Parasitology (PMC503)

11/12/2022

Helminthology
Nematoda Part 1

Marwa ElRakaiby, PhD

marwa.elrakaiby@pharma.cu.edu.eg
 Classification of Helminthes
Phylum

Platyhelminth Nemathelminth
(Flat worms) (Roundworms)

Class Trematoda Class Cestoda Class Nematoda

“Flukes” “Tapeworms” “Roundworms”

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Phylum Nemathelminths
Class Nematoda
“Roundworms”
General Features of
Nematodes

4
 General Features of
Nematodes
1. Nematodes are generally bilaterally symmetrical,
cylindrical and tapered at both ends.
2. All nematodes are dioceous. Males are usually
smaller than females.
3. The adults are equipped with complete digestive
and reproductive systems.
4. They are classified according to their location in
their host into:
a) Intestinal Nematodes
b) Tissue Nematodes
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 Intestinal Nematodes

Direct contaminative Fish-transmitted

Enterobius vermicularis Anisakis simplex

Soil-transmitted
Tissue species
(Geohelminths)
Trichinella spiralis
Ascaris lumbricoides
Dracunculus medinensis
Trichuris trichiura
Hookworms
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General Life
Cycle of
Intestinal
Nematodes

No Intermediate Host
except Anisakis simplex PMC503 Eggs 7
 Direct
Enterobius vermicularis

“The Pin Worm”

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Common Name The Pinworm – The Seatworm

Disease Enterobiasis

Location in the definitive

Small intestine of man
Host

• Auto-infection: infective eggs to mouth by

hands (scratching the perianal area)
• Person-to-person: handling of contaminated
clothes or surfaces
Mode of Transmission
• Retroinfection: migration of newly hatched
larvae from the anal skin back into the rectum
• Air: Some eggs may become airborne and
inhaled then swallowed.

Infective Stage Embryonated eggs

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 • Tape Method: transparent tape on the perianal
region to collect possible eggs (sometimes, adult
female worm) around the anus. The eggs are
visible under a microscope. It should be
conducted on 3 consecutive mornings
Laboratory Diagnosis
• Rarely, eggs in stool are seen.
• Since anal itching is a common symptom of
pinworm, an option for diagnosis is analyzing
samples from under fingernails under a
microscope.

Diagnostic Stage Characteristic eggs (Planoconvex/D-shaped)

Light infection: Asymptomatic
Heavy infection: Intense itching in anal/vaginal
Clinical Symptoms region, insomnia due to disturbed sleep, abdominal
pain, secondary bacterial infection due to the
irritation and scratching of the anal area
Albendazole
Treatment
(single tablet repeated after 2 weeks ??) 10
 What are the possible measures to
prevent and control the pinworm
infections?

In many cases, treatment

is suggested for the family
members of an infected
individual because
pinworm eggs spread
readily into the
environment.

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Geohelminth 1
Ascaris lumbricoides

Liver-Lung
Migration

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 The largest intestinal roundworm
Common Name
(female: 20 to 35 cm; male: 15 to 30 cm)

Ascariasis (The most common intestinal helminth

Disease
infection in the world)
Location in the definitive
Small intestine of man
Host
• Oral-fecal route
Mode of Transmission
• Soil contaminated with embryonated eggs

Infective Stage Embryonated eggs

Microscopically or Serologically (ELISA)
(Characteristic eggs in feces or larva in sputum)
Laboratory Diagnosis Adult worms may be present in the stool, vomited
up, or removed from the external nares, where
they may attempt to escape.
Light infection: asymptomatic
Clinical Symptoms Heavy infection: intestinal obstruction, cough
due to migration of the worm through the lungs13
 Geohelminth 2
Trichuris trichiura

“The Whip Worm”

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Common Name The Whipworm

Disease Trichuriasis
Location in the definitive
Small intestine of man
Host

• Oral-fecal route
Mode of Transmission
• Soil contaminated with embryonated eggs

Infective Stage Embryonated eggs

Microscopically
Laboratory Diagnosis
(Characteristic eggs in feces)
Light infection: asymptomatic
Heavy infection: pain, weakness, bloody
diarrhea, rectal prolapse
Clinical Symptoms
In children: chronic dysentery, severe anemia,
growth retardation, and impaired cognitive
development
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 Infective,
non-feeding Geohelminth 3
Hookworms
“Blood Feeders”

Molting

Immature,
newly
hatched
 A. duodenale and N. americanus
There are two primary differences:
1. The geographic distribution
2. The adult worms of each have minor morphologic
differences.
The egg and larva stages, however, are basically
indistinguishable.

