NEMATODES

Narlou M. Artiaga-Wenceslao, RMT, MD

• Enterobius vermicularis
• Ascaris lumbricoides
• Trichuris trichiura
• Ancylostoma duodenale
• Necator americanus
• Strongyloides stercoralis
• Capillaria phillipinensis
• Dracunculus medinensis
• Trichinella spiralis
 Enterobius vermicularis

 Pinworm
 Oxyuriasis
 Infective stage: Ovum containing rhabditiform larvae
 method of choice used to diagnose E. vermicularis:
Perianal scotch tape method
 Ova morphology: flattened on 1 side
 2-13 x.15-4 mm
Enterobius vermicularis
Eggs are deposited on perianal folds #1 . Self-infection
occurs by transferring infective eggs to the mouth with hands
that have scratched the perianal area #2 . Person-to-person
transmission can also occur through handling of
contaminated clothes or bed linens. Enterobiasis may also be
acquired through surfaces in the environment that are
contaminated with pinworm eggs (e.g. , curtains, carpeting).
Some small number of eggs may become airborne and
inhaled. These would be swallowed and follow the same
development as ingested eggs. Following ingestion of
infective eggs, the larvae hatch in the small intestine #3 and
the adults establish themselves in the colon #4. The time
interval from ingestion of infective eggs to oviposition by the
adult females is about one month. The life span of the adults
is about two months. Gravid females migrate nocturnally
outside the anus and oviposit while crawling on the skin of
the perianal area #5 . The larvae contained inside the eggs
develop (the eggs become infective) in 4 to 6 hours under
optimal conditions #1 . Retroinfection, or 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.
 Ascaris lumbricoides

 Giant Intestinal Roundworm

 Immature ova is unembryonated
 INFECTIVE STAGE: Embryonated
(mature) ovum
 Diagnoses: Eggs in feces; adult worms
 50-350 x 3-5 mm
 Ova require a period of development in
the soil before they become infective
Clinical Presentation

• Stunted growth
• Abdominal pain
• Intestinal obstruction
• Migrating adult worms may cause
symptomatic occlusion of the biliary
tract or oral expulsion.
• During the lung phase of larval migration,
pulmonary symptoms can occur (cough,
dyspnea, hemoptysis, eosinophilic
pneumonitis – Loeffler’s syndrome).
 Ascaris lumbricoides

Fertilized egg of A. lumbricoides in an unstained

wet mount of stool. A larva is visible in the egg.

A. Lumbricoides decorticated, fertile egg in

wet mounts,
Unfertilized egg of A. lumbricoides. Note the prominent
mammillations on the outer layer.

Unfertilized egg of A. lumbricoides in a wet mount of

stool. Note this specimen lacks the mammillated layer
(decorticated).
 Trichuris trichiura

 Whipworm
 Infective stage: Ovum containing
rhabditiform larva
 Eggs in feces
 Associated with rectal prolapse
 Morphology of the ova: Barrel/ Tray- shape
with bipolar plugs
Rectal Prolapse
 Ancylostoma duodenale

 Old world hookworm

 Infective stage: Filariform larva
 Free living stage: rhabditiform larvae
 Diagnosis: Eggs or rarely larvae in feces
 Associated with iron deficiency anemia
 Associated with Harada Mori technique
Harada Mori technique - method of incubating fecal
material on a filter paper strip in a test tube containing
water (cover one-third of the length of the paper strip) for
the purpose of culturing and recovering
nematode larvae (Strongyloides stercoralis, hookworm).
 Ancylostoma duodenale

• Associated with cutaneous larval migrans

• 8-13 x .45-.6mm
• Larva has long buccal capsule and very
small primordium
• Oral structures: 2 pairs of teeth
• Infection is via skin penetration
 Cutaneous larva migrans
"wandering larvae in the skin".
Ancylostoma duodenale
Oval with an empty space between the shell and the content
 Necator americanus

• New world hookworm

• Infective stage: Filariform larva

• Eggs or rarely larvae in feces

• Larvae in cultures

• Associated with iron deficiency anemia

Necator americanus
• Associated with Harada Mori technique

• Associated with cutaneous larval migrans

• 8-13 x .45-.6 mm

• Larva has long buccal capsule and very

small primordium

• Oral structures: 2 cutting plates

• Infection is via skin penetration

 Strongyloides stercoralis
• Infective stage: Filariform larva
• Autoinfection
• Free living parasite: Can survive in an external
environment on its own without depending on a
host
• Rhabditiform (non infective) larva is
characterized by short buccal (mouth) and
large genital primordium
• Baermann’s concentration is employed for
specimen recovery
• Infection is by skin penetration
Strongyloides stercoralis
Capillariasis
• C. philippinensis- intestinal capillariasis
• C. hepatica- liver capillariasis
• C. aerophila- pulmonary capillariasis

