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NEMATODES
(ROUND WORMS)
phylum Nematoda

GENERAL CHARACTERISTICS OF NEMATODES

• They are un-segmented, elongated and
cylindrical.
• They have separate sexes with separate
appearances (males smaller than female, with
curved posterior).
• They have a tough protective covering or cuticle.
• They have a complete digestive tract with both
oral and anal openings.
• The nematodes are free living (Majority) or
parasites of humans, plants or animals.

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Life cycle and reproduction

& metamorphose by
molting through 2nd ,
All nematodes hatch from eggs to become adult
3rd and 4th -stage
as first-stage larva(L1) worms.
larvae (L2, L3, and
L4)

Life cycles range from simple (e.g., ingestion of the egg is followed by
development from eggs to adult in the intestine) to complex (e.g.,
involving tissue migration or intermediate hosts or vectors).

The parasitic nematodes are divided into:

1. Intestinal
1.1 Intestinal 1.2. Intestinal 2. Tissue and blood
nematodes with nematodes without dwelling nematodes
nematodes
tissue stage tissue stage

Filarial worms
Ascaris Enterobius
lumbricoides vermicularis
Dracunculus medinensis
(Medina worm)
Trichuris
Hookworms
trichuira.
Trichinella

Strongyloides Larva migrans (visceral

stercoralis and cutaneous).

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Enterobius vermicularis
(Pinworm)

Enterobius vermicularis *in some regions Strongyloides stercoralis

(Pinworm “seatworm” and “threadworm*”)

General properties
E. vermicularis is a small, white round worm.
Females average (8-13) mm in length, males (2-5) mm.
The worm has a direct life cycle with no tissue migrate phase.
Epidemiology
E. vermicularis is a cosmopolitan, though this helminths is most
common in temperate areas and cold climate.
More than 1 billion cases occur world wide.
More prevalence in children (5- 10 year-old age) than adults.

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Life cycle of Enterobius vermicularis

Habitat: Adult worm live in the large

intestine
Definitive host: Only man
Infective stage: fully embryonated
eggs containing fully developed
larvae when laid
Diagnostic stage: either the eggs or
the worms

Life cycle Enterobius vermicularis

• Following ingestion of infective eggs, the
larvae hatch in the small intestine and the
adults establish themselves in the colon.
• The time interval from ingestion of
infective eggs to oviposition by the adult
females is about 1 month.
• Mature adult females (8 to 13 mm), and
adult males (2 to 5 mm); the adult life span
is about two months.
• The male dies after fertilization and
expelled with feces.
• Fertilized females migrate nocturnally
outside the anus and lay eggs around anus
and perianal area.
• Each female deposits about 10.000 eggs
then dies.
• The larvae contained inside the eggs
develop (the eggs become infective) in 4 to
6 hours. (so continuous infection)

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Transmission
• Infection occurs via ingestion of eggs (e.g. contaminated surfaces,
clothes, bed linens, food, drink, etc.)..
• Autoinfection: Infection occurs via self-inoculation (transferring eggs
to the mouth with hands that have scratched the perianal area)
• Rarely airborne (inhaled) Eggs contaminate bed clothes and can be
aerosolized during bed making.
• Retro-infection, the migration of newly hatched larvae from the anal
skin back into the rectum, may occur but the frequency with which
this happens is unknown.
• Contact with patient ?

Clinical Presentation
• Enterobiasis is frequently asymptomatic.
• The most typical symptom is perianal pruritus and irritation, especially
at night, sometimes itching is severe, and secondary bacterial infection
occurs. Occasionally, necrosis of the mucosal surface produces pain
when nerve endings are exposed.
• Rarely, worms may migrate to ectopic sites, mostly within the female
genitourinary tract, vulvovaginitis and pelvic or peritoneal granulomas
can occur.
• Other symptoms include, teeth grinding, enuresis, insomnia, anorexia,
irritability, and abdominal pain, which can mimic appendicitis.
• E. vermicularis larvae are often found within the appendix on
appendectomy (controversial).
• Very rare instances of eosinophilic colitis associated with E. vermicularis
larvae have been reported.

