SPECIES TAENIA TAENIA SOLIUM HYMENOLEPIS HYMENOLEPIS DIPYLIDIUM RAILLIETINA DIPHYLLOBOTRIUM ECHINOCOCCUS

SAGINATA DIMINUTA NANA CANINUM GARRISONI LATUM GRANULOSUS

COMMON Beef Tapeworm Pork Tapeworm Rat Tapeworm Dwarf Tapeworm Flea Rat Tapeworm Fish Dog or Hydratid
NAME Tapeworm/Doubl Tapeworm/Broad Tapeworm
e-pored Tapeworm
Tapeworm/Cucum
ber Tapeworm
HABITAT Upper jejenum Upper small intestines Small intestine Ileum Small intestine Small intestine Small Intestine

INFECTIOUS Cysticercus bovis Cysticercus Cellulosae Cysticercoid Cysticercoid Cysticercoid Cysticercoid Plerocercoid Hydratid cyst
STAGE Embryonated Ova
MOT Ingestion of infected meat Ingestion of an Ingestion of an IH Ingestion of an IH Ingestion of an IH Ingestion of Ingesting of cyst-
IH carrying the carrying the carrying the carrying the plerocercoid larvae containing organs of
cysticercoid cysticercoid larvae cysticercoid larvae cysticercoid larvae the infected IH
larvae
DF Humans Humans Rats/Man(accide Rodents Dogs, cats, foxes, Rat/ Man Man, other mammals Dogs/other canids
ntal) and humans (accidental)
IH Cow/cattle Man & Pig (Requires an (Does not Ctenocephalides Tribolium 1st: Cyclops, Goats, horses, camels,
intermediate necessarily require canis (dog flea) confusum (flour Copepods sheeps
host) an intermediate beetle) spp., Diaptomus spp.
Tribollium host) Ctenocephalides
(fleas, Grain beetles, fleas, felis (cat flea) Tribolium sp. & 2nd: Fish
cockroaches, or other insects feed Tenebrio sp. (Cyprinidae,
beetles, on contaminated Pulex irritans (rice & salmon, pike,
mealworms, rodents (human flea) flour beetle) perch,
earwigs) trout)
Trichodectes
canis (dog louse)

EGGS Spherical/subsp 30-45 um Circular Spherical/subspheri Spherical, thin Spindle shaped Ova contains a Hatch in the
herical 60-80 um cal shelled w/ eggs coracidium instead of duodenum
Thick brown striated Bile stained 30-47 um hexacanth embryo Contained in an hexacanth embryo
30-45 um embryophore Colorless/clay (oncosphere) w/ 6 egg capsule w/ 1-4 (oncosphere)
surrounding hexacanth Oncosphere: colored hooks eggs
Brownish embryo  Enclosed in 1 000 000 eggs/day
an inner Oncosphere: Oncosphere:
Inside the shell: membrane
 Thin  Bipolar  Thin outer and  Enclosed in 2
embryophore thickenings thick inner thin
 No bipolar membrane membranes
Oncosphere – filaments  Bipolar  Elongated
Hexacanth  Hooklets thickenings outer
embryo, have fan-like  No bipolar membrane
found inside arrangement filaments  Spherical
embryophore, s  Hooklets have inner
w/ 3 hooklets fan-like membrane
arrangements

ADULT 4 - 10 m (may 2-4m 60 cm 25 - 25 mm by 1 mm 10 - 70 cm 60 cm 3 - 10 m 3 - 6 mm

WORMS reach 25 m) Pale reddish 4 000 proglottids
1 000 - 4 000 8 000 – 10 000
proglottids proglottids
SCOLEX Cuboidal w/ 4 Smaller and spherical Rudimentary Sub-globular w/ 4 Small and globular Minute and Spatulate Pyriform
prominent w/ 4 acetabula unarmed cup-shaped suckers w/ 4 deeply globular w/ 4 Taeniid w/ 4 acetabula
suckers rostellum cupped suckers acetabula 2-3 mm by 1 mm
Cushion-like rostellum Retractable Armed w/ 30-36
1-2 mm w/ a double crown of rostellum armed w/ Protrusible Rostellum armed 2 bothria/sucking hooks
25-30 large and small single row of 20-30 rostellum armed w/ 2 alternating grooves
Some devoid of hooks Y-shaped hooklets w/ 1-7 rows of circular rows of
hooks/rostellum rose thorn- 90-140 hammer
while others shaped hooklets shaped hooks
have
Several rows of
spine also
surround the
rostellum
NECK Short Long & slender Long & attenuated Short

