NEMATODES

A. NEMATODES

➢ unsegmented bodies; hence the common name roundworms

➢ generally colorless worms
➢ have separate sexes with complete alimentary tract
❖Male – have curved tail
❖Female – straight tail
➢ infections are commonly confirmed by detecting eggs in
stool
GENERAL DESCRIPTION
 Development: pass through six developmental stages: adult
worm, egg stage and four larval stages
 Shape: elongated, cylindrical or filariform in shape with both
the ends pointed.
 Size:Variable, ranging from less than 5 mm (hookworm,
Trichinella and Strongyloides) to as long as one meter
(Dracunculus).
 Symmetry: Body is bilaterally symmetrical (one plane)
while head is radially symmetrical (multiple plane)
 Body wall: Made up of outer layer of tough acellular cuticle
and inner layer of longitudinal muscle
CLASSIFICATIONS

A. Based of Habitat
 Intestinal nematodes - Inhabitant of intestines
 Somatic nematodes - Inhabitant of various tissues
B. Based on the lay egg or larva
▪ Oviparous – (hookworm, Trichuris, Enterobius, Ascaris,
Capillaria)
▪ Viviparous – (Trichinella, Dracunculus)
▪ Ovoviviparous – (Strongyloides)
LARGE INTESTINAL NEMATODES
 Comm
Organis Transmis Symptom Treatme
on Diagnosis
m sion s nt
Name
Stool: lemon-
shaped egg
Whipworm (50-55 x 20- Mebendaz
Abdominal
25µm) ole
pain, bloody
Trichuris Peripheral
Oro-fecal diarrhea,
trichiura blood Ivermectin
prolapsed
eosinophilia; – less
rectum
increased effective
serum IgE
level
Adults of T. trichiura
Adult Trichuris trichiura males are 30-45 mm
long, with a coiled posterior end. Adult females
are 35-50 mm with a straight posterior end.
Both sexes have a long, whip-like anterior end.
Adults reside in the large intestine, cecum, and
appendix of the host. Image shows the
posterior end of an adult T trichiura, taken
during a colonoscopy. Image courtesy of Duke
University Medical Center and Centers for
Disease Control and Prevention.
EGG

A, B : Trichuris trichiura eggs (wet

preparation)

The diagnostic characteristics are:

▪ a typical barrel shape
A
▪ two polar plugs, that are unstained
▪ size: 50 to 54 µm by 22 to 23 µm

The external layer of the shell of the egg is yellow-

brown (in contrast to the clear polar plugs).

The egg is unembryonated, as eggs are when

passed with the stool.
B
LIFE CYCLE OF TRICHURIS TRICHIURA
PATHOGENICITY AND CLINICAL FEATURE

 Most infected individuals have no symptoms or only have

eosinophilia.
 In people with heavy infections: Adult female worm gets
buried in the large intestinal mucosa that leads to:
 Mechanical distortion: Leading to inflamed, edematous,
and friable mucosa
 Allergic response by the host: Increased numbers of
macrophages infiltrates in the lamina propria that produce
tumor necrosis factorα (TNFα)
TRICHURIASIS IS SPREAD BY INGESTION OFF
EGGS BY MEANS OF
CONTAMINATED/UNHYGIENIC FOOD
 Common
Name Transmi
Organism Symptoms Diagnosis Treatment
ssion

Stool:
embryonate
Peri-anal
Pinworm/ d eggs Pyrental
pruritus, rare
Enterobius Seatworm/ Oro- (60x27 µm), pamoate or
abdominal pain,
vermicularis threadworm fecal flat on one Mebendazol
nausea
side e
vomiting
Scoth-tape
method
Adult worm of E. vermiculais
 MORPHOLOGY:

ADULT:
 Short, white, fusiform
 Pointed ends
 Resemble white threads

Cervical Alae:
- At the anterior end
- Three in number
- Wing like cuticular expansions
- Transversely striated
 Morphology -- Adult
• Female -- fusiform body with a
long, thin, tapering tail, 8 to 13mm
• Male -- “6” shape, curved tail, 2 to
5mm. Males die right after mating,
thus are rarely seen
• White in color
EGG:

