WEEK 3 (LEC-LAB) MLS 306** CLINICAL PARASITOLOGY BSMLS 3A

HOOKWORMS PATHOLOGY
- Soil-transmitted helminths 1. The skin at the site of entry
- Blood sucking nematodes 2. The lung during larval migration
- Meromyarian type 3. The small intestine
Necator americanus – American hookworm, American - Exertional dyspnea
murderes, New World hookworm (Host : human) - Weakness
Ancylostoma duodenale – Old World Hookworm (Host: - Dizziness
Human) - Lassitude
Ancylostoma braziliense – Cat hookworm - Rapid pulse
Ancylostoma caninum – Dog hookworm - Edema & albuminemia
Name of hookworm Buccal cavity LARVAL STAGE
Necator americanus Semi-lunar cutting - Ground itch (Severe itching due to allergic reaction
plates at the site of larval penetration)
Ancylostoma braziliense 1 pair of teeth - Maculo popular lesion with erythema
Ancylostoma caninum 3 pairs of teeth - Itching, edema & papulovesicular eruptions
Ancylostoma duodenale 2 pairs of teeth - Upon heart to lung migration it can cause pulmonary
lesions – (petechial hemorrhages with eosinophilic
& leukocytic infiltration); bloody sputum & possible
Necator americanus pneumonia, pneumonitis & bronchitis
- Necator – means murderer ADULT STAGE
- Living worms are pinkish / cream yellow / grayish
- Abdominal pain, enteritis
white
- Hypoalbuminemia; diarrhea w/ blood & mucus;
- Small, cylindrical, fusiform
eosinophilia
- Female : longer than male, about 9-11 mm by 0.35
- Blood loss leading to iron-deficiency anemia
mm with a blunt posterior end
(microcytic, hypochromic anemia)
- Male : shorter; 5-9 mm by 0.30 mm; bursa
- N. americanus – 0.03-0.05 ml/day
copulatrix or membranous caudal bursa/ umbrella-
- A. duodenale – 0.16-0.34 ml/day
like with rib like rays (organ for copulation)
LARVAL STAGE : NON HUMAN HOOKWORM
THE MORPHOLOGICAL DIFFERENCE - A. braziliense & A. caninum
BETWEEN TWO IMPORTANT HUMAN SPECIES - Creeping eruptions
OF HOOKWORMS - Cutaneous larva migrans
Point of A. duodenale N. americanus DIAGNOSIS
differences - Direct Fecal Smear : look for hookworm eggs
Size Larger Smaller - Harada-Mori Culture Technique (for hookworm &
Shape C- shaped curvature S-shaped threadworm)
curvature - Kato technique/ Kato katz
Mouth 2 pairs of ventral 1 pair of - Concentration technique- Zinc sulfate flotation &
teeth semilunar FECT
cutting plates
Copulatory Tripartite (3 digits); Bipartite (2 HARADA-MORI
bursa simple & not barbed digits); bristle- 1. Place 7 mL distilled water in a test tube
like & barbed 2. With an applicator stick take half a gram of feces &
smear thinly on filter paper leaving about 5 cm at
HOOKWORM EGGS both ends of the filter paper unsmeared.
- Colorless to pale yellow, ovoidal; surrounded by 3. Insert the paper to the test tube with the unsmeared
thin, transparent hyaline shell membrane, measuring part touching the water
56-60 by 34-40 microns 4. Cover with aluminum foil to prevent flies & dust
- When passed to the feces, they are in the 2-8 cell 5. Keep in dark place at room temperature for 10 days.
stage (MORULA BALL FORMATION) Larva will develop to filariform
RHABDITIFORM LARVA 6. Immerse the test tube in hot water for 15 minutes to
kill the larvae
- Feeding stage of hookworm
7. Remove the filter paper with a forceps & transfer the
- Short & stout
contents of the test tube to a centrifuge tube
- Long buccal cavity with flask-shaped esophagus
8. Centrifuge for 3-5 minutes. Pipette & throw away
- Inconspicuous (small genital) primordium
the supernatant carefully
FILARIFORM LARVA 9. Transfer the sediment to a slide, put a cover slip &
- Infective stage of hookworms examine under the microscope
- Longer & slender
- With a pointed posterior end RISK FACTORS
- Sheathed
- Suitability of the environment for the eggs & larvae
- Mode & extent of fecal pollution in the soil
IMPORTANT NOTES - Mode & extent of contact between infected soil &
- Final habitat of hookworms : Small intestine skin or mouth
- Mode of transmission : Skin penetration
- Infective stage : Filariform larva
- With heart to lung migration