GENITAL Unilateral Lateral Bilateral Lateral

PORES
MATURE Square 100 - 200 follicular Broader than Broader than long Narrow Bilobed ovary Broader than long
PROGLOTTID testes long surrounded by 36 -
S 300 - 400 3 ovoid testes and 1 2 sets of 50 ovoid testes 2-4 mm by 10-12 mm
follicular testes Presence of accessory 3 ovoid testes ovary (in a reproductive
ovarian lobes and 1 ovary (in a more/less straight organs 1 set of organs
more/less
 2 large lobes of No vaginal sphincter straight pattern pattern across the “Double-pored
ovaries across the segment) tapeworm”
segment)
Vagina has
sphincter
GRAVID Longer than Sac-like uterus Sac-like uterus filled Pumpkin seed 2 mm containing Widest and longest
PROGLOTTID broad filled with eggs with eggs filled w/ capsules 200-400 mg
S (16-20 mm by 5- or packets of
7 mm) about 8-15 eggs
7-13 lateral branches of
15-20 lateral uterus
branches of
uterus Contain 30 000-50 000
ova
Contain 97 000 –
124 000 ova Undergo apolysis

Annually, 594
000 000 ova

Undergo apolysis
PATHOGENESI Most common A. Intestinal Infection Minimal and Infection is rarely Patients are Mechanical Liver (70%)
S/ chief complaint: non-specific heavy & usually obstruction due to Lungs (20-30%)
CLINICAL Passage of Mild non-specific symptoms are asymptomatic. large no. of worms Other organs (10%)
MANIFESTATI proglottids or abdominal complaints Infections are minimal
ONS segments in the usually light May show no signs Rupture of Hepatic
stool Entangled proglottids since it has short Slight intestinal but some, may Cyst
result obstructions in life span in discomfort, experience nervous  Intermittent
Mild irritation intestines, bile and humans epigastric pain, disturbances, jaundice
at the site of pancreatic ducts, and diarrhea, anal digestive disorders,  Fever
attachment appendix pruritus, allergic abdominal  Eosinophilia
reactions, discomfort, weight
Non-specific B. Cysticercosis moderate loss, weakness and Abdominal Cyst
symptoms: eosinophilia anemia. Intrathoracic Cyst
Epigastric pain, Often multiple and Peribronchial Cyst
vague develop in any Most patiensts are Hyperchromic,  Coughing
discomfort, organ/tissue symptomatic megaloblastic anemia  Allergic
hunger pangs, w/ thrombocytopenia symptoms
weakness, and leukopenia
weight loss, loss Loc: Striated muscle &  Bloody
of appetite, brain sputum
pruritus ani
Subcutaneous tissues, Brain Involvement
Entangled eye, heart, lung  + Intracranial
proglottids result peritoneum may be pressure
in intestinal involved  Jacksonian
obstructions Epilepsy
Living cyst causes
inflammation Renal Involvement
 Intermittent
Cysts may survive up to pain
5 years  Hematuria
 Kidney
Neurocysticercosis dysfunction
(NCC) – can be  Hydatid
parenchymal and material in the
extraparenchymal; urine
most serious
manifestations Multiple Cyst
 Multiple organ
Cortex: fecal/seizures failure

Subarachnoid form:
racemous cysticercosis
there’s proliferation of
cysts in the base of the
brain

Intraventricular form:
Obstructive
hydrocephalus

Spinal form is rare

Inflammation due to
death of larvae

Cerebral Cysticerosis
  Convulsions
 Visual & motor
deficits
 Headache &
vomiting

CSF
 + opening pressure
 Elevated protein
 - glucose
 + monuclear cells
 Eosinophilia

Eyes:
 Chorioretinitis &
Vasculitis
 Intraorbital pain,
photopsia,
blurring/loss of
vision
DIAGNOSIS Gravid A. Taeniasis Stool exam Stool exam Stool exam: Stool exam: Radiographic findings
proglottids are  Stool examination ova/proglottids operculated and/or
pressed or  Perianal Scotch Light Infection: eggs/proglottids ultrasonography,
flattened Tape Swab concentration of DFS combined with a
between 2 Technique stool specimens on Kato Technique history of residence in
slides and alternate days Exam of the gastric an endemic area, and
examined B. Cysticercosis juice close association with
against the light  Computed Axial dogs
or focused Tomography (CAT)
under scans CT scans/magnetic
microscope.  MRI resonance imaging
 Visualization using (MRI) used to visually
Injection of ophthalmoscopy confirm the parasitic
Indian Ink – for ophthalmic vesicles and cyst-like
accurate count of cysticercosis structures.
lateral branches
of uterus Serologic tests
confirmation of
parasitic infection
 Stool  Immunoblot,
examination –  Indirect
for the presence Hemagglutin
of eggs ation test
(IHA)
Concentration  Enzyme-
Techniques: linked
Formalin-ether/ Immunosorb
Ethyl-acetate ent Assay
(ELISA).
Perianal Scotch
Tape Swab
Technique