 Colourless, non-bile stained

 Shape: Planoconvex
 Shell : Double layered
Transparent
 Sticky outer albuminous layer

o Contains ‘tadpole shaped’,

coiled larva
 Viable up to 2 weeks
Adult Pinworms on the perianal skin
Infection

Stage Infective eggs

Type • Self-infection: anus-hands-mouth

route
• Cross-infection: contact
transmission
• Inhalation
• Retroinfection
EPIDEMIOLOGY

 Globally, around 209 million people are infected by

pinworms
 The prevalence is maximum in school children between the
age of 5 and 14 years.
 People carry the infection for years together due to auto
infective cycles
 Factors promoting infection: Over crow ding and
impaired hygiene, poor personal care
 It has been said that: “You had the infection as a child, you have
it now and you will again get it when you have children”
SMALL INTESTINAL NEMATODES
Hookworms
✓ Blood- sucking nematodes that
attack the mucosa of the small
intestine
✓ one of the important causes of iron
defi ciency anemia in both tropics
and temperate countries
✓ “ meromyarian” somatic musculature
✓ human hookworms include two
nematode (roundworm) species,
Ancylostoma duodenale and Necator
americanus.
CLASSIFICATION
 Human parasite:
 Ancylostoma duodenale or old world hook worm
 Necator americanus or new world (or American) hook
worm
 Animal parasites that rarely infect man causes
cutaneous larva migrans
 Ancylostoma braziliensis
 Ancylostoma caninum
 Ancylostoma ceylanicum
 Uncinaria stenocephala
 Common Transmissio Diagnosi Treatme
Organism Symptoms
Name n s nt
Stool: oval
segmente
New World Maculopapular d eggs (60
Necator hookworm erythema x 30 20-
americanus; (ground itch), 25µm)
Oro-fecal Albendazo
Dog or cat broncho-
Ancylostoma (egg); skin le/
hookworm pneumonitis, Eosinophil
duodenale penetration Mebendaz
(Old world epigastric pain, ia
(Hookworm hookworm) (larvae) GI
ole
s) hemorrhage, Hypochro
anemia, edema mic
microcytic
anemia
NECATOR AMERICANUS

➢ the most common species in

humans in most of the world.
➢ has a pair of dorsal and a pair
of ventral cutting plates
surrounding the anterior margin
of the bucal capsule
➢ Males have bursa diagnostic for
the genus. The needle-like
specules have minute barbs at
their tips and are fused distally.
ANCYLOSTOMA DUODENALE

➢ It was known to cause a serious

anemia in miners.
➢ Has two ventral plates, each
with large teeth that are fused at
their bases.
➢ A pair of small teeth is found in
the depths of the capsule. The
needlelike specules have simple
tips and are never fused distally.
 MORPHOLOGY

Ancylostoma duodenale Necator americanus

 The eggs are bluntly rounded, thin shelled, and are almost
indistinguishable between the different species. Measuring 60 by 40µm,
the eggs of Ancylostoma being slightly larger than those of Necator.
LIFE CYCLE
Hookworm rhabditiform larva (wet preparation).
parasite biology- larvae

Hookworm filariform larva (wet preparation).

CLINICAL FEATURES

 Infective larvae may provoke pruritic maculopapular

dermatitis and rashes (“ground itch”) at the site of skin
penetration; and
 Serpiginous tracks may be formed due to subcutaneous
migration of the larva similar to those of cutaneous larva
migrans
SYMPTOMS

 Early intestinal phase (less worm load): epigastric pain

(often with postprandial accentuation), inflammatory
diarrhea, or other abdominal symptoms accompanied by
eosinophilia
 Late intestinal phase (chronic hookworm infection with
heavy worm load): Patients develop iron deficiency anemia
and protein energy malnutrition resulting from blood loss
 Wakana disease - nausea, vomiting, pharyngeal irritation,
cough, dyspnea, and hoarseness
PREVENTION

 Improved personal hygiene

 Proper disposal of feces
 Improved nutrition with dietary iron
 Treatment of infected persons

