be a very effective macrofilaricide.

Scientific
Mansonella ozzardi (19) (no common name indicated in pdf)
name à
M. ozzardi is the only filaria parasitizing humans that is
confined to the New World (Argentina, Bolivia,
Venezuela, etc).
The adult stage inhabit the mesenteries and visceral fat;
the unsheathed nonperiodic microfilariae are found in
the blood, and may also be obtained by means of skin
biopsy.
Nuclei of the body of the microfilariae do not extend to
General
the tip of the tail, and the tail is shorter and less tapered
Character
than that of Onchocerca volvulus, the other microfilariae
istics
that may be found in skin biopsies.
Throughout most of its range, M. ozzardi is transmitted
by Culicoides flies but in the Amazon basin by the
blackfly, Simulium, or by both vectors.
Mansonellosis ozzardi is generally an asymptomatic
infection, although inguinal adenopathy has been
reported, as have pruritic and maculopapular skin lesions,
arthritis, fever and marked eosinophilia.
Asymptomatic cases do not require treatment. DEC in
Treatmen
daily doses of 4.5 to 6 mg/kg is ineffective, at least in
t
some localities. Larger doses are reported to be effective.
Mansonella streptocerca (20) (no c. name indicated in pdf)
Formerly, Dipetalonema streptocerca, is found in both
monkeys and humans in the Congo basin.
Microfilariae are found primarily in the skin but also in
the blood. Nuclei extend to the tip of the tail, which is
characteristically bent in the form of shepherd’s crook.
Small midges belonging to the genus Culicoides transmit
this filaria. Infection in humans is characterized by a
pruritic dermatitis, with hypopigmented macules and
inguinal adenopathy.
Control of Mansonelliases
No vector control program has been instituted for any of
the mansonelliases. Protection of visitors to endemic
areas is best afforded by the use of insect repellents. Both
Culicoides and Simulium are small enough to pass readily
through screening or mosquito nets.
DEC or Ivermectin. Mild to severe pruritus is a common
side effect of both drugs.
Mansonella perstans (20) (no c. name indicated in pdf)
Formerly , Dipetalonema perstans, is a common parasite
of humans and apes in large areas of Africa. The adult
worms, similar are size to other filariae live in deep
connective tissues. Their unsheathed microfilariae are
found in the peripheral blood, where they exhibit no
periodicity, and in the skin.
The microfilariae are charactertized by nuclei that extend
to the tip of the tail. The terminal nucleus or pair of
nuclei is separated slightly from the other caudal nuclei.
This filaria is transmitted by Culicoides.
Symptoms
The majority of infections are benign, although
symptomatic cases occur throughout the endemic areas.
It is difficult to evaluate repoted symptoms, but Calabar-
like swellings, pruritus, hives, fever, and headache are
reported from both Africa and South America.
Treatment is probably unnecessary in most cases. DEC
seems ineffective, as does ivermectin. Mebendazole
reportedly has a high cure rate.
Scientific
-----------------------Onchocerca volvulus (21) -----------------------
name à
C.name -----------------------Blinding filaria-----------------------
O. volvulus is widely distributed throughout Central Africa. It is also present in Saudi Arabia, Yemen, and in the Western Hemisphere in limited areas in Mexico, Guatemala,
Venezuela, Colombia, Ecuador, and Brazil. It is generally considered to have been introduced into the Americans by the slave trade.
The intermediate host and vector may be one of a number of species of Simulium, the blackfly or buffalo gnat. These minute insects are widespread in distribution, but only
certain species are suitable vectors.
After introduction into the new host, the developing worms wander through the subcutaneous tissues but settle down, usually in groups of two or more; most worms finally
General
become encapsulated. Nodules, produced by the encapsulation of the adult worms in a fibrous tissue tumor-like mass, usually form within a year after infection.
Character
The majority of nodules are located on the patient’s trunk or limbs, and few form on the head, some are in the scalp. The reason for this difference in distribution of lesions is
istics
by no means apparent, but it may be related to the biting habits of the several vectors.
The wirelike, whitish adults worms lie coiled within fibrous tissue capsules. The female may be as long as 50 cm, though it is less than 0.5 mm in diameter. Males are
considerably shorter, not more than 5 cm.