TREATMENT Praziquantel A. Taeniasis Praziquantel Praziquantel Praziquantel Praziquantel Praziquantel 2 benzimidazolic

5-10 mg/kg 25 mg/kg single 25 mg/kg single 5-10 mg/kg single 5-10 mg/kg single drugs (effective
single dose Praziquantel dose dose dose dose against cystic
(adults and 5-10 mg/kg single dose echinoccosis)
children) (adults and children) Nitazoxanide Criteria of cure:  Mebendazole
(alternative) Recovery of scolex  Albendazole
Criteria of cure: Niclosamide (but not 500 mg orally x 3
 Recovery of available locally) days A negative stool exam Note: Both well
scolex 3 months after tolerated but show diff.
 A negative Criteria of cure: Stool exam may be treatment efficacy
stool exam 3  Recovery of scolex repeated after 2 Albendaz > Mebendaz
months after  A negative stool weeks in the treatment of
treatment exam 3 months liver cyst
after treatment Successful
treatment if stools Praziquantel – 40
B. Cysticercosis are negative for H. mg/kg once per week
nana eggs at one (during treatment of
Multiple parenchymal month post albendazole)
cystic lesions: treatment
Radiation Therapy –
Praziquantel cannot be advocated as
5-10 mg/kg single dose an alternative to
divided into 3 doses x surgery
30 days
 Albendazole – 400 mg
TD x 8-30 days

Corticosteroids
80 mg prenisone / 10
mg IM dexamethasone
(4 hours after last dose)

For subarachnoid
form:
Surgical removal of
lesions
Albendazole – 10-15
mg/kg/day x 8 days

Ventrical form:
Surgical removal of cyst

Ocular Cysticercosis:
Should be treated
urgically before
praziquantel &
albendazole is given

Symptomatic cysts
outside CNS:
Surgically removal
PREVENTION  Cook food thoroughly  Rodent control  Periodic  Elimination of  All freshwater
 Temp: 140°F (60°C) for five  Elimination of the insect IH deworming of rodents from fishes should be
minutes or more.  Protection of food cats and dogs households thoroughly
 Proper sanitary waste disposal  Proper sanitary waste disposal  Insecticide  Proper storage cooked
 Inspection of meat  Treatment of infected persons dusting of cats of grain  Freezing for 24-
 Prompt treatment of infected Health education and dogs products 48 hours (18
persons  Health  Proper degree Celsius) –
 Health education education sanitary waste kills all
disposal pleroceroids
 Proper disposal of
sewage and
marketing fish
EPIDEMIOLOG Ethiopa & East Slavic countries, Latin Worldwide but Southern USA, Latin Europe, USA, Philippines Temperate zones
Y Africa America, Southeast is more common America, Argentina,
Asia, China, India among children Mediterranean, East Rhodesia, China, Present in Baltic
than adults in Asia and Philippines and Philippines countries,
poor Switzerland, Romania,
communities w/ Infants and very Danube Basin
rat manifestation young children are
usually infected In Asia, found in
Russia, Turkistan,
Israel, Northern
Manchuria, Japan