 Experimental immunization of animals with vaccines

using larval or adult stage antigen was found to be
effective
 Commo Transmissio
Organism Symptoms Diagnosis Treatment
n Name n
Itching at infection
site, rash due to
Military larval migration,
worm/ verminous Stool: Ivermectin
Strongyloides Thread Soil-skin, pneumonia, mid- rhabditiform or
stercoralis worm autoinfection epigastric pain, larvae (250x 20- Thiabendazo
nausea, vomiting, 25µm) le
bloody dysentery,
weight loss and
anemia
Strongyloides stercoralis
✓ Habitat: females live in the superficial
tissues of the small intestine (duodenum
and jejunum)
✓ Definitive host: Human, dogs and cats
✓ Route of infection: Filariform larvae
penetrate the skin of human.
✓ Infective stage: Third stage larvae (
filariform).
✓ Diagnostic stage: First stage
larvae(Rhabditiform) in feces.
✓ Geographical distribution: -
cosmopolitan parasite, mainly in moist
and warm areas of low hygiene
Morphology

Egg:
Size : 55 x 30 um.
Shape: oval . Clear, thin shelled
Similar to hookworm but are
smaller.
Eggs are laid in the mucosa, hatch into
rhabditiform larvae that penetrate
the glandular epithelium and pass
into the lumen of the intestine and
out the feces
(Eggs are seldom seen in stools).
Rhabditiform larvae
 220 x 15 um.
 Short buccal cavity.
 Diagnostic stage
 appear in stools within 4wee
ks of infection.
LIFE CYCLE
 Common Transmiss Diagnosi Treatme
Organism Symptoms
Name ion s nt

Intestinal Abdominal Stool:

roundworm pain, corticoid
Ascaris weight oval egg Mebenda
Oro-fecal
lumbricoides Round loss, (40- zole
worm of distended 70x35-
man abdomen 50 µm)
Ascaris lumbricoides
▪ Giant roundworm
▪ 1 billion individuals are infected; 70% of which
are from Asia
▪ Soil- transmitted helminth
▪ Carries varying degrees of pathology:
(1) tissue reaction to the invading larvae
(2) intestinal irritation to the adult
(3) other complications due to the extra-
intestinal migrations
ASCARIS LUMBRICOIDES
Female
▪ slightly larger
▪ between 20 to 35cm long
▪ a vulva approximately a third
of the length of the body down
from the head
▪ have a blunt tail
Male
▪ more slender males
▪ between 10 to 30cm long
▪ have a curved tail with two
spicules
▪ no copulatory bursa.
 A pair of female and male worms of A. lumbricoides.
Notice the vulvar waist(arrow)of the female worm and the
coiled end of the male worm.
 Egg shell

Ovum

Albuminous layer

A. lumbricoides, fertilized egg (6050 micrometer)

 THREE TYPES OF ASCARIS EGGS

1. Fertilized eggs: broad oval in

shape, brown in color, an average
size 60× 45µm.
2. Unfertilized egg: Longer and
slender than a fertilized egg.
3. Decorticated eggs: Both fertilized
and unfertilized eggs sometimes
may lack their outer albuminous
coats and are colorless.
 LIFE CYCLE
1. Site of inhabitation: small intestine
2. Infective stage: embryonated eggs
3. Route of infection: by mouth
4. No intermediate and reservoir hosts
5. Life span of the adult: about 1 year
This worm lives in the lumen of small intestine, feeding on the intestinal
contents, where the fertilized female lays eggs. An adult female can produce
approximately 240,000 eggs per day, which are passed in feces. When passed, the
eggs are unsegmented and require outside development of about three weeks
until a motile embryo is formed within the egg.
PATHOGENESIS AND CLINICAL FEATURE

 Pulmonary symptoms: Observed in the second week after

ingestion of eggs. Migrating larvae in lungs provoke an
immune mediated hypersensitivity response. Common
symptoms include a nonproductive cough, chest discomfort
and fever
 Eosinophilic pneumonia (Loeffler’s syndrome): In severe
cases, patients develop dyspnea and an transient patchy
infiltrates seen on chest X-ray along with peripheral
eosinophilia.
OTHER SYMPTOMS