N.B:
Mixed infections with any combination of hookworm,
Trichuris, and Ascaris are possible because all three
organisms require the same soil conditions to remain
viable.
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 Ancylostoma duodenale Necator americanus

Common Name Old World Hookworm New World Hookworm

Disease Ancylostomiasis Necatoriaisis

Definitive Host Man

Int. Host None

Mode of Direct skin penetration usually between the toes/fingers by
Transmission proteolytic enzymes

Habitat Small intestine

Entry: Intense itching and burning, pruritus may lead to
secondary infection hence “Ground Itch” condition with
papulovascular dermatitis
Migration to lungs: cough, bronchitis, blood-stained sputum
Clinical Symptoms GIT symptoms: abdominal pain, nausea, diarrhea, loss of
appetite.
Severe Cases: Loss of blood and proteins “microcytic
hypochromic anemia.”
In children, growth and mental retardation.
 How heavy, even fatal, ancylostomiasis may
occur in children of one-month-old?

Translactational - Transmammary
Route of Transmission

• Larvae spread around the body

to become dormant (hypobiosis) inside muscle fibers.
• After childbirth, some larvae are stimulated to re-enter the
circulation (hormonal changes), then pass into the
mammary glands, the newborn can receive a large dose of
infective larvae through milk.
Can Necator americanus be transmitted
to babies translactationally?

No, because N. americanus (slayer of Americans)

larvae do not undergo hypobiosis.
 A. duodenale N. americanus
Adult

Laboratory Microscopically (characteristic eggs in feces)

Diagnosis Serologically (ELISA)
Infective
Stage Filariform “L3 stage” Larva

Diagnostic
Stage
Indistinguishable
 Hookworm Prevalence
Unlike most intestinal helminthiases, it is higher in
adult males.

WHY?

Occupational Infection: coworkers and close-groups

(agriculture, mining) maintain high prevalence by
contaminating their work environment.
Hookworm Infection and Pica
• Pica is an eating disorder of the
consumption of substances that
are non-nutritive such as paper,
dirt, hair, clay, metal, glass or
sand.
• Pica is a specific appetite caused
by mineral deficiency such as iron.
• Recently, it has been tied to OCD
and mental disorders.
 A. caninum
&
A. braziliense
 A. caninum and A. braziliense

Cutaneous Larva Migrans (CLM),

Common Name
Creeping Eruption

Disease Zoonotic Disease

Cats, dogs
Definitive Host
Man is an accidental (dead-end) host

Mode of Direct skin penetration usually between the

Transmission toes/fingers by L3 filariform larva

Small intestine in cats and dogs

Habitat
Skin epidermis in man

It resembles Ground Itch condition but lasts longer:

Clinical Symptoms Intense itching and burning, pruritus may lead to
secondary infection with papulovascular dermatitis
 Why can’t A. caninum cause
intestinal infection in humans?
Because it lacks the required proteolytic enzymes
to move across the basement membrane deeper
into the skin

Creeping
Worms
 Treatment and Prevention
• Anthelmintic drug: Albendazole
• Cryotherapy: Liquid nitrogen
• Anti-itch creams: Calamine Lotion
• Wearing shoes in endemic areas, avoid skin contact
to soil and/or sand contaminated with dog feces,
banning dogs from beaches…
Fish –transmitted:
Anisakis simplex
Common Name Cod-worm / Herring-worm disease

Disease Anisakiasis

Marine mammals (whale, seal dolphin)

Definitive Host
Man is an accidental (dead-end) host

Int. Host Crustaceans

Paratenic Host Fish (salmon, sardine) & squid

Infective Stage L3 filariform larva

Oral ingestion of raw/undercooked/salted fish

Mode of Transmission
(Sushi/Sashimi) containing the infective stage

Habitat Small intestine of marine mammals and man

Within a few hours of ingestion, the worm
tries to burrow though the intestinal wall,
but since it cannot penetrate it, it gets stuck
and dies. The presence of the parasite
triggers an immune response; immune cells
surround the worms, forming a ball-like
structure that can block the digestive system
causing severe abdominal pain, nausea and
vomiting.

Clinical Allergic symptoms (Ig E): urticaria, angioedema &

Symptoms anaphylaxis
GIT symptoms: epigastric pain, nausea, vomiting

Laboratory Serologically (ELISA), Endoscopy (removal of worms)

Diagnosis Worms coughed up are brought in by patients.
Infective
Stage Filariform “L3 stage” Larva

Diagnostic
Filariform “L3 stage” Larva
Stage
Ø The morphologic forms recovered in cases of pinworm
infection are which of the following?
A. Eggs and adult females
B. Adult males and females
C. Eggs and larvae
D. Larvae and adult males

Ø Children infected with Trichuris trichiura commonly suffer

from:
A. Mental confusion
B. Hemoglobinuria
C. Severe anemia
D. Rectal prolapse
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Ø Individuals contract hookworm via which of the following?
A. Contaminated water
B. Skin penetration
C. Insect bite
D. Contaminated food

Ø Individuals contract anisakiasis via which of the following?

A. Drinking water containing L3 larvae
B. Skin penetration by L3 larvae
C. Insect bite containing L3 larvae
D. Ingestion of salted fish containing L3 larvae

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Thank you

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