In Americas, Chile,
Argentina, Northern
American states,
Canada

Philippines: 7 human
 LIFE CYCLE

TAENIA SAGINATA TAENIA SOLIUM HYMENOLEPIS HYMENOLEPIS NANA DIPYLIDIUM RAILLIETINA DIPHYLLOBOTRIUM ECHINOCOCCUS
DIMINUTA CANINUM GARRISONI LATUM SPECIES
1) Eggs or gravid 1) Eggs or gravid 1) Eggs are passed 1) Eggs are 1) Gravid proglottids 1) Motile 1) Immature eggs are 1) The adult
proglottids are proglottids are out in the feces of immediately are passed intact proglottids passed in feces. Echinococcus
passed out in feces passed out in feces the infected infective when in the feces or containing Under appropriate granulosus (3 to 6
into environment into environment definitive host passed with the emerge from the numerous egg conditions, the eggs mm long) resides
(can survive days (can survive days (rodents, man) stool and cannot perianal region of capsules are mature in the small bowel
to months) to months) survive more than the host, shed in the (approximately 18 of the definitive
2) These eggs may 10 days in the subsequently definitive host’s to 20 days) and yield host
2) Eggs or gravid 2) Eggs or gravid either disintegrate external releasing typical feces. oncospheres.
proglottids proglottids in the environment. egg packets. 2) Gravid proglottids
ingested by cattle. ingested by hogs. environment or 2) Eggs are ingested 2) An unknown 2) Oncospheres release eggs that
may mature which by an arthropod 2) Following intermediate develop into a free- are passed in the
3) In the animal’s 3) In the animal’s can be ingested by intermediate host ingestion of an egg host (likely an swimming feces.
intestine, the intestine an intermediate (various species of by the arthropod such coracidium.
oncospheres (duodenum), the host (various beetles and fleas intermediate host, as flour 3) After ingestion by
hatch. oncospheres arthropod adults may serve as oncosphere is beetle/Tribolum 3) Coracidium is a suitable
hatch. or larvae) intermediate released into the spp.) ingests ingested by a intermediate host,
4) Penetrates the hosts) they flea's intestine. proglottids, or suitable freshwater the egg hatches in
intestinal wall, 4) Penetrates the 3) The oncospheres develop into perhaps free egg crustacean copepod the small bowel
and migrate to the intestinal wall, are released from cysticercoids, 3) The oncosphere capsules. (first intermediate (duodenum) and
striated muscles, and migrate to the the eggs and which can infect penetrates the host). Inside the releases an
where they striated muscles, penetrate the humans or intestinal wall, 3) Within the copepod, the oncosphere.
develop into where they intestinal wall of rodents upon invades the intermediate coracidia develop
cycticercus bovis develop into the host which ingestion and insect's hemocoel host, into procercoid 4) Oncosphere
in 2 months cycticercus develop into develop into (body cavity), and oncospheres are larvae. penetrates the
cellulosae cysticercoid adults in the small develops into a released from intestinal wall and
5) Humans readily larvae. This intestine. cysticercoid the eggs and 4) The procercoid migrates through
become infected persist through larva. larvae (through the circulatory
 when these 5) Humans readily the arthropod’s 3) When eggs are develop into ingestion of system
encysted larvae become infected morphogenesis to ingested in 4) The vertebrate cysticercoids. copepod) is (mesenteeic
are ingested from when these adulthood. H. contaminated host becomes ingested by a second venules) into
raw or improperly encysted larvae diminuta infection food or water or infected by 4) The definitive intermediate host various organs,
cooked beef. are ingested from is acquired by the from hands ingesting the adult host (rodents or typically minnows especially the liver
improperly mammalian host contaminated flea containing the man) becomes and other small and lungs.
6) The larva is cooked infected after ingestion of with feces, the cysticercoid infected after freshwater fish.
digested out of the meat (measly an intermediate oncospheres ingesting Inside the new host, 5) In these organs,
meat, and the pork) host carrying the contained in the 5) In the small intermediate the procercoid the oncosphere
scolex attaches to cysticercoid eggs are released. intestine of the hosts larvae develop into develops into a
the intestinal 6) The larva is larvae. vertebrate host containing a plerocercoid cyst that enlarges
mucosa where it digested out of the 4) The oncospheres the cysticercoid cysticercoids larvae (sparganum). gradually,
will become meat and the 4) After ingestion, (hexacanth develops into the producing
mature/adult scolex attaches to the tissue of the larvae) penetrate adult tapeworm 5) The unarmed 5) The plerocercoid protoscolices and
tapeworm in the intestinal infected the intestinal which reaches scolex everts larvae daughter cysts
about 12 weeks, mucosa. arthropod is villus and develop maturity about 1 and anchors to (sparganum) that fill the cyst