 Malnutrition and growth retardation

 Intestinal complications
 Extraintestinal complications - biliary colic, cholecystitis,
pancreatitis, or (rarely) intrahepatic abscesses.Wandering
worms may migrate to pharynx and can cause respiratory
obstruction or may block the eustachian tube
 Allergic manifestation
pathogenesis & clinical
manifestations
A.lumbricoides in common bile duct
 Cross section of a liver specimen contains many adult
worms of A.lumbricoides obstructing the intrahepatic
and extrahepatic bile ducts.
 SOMATIC NEMATODES
(Blood and Tissue Nematodes)
 Common Trans
Organism Name missio Symptoms Diagnosis Treatment
n
Depends on worm
location and burden: Medical
gastroenteritis; edema, history,
Poorly corticosteroid
Trichinella Tissue muscle pain, spasm; eosinophilia,
cooked and
spiralis roundworm eosinophilia, tachycardia, muscle
pork Mebendazole
fever, chill headache, biopsy,
vertigo, delirium, coma, serology
etc.
 Trichinella spiralis – tissue
roundworm
• caused trichinosis
• acquired through consumption of
poorly cooked meat
• the larvae in the tissue are coiled
in a lemon-shaped capsule

Measly pork – contaminated pork

containing encysted larvae
 Trichinella sp.

Intestinal: diarrhea, nausea,

abdominal cramps and malaise
Muscle: fever, periorbital edema,
muscle pain, swelling, weakness;
damages chewing and swallowing ;
myocarditis
10-20%: CNS involvement
High eosinophilia: 20-90%
Encysted larvae of Trichinella in pressed muscle tissue.
The coiled larvae can be seen inside the cysts
Diagnosis

• medical history
• eosinophilia
• muscle biopsy
• serology
 Commo Transmi Treatme
Organism Symptoms Diagnosis
n Name ssion nt
Guinea
worm
Medina
Oral: Blistering skin, Physical
Dracunculus worm Mebendaz
cyclops in irritation, examinatio
medinensis Serpent ole
water inflammation n
worm
Dragon
worm
Guinea worm disease, also called
dracunculiasis, is a parasitic worm
infection.

It is caused by the parasite Dracunculus

medinensis.
HOSTS

Definitive: Humans
Intermediate: Copepod
LIFE CYCLE
 PATHOGENESIS
Infection occurs when larvae of the
Dracunculus is ingested through the
drinking water.
The larvae has to be first swallowed
by an intermediate host.This host is
a Daphnia, but often called “water
fleas”.
Daphnia are small crustaceans that
are found in lakes where they are a
valuable source of food for other
marine life.
PATHOGENESIS

They mature inside of the

Daphnia and become infective
in about 10 days.

Once they have matured they

can be swallowed and infect a
person.
PATHOGENESIS

After the infected Daphnia is ingested

by a person the stomach acids will
digest the Daphnia, but not the mature
worms.

The worms can grow to be up to 3 feet

long within a year of ingestion.
PATHOGENESIS

After this time the female

worms will migrate to the
surface of the body causing a
blister to form.

This blister causes the person

infected to seek water to
relieve swelling and pain. This
only causes the blister to
rupture so that the worm can
be exposed and it can lay its
larvae.
PATHOGENESIS

For several days

after the worm has
been exposed it will
release millions of
immature worms
whenever it comes
in contact with
water.
Blister Ruptured blister
NO VACCINES OR MEDICINE CAN TREAT OR
PREVENT GUINEA WORM DISEASE
SYMPTOMS

People usually don’t develop

symptoms until about a year of
contact with the contaminated
water.
A rash accompanied by severe
itching develops where the blister
is present.
Nausea, vomiting, diarrhea, and
dizziness might follow right before
the worm is about to exit the body.
 SYMPTOMS

Inadequate access to medical

help can lead to some
complications.
Ulcers may become infected
and cause locked joints or
even permanent crippling.
Some worms may not find
their way to the skin surface
and become encapsulated in
tissues and some found near
joints may cause chronic
arthritis.
TREATMENT
Only once the worm has
emerged from the wound can
it be pulled out

It is pulled out a few

centimeters each day and
wrapped around a small stick
which takes weeks or even
months to completely remove
the worm.
CON. TREATMENT
There are no
medications for the
complete treatment or
prevention of this
infection.