Microfilariae make their way out of the nodules and migrate actively through the dermis and in the connective tissues, not only in the vicinity of the nodules but at some
distance from them. Rarely, microfilariae may be found in urine, blood, or sputum. As seen in skin biopsies, the larvae are unsheathed and are 150 to over 350 um long.
Simuliid gnats have larval stages that are aquatic, most of them requiring swiftly flowing streams in which the larvae and pupae attach to submerged rocks or vegetation. Some
Epidemio
species develop in more quiet waters and certain African species attach themselves to fresh-water crabs. It follows that endemic areas generally coincide with the course of
logy
rivers or streams, hence the common name for the disease: river blindness.
S.name -----------------------Onchocerca volvulus (21) -----------------------
C.name -----------------------Blinding filaria-----------------------
Diagnosis is by identification of the microfilaria in skin snips. After preparing the skin with a volatile antiseptic agent, a fold of skin may be squeezed between thumb and
forefinger of one hand while a thin slice of skin is removed with a razor blade held in the other, or a needle may be used to catch and raise a small cone of skin, which is then
removed with scissors or a razor blade. The tissue is then placed in saline and may be teased to faciliate liberation of the microfilariae, or incubated for 4 hours in a culture
medium such as NCTC 135 in Hank’s basic salt solution.
If skin snips reveal no microfilariae, a presumptive diagnosis may be made by means of the Mazzotti test. This consist of the oral administration of a single dose of 50 mg DEC,
which generally provokes intense pruritus (death of microfilariae) within a few hours. Itching can then be controlled by short term administration of corticosteroids. This test is
rarely used anymore because it can cause a severe allergic reaction, possibly leading to death, and has been replaced for the most part by the DEC patch test.
A patch test – local application of 10% of DEC in anhydrous lanolin covered with an occlusive dressing – is reported to provoke in infected person’s local dermatitis without
systemic reaction. The DEC patch test was created as an alternative to the Mazzotti test because of the potential for serious side effects associated with the large dose of DEC.
Diagnosis
The application site is later examined for skin inflammation due to DECinduced microfilariae death
The ELISA tests for the presence of antigens to the Onchocerca volvulus parasite requires a small sample of blood from a simple finger prick that is examined with expensive
lab equipment. This test does have a high sensitivity for the antigens but expensive & does not determine if the antigens are due to a current infection or a previous infection.
PCR testing involves the removal of skin from a nodule and then extracting DNA from the microfilariae. PCR is very sensitive to lowlevel infections so it is the best method for
diagnosing the start of a new infection. It is an improvement on the simple nodulectomy procedure, but it is very expensive due to laboratory costs and the patients dislike the
invasiveness of a nodulectomy.
Rapid-format Antibody card testing requires a drop of blood from a finger prick in order to test for the presence of antibodies to O. volvulus. A positive test will result in a
color change on the card surface. This test is similar to the ELISA, but does not require lab testing and provides instantaneous results in the field. It is just as sensitive as the
ELISA and less expensive.
The nodules, though sometimes disfiguring, are not painful, and the importance of the infection lies not in the adult worms but in the effects their microfilariae may produce.
1. Sowda - a severe cutaneous reaction in which skin gets dark, thick, itchy and covered with scaly papules
2. Mal morado - reddish-blue discoloration on trunk and arms
3. Erisípela de la costa - macular rash with edema of the face, typically on one side of the face
4. Lichenified Onchodermatitis (LOD) - raised, hyperpigmented plaques that appear with lymphadenopathy
5. Atrophy - wrinkling and dryness of skin particularly noticeable in younger individuals
Symptom 6. Depigmentation - partial loss of pigment around hair follicles. Leopard skin is the complete loss of pigment around the hair follicle and is usually found on the shins. Elderly
s individuals are especially susceptible to leopard skin.
7. Lymphadenitis - inflammation of the lymph nodes that results in swelling. In African cases of onchocerciasis the affected sites are the femoral and inguinal nodes (groin area)
while in the Americas the lymph nodes of the head and neck are affected.