which can survive 7) Maturity is digested releasing into cysticercoid month after the wall of the infects humans by interior.
for years. attained in the cysticercoid larvae. infection. small intestine, consuming larger
approximately 12 larvae in the 5) Upon rupture of where predator fish (trout,
weeks stomach and small the villus, the 6) The adult maturation to perch, walleyed
intestine. cysticercoids tapeworms reside the adult stage pike) which
If man ingested the return to the in the small occurs. ingested a second
eggs: 5) Eversion of the intestinal lumen, intestine of the intermediate host
scoleces occurs evaginate their host, where they contaminated with
Oncosphere hatches in shortly after the scoleces, attach to each attach by the said larval form.
the duodenum cysticercoid the intestinal their scolex.
larvae are mucosa and 6) After ingestion, the
Spreads to different released. Using develop into 7) The proglottids plerocercoid
organs thru the the four suckers adults that reside mature, become develop into
bloodstream which on the scolex, the in the ileal portion gravid, detach immature adults
causes human parasite attaches of the small from the and then into
cystercercosis to the small intestine tapeworm, and mature adult
intestine wall. producing gravid migrate to the tapeworms which
proglottids. anus or are passed will reside in the
6) Maturation of the in the stool. small intestine.
parasites occurs 6) Eggs are passed in They attach to the
within 20 days the stool when intestinal mucosa by
and the adult released from means of the two
worms can reach proglottids. bilateral groves
 an average of 30 7) An alternate mode (bothria) of their
cm in length of infection scolex.
consists of
7) Eggs are released internal 7) The mature adult
in the small autoinfection, tapeworms produce
intestine from where the eggs eggs which are then
gravid proglottids, release their passed into the
repeating the hexacanth feces. Eggs appear in
parasite life cycle. embryo, which the feces 5 to 6
penetrates the weeks after
villus continuing infection.
the infective cycle
without passage
through the
external
environment.
 HOOKWORM
SPECIES ASCARIS LUMBRICOIDES TRICHURIS CAPILLARIA STRONGYLOIDES TRICHINELLA ENTEROBIUS
NECATOR ANCYLSTOMA TRICHIURA PHILIPPINENSIS STERCORALIS SPIRALIS VERMICULARIS
AMERICANUS DUODONALE
COMMON NAME Giant Intestinal New World Old World Whipworm Pudoc Worm Threadworm Pork Worm Pinworm/Seatworm
Roundworm Hookworm Hookworm (Inadequate
cooked pork)
EPIDEMIOLOGY East Asia & Pacific Islands Africa & Europe & East Asia & Pacific Philippines Worldwide Europe &
Americas Southwestern Islands (Northern Luzon) America
Asia
HABITAT Lumen of the small Lumen of the small intestine Cecum and Small intestine Small intestine Muscles Colon, usually in
intestine ascending colon cecum, & rectum
(Large Intestine) (Large Intestine)
Note: Do not attach to the Note: Do not attach to the mucosa
mucosa
INFECTIVE STAGE Embryonated egg (L2) Filariform larvae Embryonated egg Infective larvae Infective filariform Encysted larvae Embryonated egg
(L2) larvae in striated (L2)
muscles
DIAGNOSTIC Fertilized/unfertilized egg Eggs in feces Unembryonated eggs Unembryonated Eggs containing Larvae Eggs in perianal
STAGE in feces eggs in feces rhabditiform larvae folds
in feces
MOT Ingestion of infective Skin penetration of infective larvae Ingestion of infective Ingestion of Skin penetration of Ingestion of Ingestion of
embryonated egg embryonated egg infective larvae infective larvae infective larvae infective
embryonated egg
EGGS Infertile egg » bluntly rounded ends and a » lemon or » peanut- » thin-shelled, » Asymmetrical
» Oblong/elongate single thin transparent hyaline football-shaped shaped with transparent, w/ one side
d shell with mucus striated shells & segmented ova flattened and
» 88-94 um by 39- » unsegmented at oviposition plugs flattened » 50 to 58 μm by other side is
44 um » 50 to 54 μm by bipolar plugs 30 to 34 μm. convex
» Thin shell & Note: Eggs of A. duodenale and N. 23 μm » 36 to 45 µm by (inflated
irregular americanus are considered as » yellowish outer 20 µm. football)
mammilated indistinguishable and a » 50-60 um by
coating filled w/ transparent Note: 20-30 um
refractile granules inner shell. Become
» eggs become embryonated in the Oviposition: 1
Fertilized egg infective in 15 to external month
» More rounded 30 days environment in 5-
» 45 – 70 um by 35 – 10 days Can survive in the
50 um soil for 2-3 weeks
 » Thick outer & Note: Fertilized eggs
mammilated are unsegmented at
albuminous layer oviposition and
w/ embryonic
corticatications & development takes
inner lipoidal, place outside the
vitelline host when eggs are
membrane deposited in clayish
surrounding the soil. Compared with
developing Ascaris eggs,
embryo Trichuris eggs in soil
are more susceptible
No. of eggs: 200,000/day to desiccation.