Antibiotic ointment is
recommended to
prevent bacterial
infection.
A Guinea worm pulled out from an ulcer of a leg of Ghanaian man by an
experienced health worker
NEMATODES: FILAROIDEA
THE FILARIAL WORMS

Filaroids
➢ Tissue-dwelling parasites
➢ Intermediate host: arthropods
➢ Parasitic in all vertebrates, except fish
➢ Slender worms with reduced lips and buccal capsule
➢ Resides in the lymphatic system, skin, subcutaneous
tissue and rarely in body cavity
 Filarial Worms
 Wuchereria bancrofti
 Brugia malayi
 Onchocerca volvulus
 Loa loa
MICROFILARIAL PERIODICITY

 It is defined as the time when most of the microfilariae are

found in the peripheral blood
 Common Transmissio
Organism Symptoms Diagnosis Treatment
Name n
Medical
Wuchereria Recurrent history,
bancrofti; fever, lymph- physical
Mebendazol
W. brugia Bancroft’s Mosquito adenitis, examination,
e; Diethyl-
malayi filariasis bite splenomegaly, microfilaria
carbamazine
(elephantiasis lymphedema, in blood
) elephantiasis (night
sample)
FAMILY ONCHOCERCIDAE

Wuchereria bancrofti
 Elephantiasis
 Two other species of filaroids:
1. Lymphatic filariasis – infection of the
lymphatic system by filarial worms
2. Bancroftian filariasis (W. bancrofti)
WUCHERERIA BANCROFTI

Epidemiology
 Mosquito vectors : prefer human blood and near human habitation
 Anopheles, Aedes, Culex, Mansonia
 Widely distributed in tropics and subtropics
 In Philippines: two types
1. Urban type – in abaca raising areas; Aedes (Finlaya) poecilus
2. Rural type – away from houses towards the mountains and hills; Anopheles
minimus flavirostris
 WUCHERERIA BANCROFTI
In the Philippines, the provinces endemic for Wuchereria
bancrofti are:
 Camarines Norte Bohol Romblon
 Camarines Sur Samar Masbate
 Albay Leyte Palawan
 Sorsogon all provinces in Mindanao
 Quezon Mt. Province (Bontoc)
 Mindoro Sulu
MORPHOLOGY

 Adult worms:
 Long and slender with a smooth cuticle and bluntly rounded ends
 Head: slightly swollen and bears circles of well-defined papillae
 Mouth: small; buccal capsule is lacking
 Male: about 40mm long, 100m wide; tail is fingerlike
 Female: 6cm to 10cm long, 300m wide; vulva is near the level of the middle
esophagus
WUCHERERIA BANCROFTI
Biology
 Adult live in the major lymphatic ducts of humans
 Internal nuclei and presence or absence of a sheath
help to identify several species of microfilariae
 Females release microfilariae into the lymph
 Periodicity of microfilariae in the peripheral blood
 Maximal number: 10 p.m. and 2 a.m.
 During the day: concentrated in blood vessels of the deep
tissues of the body (pulmonary capillaries)
LIFE CYCLE
 Host: W. bancrofti completes its life cycle in two hosts.
1. Definitive host: Man
2. Intermediate host: Mosquito named Culex
quinquefasciatus is the principle vector worldwide.
Rarely Anopheles (rural Africa) or Aedes (Pacific Island)
can serve as a vector.
▪ Infective form: Third stage filariform larvae are the
infective form found in the proboscis of the mosquito.
▪ Mode of transmission: L3 filariform larvae get deposited
in skin by the insect bite.
WUCHERERIA BANCROFTI
Treatment, Prevention and Control
 Diethyl-carbamazine (DEC, Hetrazan)
 Apply pressure bandages – for edematous limbs
 Surgical removal of elephantoid tissue
 Protection against mosquito bites in endemic areas
 Insect repellant
 Mosquito netting
 Education of people in endemic areas
 BRUGIA MALAYI
Biology
 Intermediate hosts: Mansonia, Aedes, Culex
 Adults live in the lymphatics
 Same symptoms with W. bancrofti; more restricted to the distal
extremities of the arms and legs
 Microfilariae can be differentiated by the presence of nuclei in the tail
tip
 B. timori – found only from Lesser Sunda Islands of southeast Indonesia
 Nocturnal periodicity
 Vector: Anopheles barbirostris
 B. pahangi – very important lab model for the study of lymphatic
filariasis
BRUGIA MALAYI