8. Hanging groin - skin in groin area is atrophied and inelastic, resulting in sagginess. Possible enlarged lymph nodes.
9. Ocular lesions - Eye involvement occurs during chronic onchocerciasis because of the migration and death of microfilariae in the eye tissues. Conjuctivitis often is the first
reaction to the microfilariae. Dead microfilariae also cause corneal infections that can result in scelerosing keratitis and vascularization. Sclerosing keratitis is the main cause of
blindness in onchocerciasis cases. Other effects of microfilariae migration include glaucoma, iritis, iridocyclitis, optic neuritis, and papillitis.
Treatmen DEC is very effective but the rapidity of onset of its action can lead to severe side effects. Ivermectin exerts its microfilaricidal effect more slowly; pruritic reactions are less severe, and ocular
t reactions minimal. Nodulectomy, the surgical removal of palpable nodules, has long been practiced in Mexico and Guatemala.
Blackflies bite during the day. The best prevention is to avoid infective bites of the blackfly by: 1. Using insecticides 2. Wearing long sleeve shirts and pants
Preventio There is neither a vaccine nor recommended drug available to prevent onchocerciasis. The infection is transmitted in rural areas and contracting onchocerciasis requires more than one
n infectious bite. Thus, risk of infection is greater in adventure travelers, missionaries, and Peace Corps volunteers who are likely to have intense and prolonged exposure to blackfly bites (living or
working in an endemic region for more than three months).
DIROFILARIASIS
The genus Dirofilaria includes vector-borne filarial nematodes, which are usually associated with carnivore
hosts. Some Dirofilaria spp. are zoonotic; the most commonly seen species in human patients are D. repens, D.
tenuis, and D. immitis (the dog heartworm).
Rare human infections with other species such as D. striata and D. ursi-like species (D. ursi or D. subdermata)
have been reported. Recently, a D. repens-like agent infecting humans was identified in Hong Kong, which has
been proposed as a new species D. hongkongensis.
Human dirofilariasis is generally divided into pulmonary dirofilariasis (D. immitis) and subcutaneous
dirofilariasis (D. repens, D. tenuis, and others)
D. immitis produces both canine and feline cardiopulmonary dirofilariasis, whereas D. repens causes both
canine and feline subcutaneous dirofilariasis.
In addition, D. immitis and D. repens are responsible for human pulmonary and subcutaneous/ocular
dirofilariasis, respectively, throughout the world.
The most typical hosts for D. immitis are domestic dogs, coyotes, jackals, and wolves. Adult worms are
occasionally found in others species such as domestic cats, bobcats, ferrets, and foxes. However,
microfilaremia is usually low or absent in these aberrant hosts and thus they are not major reservoirs. Vectors
include mosquitoes from several genera (Aedes, Culex, Anopheles, Mansonia).
D. repens definitive hosts include primarily wild and domestic canids, and occasionally felids. The only known
natural definitive host for D. tenuis is the raccoon. Both are by various mosquito vectors from the genera
Aedes, Culex, and Anopheles.
Among the rarer causes of subcutaneous dirofilariasis, D. ursi is a parasite of bears including American black
bears (Ursus americanus), grizzly bears (U. arctos), and Asian black bears (U. thiabetanus), and is transmitted by
black flies (Simulium spp.), rather than the mosquito vectors of most other Dirofilaria species. The North
American porcupine (Erethizon dorsatum) is the definitive host for D. subdermata. D. striata has been
described from some wild Nearctic felids (e.g. bobcats, pumas, ocelots).
 Scientific name: Dirofilaria immitis (21)
Common name (disease): Pulmonary Dirofilariasis
Intermediate Hosts: mosquitoes (Aedes, Culex, Anopheles, Mansonia)
Infective stage to Intermediate Host: microfilariae
Definitive Host: usually a domestic dog or coyote in the United States (although a wide variety
of other animals can also be infected, including felids, mustelids, pinnipeds, beaver, horses,
and humans)
Infective stage to Definitive Host: third-stage filarial larvae
In humans, D. immitis larvae tend to follow the same migratory pathway as in the canine host,
ending up in the lungs, where they often lodge in small-caliber vessels, causing infarcts and
l
typical “coin lesions” visible on radiographs.
Scientific name : D. repens, D. tenuis, and others (22)
Common name (disease): Subcutaneous Dirofilariasis
D. repens usually manifests as either a wandering worm in the subcutaneous tissue or a
granulomatous nodule, although there are reports of pulmonary dirofilariasis with this
species.