Oviposition: between 2-3 No. of eggs: 3,000-

months since ingestion 20,000/day
Oviposition: 60 to
In the soil, 2-3 weeks for 70 days after
eggs to develop into IS infection.

Life span of egg in the

soil: months-2 years
LARVAE Similar to adult but » Larvae hatch into rhabditiform Rhabditiform » spear-like Develop into IS in 4-
smaller in 1-2 days larvae burrowing 6 hours
» Develop into filariform (IH) » 225 μm by tip at its
Develop into IS after 18 after 5-10 days 16 μm tapering
days-weeks » IH can survive 3-4 weeks in soil » elongated anterior end
Mature in the lungs for 10- » Life span: 1-2 years esophagus » 80-120µ by
14 days with a 5.6 µ at birth
Rhabditiform pyriform and grows
» Resemble those of posterior but little
Strongyloides stercoralis, bulb. until it has
but are somewhat larger, entered a
more attenuated (thin or Note: This species muscle fiber,
reduced in thickness) differs from the where it
posteriorly. hookworm in being attains its
slightly smaller size of 900
buccal cavity/capsule: and less attenuated to 1300µm
posteriorly. It also by 35-40µm
 » longer in hookworms has a shorter buccal
compared in S. Stercoralis. capsule and a Average lifespan
larger genital of the encysted
genital primordium primordium. larva is about 5
» smaller in hookworms to 10 years and
compared in S. stercoralis. Molt four times to can survive for
become free living up to 40 years.
adult males and
females

molt twice and

become infective
filariform larvae.
Filariform Filariform Filariform Larvae
» 550 μm in
Conspicuous Inconspicuous length. It is
buccal spears buccal spears similar to the
(parallel and transverse hookworm
throughout their striations on filariform larva
lengths) and the sheath in but is usually
transverse the tail region. smaller, with a
striations distinct cleft at
present on the the tip of the tail.
sheath in the tail (Notched tail)
region.
Note: The S.
stercoralis filariform
larva differs from
that of the
hookworm in two
respects. First, it has
a long esophagus,
compared with that
of the hookworm.
Second, the tail of S.
stercoralis is
notched, unlike that
of hookworm, which
is pointed.
 Molt twice and
become adult female
worms

ADULT WORM 3 lips and a sensory » small, » slightly » 4 cm » thin Parasitic or filiform » slender » small, thin,
papillae; have smooth cylindrical, larger filamentous female anterior end white
striated cuticles fusiform » single- Male: anterior end » 2.2 mm by 0.04 with a small, roundworm
» grayish- paired » 30-45 mm » slightly thicker mm orbicular, » length of staple
Male: white reproducti » Coiled and shorter » colorless, semi- non- wire (1 cm)
» 10-31 cm nematodes ve organs. posterior w/ posterior end transparent, papillated » with
» Bluntly pointed » S-shaped » C-shaped a single » esophagus has with a finely mouth. transparent
tail that is curved body body spicule rows of striated cuticle cephalic wings
ventrad curvature curvature Female: secretory cells » slender tapering Male:
» Single, long, » 35-50 mm called anterior end and » 1.50mm by Male:
torturous tubule Buccal capsule: Buccal » Blunt stichocytes and a short conical 0.04mm » curved tail
w/ 2 retractile ventral pair of capsule: has posterior stichosome. pointed tail. » ventrally
copulating semilunar two pairs of end » anus is » buccal cavity curved Female:
spicules cutting plates curved ventral subterminal. has four posterior » long, pointed
Female: teeth Life span: about 1 indistinct lips. end w/ two tail
» 22-35 cm Male: year. Male: » long slender lobular
» Straight posterior » 5-9 mm by Male: » 2.2-3.2 mm esophagus caudal Life span: 2 months
end 0.30 mm » tridigitate » has chitinized extends to the appendages
» Paired » bidigitate or or spicule and a anterior fourth » presence of
reproductive bifid dorsal tripartite long spicule of the body claspers (a
organs in the ray (bursa) dorsal ray sheath » intestine is pair of pear-
posterior 2/3 with barbed, (bursa) continuous to shaped
fuse spicules with plain- Female: the subterminal clasping
Life span: 1-2 years bristle like » 2.5-4.4 mm anus papillae
Female: spicules. » vulva in » vulva is located used to hold
» 9-11 mm by females is one-third the the female
0.35 mm. Female: located at the length of the during
» simple » simple junction of body from the mating)
conical tail conical tail. anterior and posterior end » dies after
middle thirds. » uteri contain a fertilizing
single file of 8 to the female.
Typical female: 12 thin-shelled,
transparent, Female:
segmented ova,
 » 8-10 eggs in 50 to 58 μm by » 3.50mm by
uterus in a 30 to 34 μm. 0.06 mm
single row » bluntly
Atypical female Note: No male form rounded
» 40-45 eggs of this parasite been posterior
arranged in 2-3 reliably identified & end.
rows. the female » single ovary
reproduces in a w/ vulva
parthenogenetic » long, narrow
manner. digestive
tract
Free-living female » dies after 4
» 1 mm by 0.06 weeks-4
mm months
» muscular
double-bulbed
esophagus
» intestine is a
straight
cylindrical tube.