Between the first case reported in 1964 and the end of 1967, more than 1000 cases were
documented in and around Northern Luzon particularly at Tagudin, Ilocos Sur, including 77
deaths. Witch doctors were hired by the locals to exorcise the curse placed on them by the
river god, which they believed was responsible for this sudden disaster
Capillariasis
• Peanut shaped ova (20 x 40u)
• Pudoc worm
• Similar to T. trichiura
• Autoinfection
• Infective larvae- infective stage
Typically, unembryonated eggs are passed in the
human stool The number 1 and become
embryonated in the external environment The
number 2 ; after ingestion by freshwater fish,
larvae hatch, penetrate the intestine, and migrate
to the tissues The number 3 . Ingestion of raw or
undercooked fish results in infection of the human
host The number 4 . The adults of Capillaria
philippinensis (males: 2.3 to 3.2 mm; females: 2.5
to 4.3 mm) reside in the human small intestine,
where they burrow in the mucosa The number 5 .
The females deposit unembryonated eggs. Some
of these become embryonated in the intestine,
and release larvae that can cause autoinfection.
This leads to hyperinfection (a massive number of
adult worms) The number 6 . Capillaria
philippinesis is currently considered a parasite of
fish eating birds, which seem to be the natural
definitive host The number 7 .
 Dracunculus medinensis

Guinea worm
Fiery serpent worm
Infective stage:
L3 larvae

length: 70 to 120 cm
Humans become infected by drinking unfiltered water
containing copepods (small crustaceans) which are
infected with larvae of D. medinensis . Following
ingestion, the copepods die and release the larvae,
which penetrate the host stomach and intestinal wall
and enter the abdominal cavity and retroperitoneal
space . After maturation into adults and copulation,
the male worms die and the females (length: 70 to 120
cm) migrate in the subcutaneous tissues towards the
skin surface . Approximately one year after infection,
the female worm induces a blister on the skin,
generally on the distal lower extremity, which
ruptures. When this lesion comes into contact with
water, a contact that the patient seeks to relieve the
local discomfort, the female worm emerges and
releases larvae . The larvae are ingested by a copepod
and after two weeks (and two molts) have developed
into infective larvae . Ingestion of the copepods closes
the cycle .
D. medinensis
 Trichinella spiralis

• Encysted larva
• Muscle biopsy
• Myocarditis
• Bentonite flocculation tests
Trichinella spiralis
DRUG OF CHOICE
Albendazole

MECHANISM OF ACTION

Albendazole causes degenerative alterations in the intestinal cells of the worm by

binding to the colchicine-sensitive site of tubulin, thus inhibiting its polymerization
or assembly into microtubules. The loss of the cytoplasmic microtubules leads to
impaired uptake of glucose by the larval and adult stages of the susceptible
parasites, and depletes their glycogen stores. Degenerative changes occur in
the endoplasmic reticulum, the mitochondria of the germinal layer, and the
subsequent release of lysosome.
THE MECHANISM OF ACTION OF PYRANTEL PAMOATE

Pyrantel pamoate acts as a depolarizing neuromuscular blocking agent, thereby causing sudden contraction,
followed by paralysis, of the helminths. This has the result of causing the worm to "lose its grip" on the intestinal
wall and be passed out of the system by natural process. Since Pyrantel is poorly absorbed by the host's
intestine, the host is unaffected by the small dosage of medication used. Spastic (tetanic) paralyzing agents, in
particular pyrantel pamoate, may induce complete intestinal obstruction in a heavy worm load.This obstruction is
usually in the form of a worm impaction and happens when a very small, but heavily parasitized animal is treated
and tries to pass a large number of dislodged worms at once.

MECHANISM OF ACTION OF THIABENDAZOLE

Thiabendazole is a benzimidazole derivative with anthelminthic property. Although the mechanism of action has
not been fully elucidated, thiabendazole inhibits the helminth-specific mitochondrial
enzyme fumarate reductase, thereby inhibiting the citric acid cycle, mitochondrial respiration and
subsequent production of ATP, ultimately leading to helminth's death. In addition, it has been suggested
that thiabendazole may lead to inhibition of microtubule polymerization by binding to beta-tubulin and has an overt
ovicidal effect with regard to some trichostrongylids.
END