 Males: 13.5mm to 20.5mm long ad 70m to 80m wide

 Tail: curved ventrally with 3 0r 4 pairs of adanal and or 3 or 4
pairs of postanal papillae
 Spicules are unequal and dissimilar
 Presence of small gubernaculum
 Females: 80mm to 100mm long by 240m to 300m
wide
 Tail: fingerlike, covered with minute cuticular bossess
 Vulva: near the level of the middle esophagus
BRUGIA MALAYI

Epidemiology
 Only one type of malayan filariasis in Philippines
 Mosquito vectors: Mansonia bonneae (freshwater
swamps), M. uniformis (rice fields)
 night-biters (5pm to 11pm)
 Provinces in the Philippines endemic for malayan
filariasis are:
1. Palawan (municipality of Quezon)
2. Sulu (municipality of Bongao in Tawi-tawi)
3. Agusan
4. Eastern Samar
LYMPHATIC FILARIASIS
 Commo Transmissi Treatmen
Organism Symptoms Diagnosis
n Name on t
Medical
Nodular and
history,
erythematous Mebendazo
River physical
Onchocerc dermal lesions, le; Diethyl-
blindness Black fly bite examination,
a volvulus eosinophilia, carbamazin
microfilaria
urticaria, e
in nodular
blindness
aspirate
ONCHOCERCA VOLVULUS

 Onchocerciasis, a.k.a ‘river blindness’

 Can also cause severe skin disease; skin
lesions
 Africa, Arabia, Guatemala, Mexico,Venezuela,
and Colombia
ONCHOCERCA VOLVULUS

Biology
 Adult worms: under the skin; if over a bone –
prominent nodule appears
 Africa: most infections are below the waist
 Central America: above the waist
 Intermediate host: Simulium spp.
River Blindness, a parasitic disease, is the second leading
infectious cause of blindness
 blackfly
Onchocerca
volvulus
ONCHOCERCA VOLVULUS
ONCHOCERCA VOLVULUS
ONCHOCERCA VOLVULUS
ONCHOCERCA VOLVULUS
Treatment
 Ivermectin

Prevention
 Elimination of vectors
 Application of DDT to swift-running streams: side
effects
 Other insecticides: expensive
Organis Commo Transmiss Treatme
Symptoms Diagnosis
m n Name ion nt
African
As in As in
eye
Loa loa Deer fly onchocercias onchocerci As above
worm
is asis
LOA LOA

 “Eye worm”
 Produces loiasis or fugitive or Calabar swellings
Epidemiology
 Rain forest areas of West Africa and equatorial Sudan
Biology
 Adults: live in subcutaneous tissues (back, chest, axilla, groin, penis, scalp,
and eyes)
 Infections of deep tissues, fatal encephalitis
 Microfilariae: in peripheral blood (maximal during daylight); night - in lungs
 Intermediate host: deer fly, Chrysops
LOA LOA

Pathogenesis
 Wander through subcutaneous connective tissues
 If in one spot: results in localized Calabar swellings (esp. in wrists, and
ankles)
 Migrate through the conjunctiva and cornea
Diagnosis and Treatment
 Microfilariae in the blood
 Visual observation of worm in the cornea or over the ridge of the nose
 Surgical removal
 DEC and Ivermectin
 Control of deer flies (swampy areas in forest)
LOA LOA
 MAJOR FILARIAL INFECTIONS OF HUMANS
species Disease Geographic Location of Location of vector Lab.
distribution adult in microfilaria diagnosis
humans

Wuchereria elephantiasis Tropical Lymphatic Blood mosquitoes Blood

bancrofti and vessels (nocturnal film
subtropical periodicity)
areas
Brugia elephantiasis Asia Lymphatic Blood mosquitoes Blood
malayi vessels (nocturnal film
periodicity)

Onchocerc Onchocerciasis Africa, Subcutaneous Skin, eyes, Simulium Skin snip

a volvulus (river Central nodules no spp. (black
blindness) and South periodicity fly)
America,
Yemen

Loa loa loiasis Central Moving in Blood Chrysops Blood

Africa subcutaneous (diurnal spp. (deer film
tissues periodicity) fly)