Free-living male
» 0.7 mm by 0.04
mm
» ventrally curved
tail, two
copulatory
spicules, a
gubernaculum,
but no caudal
alae.

PATHOGENESIS/ Asymptomatic Skin- the site of entry of the Infections with over  abdominal pain 3-phases of acute Enteric Phase Asymptomatic
CLIN. filariform larvae: 5,000 T. trichiura and infection in or the stage of
MANIFESTATIONS Reaction of tissues to  maculopapular lesions eggs per gram of borborygmi Strongyloidiasis: intestinal  Perianal
invading larvae:  localized erythema feces are usually  intermittent invasion. pruritus
symptomatic. diarrhea  Diarrhea or  Teeth grinding
(passing out 8 constipation  Insomnia
 Eosinophilia (during  severe itching also called Petechial to 10 A. Invasion of the  Vomiting  Abdominal
larval migration) “ground itch” or “dew hemorrhages voluminous skin by the filariform  Abdominal pain/appendicit
 Host sensitization - itch” stools/day) larva. cramp is
allergic manifestations  edema Enterorrhagia or  weight loss  Erythema  Malaise
(lung infiltration,  later papulovesicular intestinal bleeding is  malaise  Pruritic elevated  Nausea
asthmatic attacks, eruptions which can last common.  anorexia hemorrhagic Onset is within
edema of the lips) for 2 weeks.  vomiting papules 2-30 hours after
 Mild/moderate Appendicitis or  edema. B. Migration of the ingestion
infections: Lungs granuloma larva through the
» Vague  Bronchitis formation. Laboratory findings body. Invasion phase
abdominal  Pneumonitis show Lungs are destroyed or the stage of
pain (most  Minute hemorrhages with Trichuris  Severe protein- causing: muscle invasion.
frequent eosinophilic and leukocytic dysentery losing  Lobar
complaint) infiltration. syndrome enteropathy pneumonia with It begins when
» Nausea manifested by and haemorrhage new infective
» Vomiting Intestine: chronic dysentery & hypoalbumine  Cough and larvae are
» Diarrhea/blo  abdominal pain rectal prolapse mia tracheal released from
ody stools  steatorrhea  Malabsorption irritation adult female and
 diarrhea with blood and Heavy chronic of fats and (mimicking ends with
 Large number of mucus, trichuriasis: sugars bronchitis). deposition of
worms in the intestine,  eosinophilia  frequent  Decreased larvae in muscle.
one may experience:  Hypoalbuminemia bloodstreaked excretion of C. Penetration of the  Fever
» severe abdominal  diarrheal stools xylose intestinal mucosa by  Myalgia
pain Hookworm infection is usually  abdominal pain  Low serum the adult female  Periorbital
» fatigue chronic, hence patients often show  tenderness potassium,  may be found in edema
» vomiting no acute symptoms.  nausea sodium and the intestinal  Weakness of
» weight loss  vomiting calcium mucosa from the affected
» malnutrition Chronic moderate or heavy  weight loss.  High levels of pylorus to the muscle
» Loeffler’s hookworm infection: progressive,  Anemia (0.8 to immunoglobuli rectum, but the  Myocarditi
syndrome and secondary, microcytic, 8.6 ml/day) nE greatest  Encephaliti
tropical hypochromic anemia of the iron-  Poor appetite, numbers are  Eosinophilia
Eosinophilia deficient type wasting, found in the
» serious stunting, duodenal and (Onset within 1-
hemorrhagic Other symptoms: reduced upper jejunal 4 weeks after
pneumonia (lung  exertional dyspnea intellectual and regions. infection)
migration)  weakness cognitive
 dizziness development in Light infection: Convalescent
 Toxic manifestation  lassitude children. no intestinal phase- or the
caused of by- symptoms
 products of living or  while signs include rapid  800 worms will stage of
dead worms: pulse, edema, and cause anemia in Moderate encystation.
» edema of the face albuminuria. children infection: This occurs only
» giant urticaria diarrhea alternating in striated
accompanied by Light infection: with muscles.
insomnia Parasite can be constipation.  acute
» loss of appetite discovered only thru interstitial
and weight. stool examination Heavy infection: inflammatio
as it is  Cochin China n
Irritation of the asymptomatic. diarrhea  edematous
intestines by the characterized by swelling
mechanical and toxic numerous  cellular
action of the adult These episodes of infiltration
are giant round watery and of PMNs
bloody stools.  eosinophils,
Extraintestinal lymphocytes
Migration Chronic and at times,
 Acute Appendicitis strongyloidiasis is foreign body
 Acute Hemorrhagic often asymptomatic. cells
Pancreatitis However,  adjacent
 Acute Peritonitis intermittent muscle
 Intestinal volvulus vomiting, diarrhea, fibers
 Intussusception constipation, and undergo
 Obstruction borborygmi hydropic
 Regurgitation (gurgling stomach) degeneratio
 Abscess Formation may be observed. n and
hyaline
 Moderate infections:
necrosis.
» lactose
intolerance & Vit
A malabsorption
 Heavy infections:
» bowel obstruction