D. tenuis follows a similar presentation, but may also be found around the eye or on the
conjunctiva. Because of this, the infection in humans was first known as Dirofilaria
conjunctivae.
Subcutaneous infections with Dirofilaria striata, D. ursi, and possibly D. subdermata have been
reported. Characteristics visible in clinical specimens have not been sufficient to definitively
distinguish D. ursi and D. subdermata, so suspected infections are usually reported as “D.
ursi-like”. These less common species presumably follow a similar life cycle, but with different
hosts.

UNCOMMON INTESTINAL NEMATODES

Eustrongylides spp.(23) Oesophagostomum spp. (25) Acanthocephala (26)
General Characteristics General Characteristics Acanthocephalans
- adults in wading birds (definitive host) - Oesophagostomum bifurcum is the most-common species infecting humans 1. Moniliformis moniliformis
- larvae in fish (intermediate host) in Africa. 2. Macracanthorhynchus hirudinaceus
- man (paratenic host) : consumption of live bait
minnows consumption of sushi
- therapy: surgery (worms invade abdominal
cavity)
Gongylonema spp. (24)
General Characteristics
- threadlike nematodes of ruminants, swine,
bears, hedgehogs, monkeys and occasionally
man
- location of adults in the host: duodenum,
stomach, esophagus buccal cavity (in humans)
- intermediate hosts: cockroaches and other
insects - acquired by man through ingestion of
the insects or of water containing the larval
stages from disintegrating insects
Ruminants are any even-toed, hoofed mammal of
the suborder Ruminantia, being comprised of
cloven-hoofed, cudchewing quadrupeds, and
including, besides domestic cattle, bison, buffalo,
deer, antelopes, giraffes, camels, and chevrotains.
- definitive hosts: ruminants, pigs, monkeys, and humans
- resemble hookworms; their eggs indistinguishable
-larvae develop in the soil, and when ingested, penetrate the intestinal wall
where some develop rapidly into adults and reenter the intestine (some
remain in an immature state for long periods, forming nodules in the
intestinal walls, the omentum, or even the abdominal wall)
- two clinical conditions in humans:
1. unilocular disease (Dapaong tumor or “turtle in the belly”)
- painful abdominal mass that frequently adheres to the abdominal wall
2. multilocular disease - hundreds of pea-sized nodules in the submucosa &
serosa of the large intestine
Life Cycle
Common livestock such as sheep, goats, and swine, as well as non-human
primates, are the usual definitive hosts for Oesophagostomum spp., but other
animals, including humans and cattle, may also serve as definitive hosts. Eggs
are shed in the feces of the definitive host, and may be indistinguishable from
the eggs of Necator and Ancylostoma. Eggs hatch into rhabditiform (L1)
larvae in the environment, given appropriate temperature and level of
humidity. In the environment, the larvae will undergo two molts and become
infective filariform (L3) larvae. Worms can go from eggs to L3 larvae in a
matter of a few days, given appropriate environmental conditions. Definitive
hosts become infected after ingesting infective L3 larvae. After ingestion, L3
3. Macracanthorhynchus ingens
4. Bolbosoma spp. Acanthocephala
General Characteristics
- belong to their own phylum while superficially resembling nematodes
- cylindrical worms with spiny proboscis (thorny-headed worms) - adults
possesses no digestive tract
- intermediate host: arthropod
Life Cycle
Eggs are shed in the feces of the definitive host, which are usually rats for M.
moniliformis and swine for M. hirudinaceous, although carnivores and
primates, including humans, may serve as accidental hosts. The eggs contain
a fully-developed acanthor when shed in feces.
The eggs are ingested by an intermediate host, which is an insect (usually
scarabaeoid or hydrophilid beetles for M. hirudinaceous and beetles or
cockroaches for M. moniliformis). Within the hemocoelom of the insect, the
acanthor molts into a second larval stage, called an acanthella. After 6-12
weeks, the worm reaches the infective stage called a cystacanth. The
definitive host becomes infected upon ingestion of intermediate hosts
containing infective cystacanths. In the definitive host, liberated juveniles
attach to the wall of the small intestine, where they mature and mate in
larvae burrow into the submucosa of the large or small intestine and induce
cysts. Within these cysts, the larvae molt and become L4 larvae. These L4
larvae migrate back to the lumen of the large intestine, where they molt into
adults. Eggs appear in the feces of the definitive host about a month after
ingestion of infective L3 larvae.