LPU-BATANGAS TAMAYO, H.B.A RMT 2023

WEEK 3 (LEC-LAB) MLS 306** CLINICAL PARASITOLOGY BSMLS 3A
STRONGYLOIDES EGG/OVA
EPIDEMIOLOGY
- Chinese lantern Ova; clear thin shell
- Over 576-740 million people are infected
- Associated anemia caused at least 50,000 deaths/yr PATHOLOGY (AUTOINFECTION; SELF-
- Greater in agricultural areas INDUCED)
- Prevalence is bet 40-45% nationwide 3 Phases of infection
- Compostela valley province – more than 50% in late
1. Invasion of the skin by the larva
1990s
2. Migration of the larvae through the body
- A. ceylanicum in 1968 (woman from Ilocos Norte)
3. Penetration of the intestinal mucosa by the
- Out of 1,958 positive, 97 were N. americanus , 1% adult
A. duodenale , and 2 % were mixed infection Skin : allergic reaction at the site of larval penetration
- Davao Del Norte – 13.6 % With heart to lung migration (lobar pneumonia)
- Manila – 22.7% Cough & tracheal irritation mimicking bronchitis
- Cebu – 14.8% among food handlers
- A. duodenale – Europe & Southwestern Asia - Intestinal pain, diarrhea (Vietnam, cochin china
- N. americanus – tropical Africa & the Americans
diarrhea) vomiting, eosinophilia (unexplained)
PREVENTION, TREATMENT & CONTROL - Causes honeycomb appearance of the intestinal
- Mebendazole/albendazole (drug of choice) mucosa
- When the anemia is very severe – what should be - Hyperinfection
done? - Chronic strongyloidiasis – often asymptomatic
- Proper disposal of human feces - Borborygmi may be observed
- Personal hygiene - Recurrent asthma & nephritic syndrome
- Health education/treatment of infected individuals
- Mass chemotherapy / protection of susceptible Complications
individuals - Edema
- WASHED - Emanciation
- Loss of appetite
- Anemia
STRONGYLOIDES STERCORALIS - Lobar pneumonia
- Threadworm - Ileus, intestinal obstruction, gastrointestinal
- Fecally transmitted & soil transmitted helminths bleeding
- Facultative parasite - Malabsorption leading to cachexia
- Female is capable of parthenogenesis
PARASITIC / FILARIFORM IMPORTANT NOTES
- FEMALE : - Mode of transmission : Skin penetration
- Colorless, small, semi transparent measuring 2.2 by - Diagnostic stage : Rhabditiform larva
0.04 mm in length with the esophagus occupying 1/3 - Infective stage : Filariform larva
of the anterior part of the worm DIAGNOSIS
- Buccal cavity : has 4 indistinct lips
- Direct Fecal Smear : look for hookworm eggs
- Tapering anterior end ; short conical pointed tail
- Harada-Mori ; Baermann funnel gauze method
FREE LIVING FEMALE
(conc, technique)
- Shorter than parasitic but stouter with a double bulb - Beale’s string test
muscular esophageal pharynx - Duodenal aspiration / small bowel biopsy
- 1 mm by 0.06 mm - In disseminated cases, larva may be found in urine
- Intestine is straight cylindrical tube / sputum
NO PARASITIC MALE ; FREE LIVING MALE
EPIDEMIOLOGY
- 0.07 by 0.04 mm
- Tropics & subtropics as well as Europe & US
- Broadly fusiform , smaller than the free living
- 50 – 100 million people
female, with ventrally curved tail, 2 copulatory
- Very low, Laguna has the prevalence rate
spicules, a gubernaculum but no caudal alae
- Out of 4,208 stools examined only 50 samples were
positive
- Prevalence fluctuate between 0 to 2.3%
Point of Hookworm Strongyloides - Frequent in male children 7 – 14 years old
differences
- Autoinfection explains how some people remain
I. Rhabditiform larva infected for more than 30 years even after leaving
A. Buccal Long Short the endemic area.
cavity TREATMENT, PREVENTION & CONTROL
B. Esophagus Deep, flask- Elongated,
- Same w/ hookworm
shaped shallow, club-
shaped
C. Genital Inconspicuous Conspicuous
primordium (Small) (prominent,
larger)
II. Filariform larva
A. Sheath Positive Negative
(sheathed) (unsheathed)
B. Tail Pointed tail Alpha-notched
tail

LPU-BATANGAS TAMAYO, H.B.A RMT 2023