DIAGNOSIS  Direct Fecal Smear  Direct Fecal Smear  Direct Fecal  DFS  Finding of Direct Methods:  Tape method
 Kato Thick Smear  Kato Thick or Kato Katz Method Smear  Stool Conc. unexplained Detection of  Clear-cellulose
 Concentration  Conc. Method  Kato Thick Methods eosinophilia as larvae in deltoid, swab
Techniques:  Flotac Smear Method  Duodenal a clue pointing biceps, » Widely used
» Sedimentation  Culture Methods (Harada Mori) aspiration gastrocnemius procedure
 » Floatation Molecular approaches (PCR based) » Uses 20-60  Enzyme-linked to or pectoralis are for the
» Kato Katz mg of stool immunosorben strongyloidiasis. usually selected detection
sample t assay (ELISA)  Repeated for biopsy and  Commercial
» Highly reco concentration xenodiagnosis. collection
in diagnosis techniques system
of trichuris (Baermann Indirect » Pinworm
 Acid Ether and funnel gauze Methods paddles
Formalin-Ether method)  History
acetate Conc. usually leads to  Stool Exam
Technique detection of the (Diarrheic
 Flotac Technique infection. stage)
 Harada-Mori or  Blood
Test Tube Examination
Culture  Radiological
» use of test Exam
tubes and  Molecular−
filter paper PCR
strips.  Bachmann
 Modified Intradermal
Modified agar test
plate culture.  Serology−
Hypergamm
aglobinemia
- IgE – ELISA
 Confirmator
y test −
Bentonite
flocculation
test − Latex
fixation test

TREATMENT  Albendazole  Albendazole  Mebendazole Mebendazole  Albendazole Mild  Mebendazole

» 400 mg single » 400 mg single dose – adults » drug of » drug of  Thiabendazole  Supportive  Albendazole
dose and children choice for choice  Ivermectin treatment  Pyrantel
 Mebendazole  Mebendazole treatment » 200 mg TD like bed rest, Pamoate
» 100 mg twice a » 500 mg single dose » 100 mg TD for 20 days. analgesics
day for 3 days or for 3 days. and
500 mg single CLM Albendazole antipyretics.
dose  Thiabendazole  Albendazole
 Ivermectin » 25 mg/kg twice daily » alternative » 400 mg OD Moderate
» 100 -200 mg/kg  Ethyl chloride and Carbon drug for 10 days.  Albendazol
once » 400 mg e
 Piperazine orally for 3 » 400 mg
» 50 mg/kg a day days. BID for
for 5 days 8 days.
» Or 75 mg/kg one  Mebendazo
dose le
 Alternative drug: » 200 to
Nitazoxanide and 400 mg
Levamisole TID for
3 days,
then
400 mg
TID for
8 days.

Severe
 Add
glucocortic
oids like
prednisolon
e to either
medication.