Geographic Distribution
Oesophagostomum spp. are widely distributed wherever livestock is raised,
but more common in the tropics and subtropics. The highest incidence in
humans is in the northern regions of Togo and Ghana, where O. bifurcum
(primarily a monkey parasite) appears to cycle naturally in the human
populations. Sporadic cases in humans have also been recorded in Brazil,
Malaysia, Indonesia, French Guiana, and West Africa.
Clinical Features
Acute abdomen is the most-common manifestation in humans, mimicking an
appendicitis. A low-grade fever and tenderness in the lower-right quadrant
are the most-common symptoms; vomiting, anorexia, and diarrhea are less-
common. Intestinal obstruction may also occur, mimicking a hernia. Patients
may also present with large, painless cutaneous masses in the lower
abdominal region. In rare instances, Oesophagostomum spp. will perforate
the bowel wall, causing purulent peritonitis or migrate to the skin, producing
cutaneous nodules.
Laboratory Diagnosis
Diagnosis is difficult during routine ova and parasite (O&P) examinations of
stool, due to the similarity of Oesophagostomum eggs to the eggs of Necator
and Ancylostoma. Eggs tend to be shed in greater numbers during cases of
oesophagostomiasis than hookworm infection, however. Finding an intact
worm during surgery or in a biopsy specimen can provide a definitive
diagnosis.
- The eggs of O. bifurcum measure 60-75 µm long by 35-40 µm wide. Eggs are
often in a later stage of cleavage than hookworm species when shed in feces.
- Adults of Oesophagostomum spp. are bursate nematodes, related to and
morphologically-similar to, the hookworms. Females measure 1.5-3.0 cm in
length; males are smaller.
In both sexes, the anterior end has a cephalic inflation or vesicle, a transverse
cephalic groove, and an oral opening guarded by external and internal leaf
crowns (corona radiata).
- The cuticle is ringed with transverse striations. The posterior end of the
female is short and pointed.
- The male possesses a symmetrical bursa and paired, equal spicules. Adults
reside in the large intestine of the definitive host.
Treatment
1. surgery (worms in the extraintestinal foci)
2. albendazole (intestinal worms)
about 8-12 weeks. In humans the worms seldom mature, or mature but will
rarely produce eggs.
- Bolbosoma has a life cycle involving crustaceans as first intermediate host,
fish as second intermediate host; the adults are found in sea mammals such
as whales. Rare reports of infection with this or similar acanthocephalans are
known from Japan and among fish-eating Inuit (Eskimos).
Geographic Distribution
Acanthocephalans are widely distributed and cases of acanthocephaliasis
generally occur in areas where insects are eaten for dietary or medicinal
purposes.
Clinical Feature
Clinical symptoms of acanthocephaliasis are often severe, due in part to the
mechanical damage caused by the insertion of the armed proboscis into the
lumen of the host's intestine. Symptoms may include abdominal pain and
distension, fever, decreased appetite, nausea, vomiting, weight loss, diarrhea,
constipation or bloody stools.
Laboratory Diagnosis
Diagnosis is made by the observation of eggs or adults in stool. As humans are
not the usual definitive host for acanthocephalans, the parasites often do not
reach sexual maturity in the human host. Eggs in feces, especially in the
absence of other symptoms, may indicate spurious passage.
- Macracanthorhynchus hirudinaceous eggs are 80-100 µm long by 50 µm
wide. They are ovoid and have a thick, dark brown shell that is textured. Eggs
are shed in feces and contain a larva (acanthor) that possesses rostellar
hooks.
- Moniliformis moniliformis eggs are 90-125 µm long by 65 µm wide. They
are elongate-oval and have a thick, clear shell. Eggs are shed in feces and
contain a larva (acanthor) that possesses rostellar hooks.
Treatment
Piperazine citrate, tetramisole and bithionol are recommended for expulsion
of the worms from the human host. Surgery may be necessary in patients
with acute abdomen