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Laboratory diagnosis
Microscopic identification of eggs collected in the perianal area is the
method of choice for diagnosing enterobiasis.
To improve sensitivity, collection should be done in the morning, before
defecation and washing, or bathing and should be repeated 4 to 6
consecutive days to rule out infection
➢ by pressing transparent cellulose tape (“Scotch test”, cellulose tape slide
test) on the perianal skin and then examining the tape placed on a
microscope slide.
➢Alternatively, anal swabs or “Swube tubes” (a paddle coated with adhesive
material) can also be used for collection.
Eggs can also be found, but less frequently, in the stool (by direct saline
smear method)
Occasionally eggs are encountered in the urine or vaginal smears.
Adult worms are also diagnostic, when found in the perianal area, or during
anorectal or vaginal examinations. In cases of ectopic infection, eggs may be
seen in the urine or in cervicovaginal Papanicolaou smears.

Laboratory diagnosis

Enterobius vermicularis ovas using scotch tape test

An ova of Enterobius vermicularis in stool samples

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Treatment

• Mebendazole, pyrantel pamoate, or albendazole

• Given in one dose initially, and then another single dose of the same
drug two weeks later ? (The medication does not reliably kill pinworm
eggs)
• In households where more than one member is infected or where
repeated, symptomatic infections occur, it is recommended that all
household members be treated at the same time.

Control and prevention

The eggs only survive 6-12 hours, but they may remain
viable for a few weeks in colder, more humid
environments so:
• Practicing proper personal hygiene, particularly hand
washing
• Thorough cleaning of all potentially infected
environment surfaces including linens, towel,….
• Apply an ointment to an infected perianal area to help
prevent egg dispersal into the environment; and
avoiding scratching the infected area.
• Providing treatment to all household members are
important steps to help prevent further infections.

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Trichuris trichiura
Human whipworm

Trichuris trichiura

• Geographical distribution: Worldwide distribution (more common in

worm moist regions)
• Morphology : round, pinkish-white, anterior thin or whip-like, a coiled
posterior thick part blunty rounded, Size: ♀ 35–50 mm long ♂ 30–45
mm
• T. trichuria worm inhabit human large intestine
• The female produces large number of eggs 2,000–10,000 per day
• The worms are not found stool because they attach to the mucosa of
large intestine

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Life cycle
• Inhabit: human large intestine (ceacum)
• Definitive host: man
• Reservoir host: some mammals
• Infective stage: embryonated egg
• Diagnostic stage: unembryonated egg (feces)

Life cycle 5. After ingestion (soil-

contaminated hands or food),
Eggs become infective
in 15 to 30 days the eggs hatch in the small
intestine, and release larvae

In the soil 6. They mature and

establish themselves as
adults in the colon

Between 3,000 and 20,000

eggs shed per day. The females begin to
oviposit 60 to 70 days after
infection.

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Clinical Features
• People with light infections usually have no symptoms.
• People with heavy infection show symptoms like:
➢Frequent defecation
➢Painful passage of stool
➢Stool appearance: contains a mixture of mucus and blood (dysentery). (The
clinical feature is identical to amebic dysentery).
• Complications:
➢ Colonic obstruction because of the tangle of worms
➢ Ulceration of large intestine which result in blood loss.
➢ Iron deficiency anemia
➢ Rectal prolapse

Laboratory Diagnosis
1-Stool sample is suitable for the diagnosis.
A- direct wet examination for feces (heavy infection)
B-Concentration by sedimentation or by floatation to detect (very light
infection)
2-Quantification can be useful: Because the severity of symptoms
depend on the worm burden (e.g. with the Kato-Katz technique)
3- Examination of the rectal mucosa by proctoscopy (or directly in case
of prolapses) can occasionally demonstrate adult worms.

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Laboratory Diagnosis
• Trichuris trichiura eggs are 50 x 25 micrometers.
• They are barrel-shaped, thick-shelled and possess a pair of polar
“plugs” at each end.
• The eggs are unembryonated when passed in stool.

Treatment
• Mebendazole
• Albendazole

Drug Dosage for adults and children

Albendazole 400 mg orally for 3 days

Mebendazole 100 mg orally twice a day for 3 days

Ivermectin 200 mcg/kg/day orally for 3 days

• Infections are generally treated for 3 days.

• May repeat a stool exam after treatment.
• Iron supplements may also be prescribed if the infected person suffers from
anemia.

• The prognosis is good in light infection Poor in heavy chronic infection

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Prevention & control

Effective sewage disposal systems

Prevent contamination of soil with human feces
Washing hands before eating and after toilet (children, soil worker)
Washing vegetables & fruits
Do not use the night soil as fertilizer

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