Nematodes Overview

intestinal-- Strongyloides larva

systemic-- microfilaria (Wuchereria)

Transmission and Clinical Complications Large Intestine
Trichuris (whipworm) Enterobius (pinworm)

transmission
oral oral

complications
hemorrhagic colitis perianal itch

Small intestine
Ascaris (round worm) oral percutaneous and Strongyloides (thread worm) autoinfection Ancylostoma & Necator percutaneous (hookworms) small intestine obstruction duodenitis, cutaneous larva currens, hyperinfection in immunocompromised iron deficiency anemia

Worm
Trichinella spiralis or nativa Toxocara canis (visceral larva migrans) Wuchereria bancrofti or Brugia malayi (lymphatic filariasis) Onchocerca volvulus (river blindness)

transmission clinical picture & diagnosis
raw pork, bear, walrus oral mosquito vector black fly vector horse fly vector myositis, diarrhea Dx. eosinophilia, raised CPK, serology eosinophilia, hepatomegaly, cough, fever Dx: serology elephantiasis, chyluria or hydrocoele Dx: microfilaria in blood, serology, antigen capture itchiness, persistant skin nodules, blindness Dx: adults in skin nodules, microfilaria in skin biopsies (snips) Calabar swellings (3-4 days), eye worm Dx: microfilaria in blood

Loa loa (eye worm)

develops by molting (shedding cuticle . diethylcarbamazine. Onchocerca.Diagnosis: stool examination for larvae (strongyloides) or eggs (the rest) Treatment: albendizole or ivermectin (strongyloides) or mebendazole (the rest) Systemic Diagnosis: blood or tissue examination for microfilaria. nervous. There are two basic groups: Nematodes .1 mm to 1 meter .albendizole Introduction The helminths (from the Greek meaning worm) are higher.digestive.organs .with adults in bowel . multicellular forms of parasite with specialized organs. Toxocara.ivermectin.round in cross section .separate sexes . muscle.cestodes (tapeworm) . albendizole Trichinosis. sexual .flatworms . cuticle.roundworms Platyhelminths . Loa.variable size .reproduction and development: egg egg fertilization embryo in egg larva 4 molts adult Categories Bowel nematodes . serology for Trichinella and Toxocara Treatment: Wuchereria. excretory.trematodes (fluke) Nematodes Characteristics .bilaterally symmetrical .

spread: fecal . via foods and hands) Biology .oral (esp.Trichuris trichiura Ancylostoma duodenale and Necator americanus Enterobius vermicularis Strongyloides stercoralis Tissue nematodes . native etc Toxocara canis (visceral larva migrans) Filaria . Trichuris trichiura (Whipworm) Epidemiology .about 350 million infected. in some areas 90-100% of population .life cycle: people infected by swallowing embryonated egg egg hatches in .Wuchereria bancrofti Brugia malayi Onchocerca volvulus Loa loa etc.restricted to warm climate by necessity for egg to embryonate on moist warm soil for10-14 days before becoming infective .adults or larval stage in tissue Trichinella spiralis.

spread: fecal .mebendizole. anemia.small intestine attaches to colonic epithelium and matures to egg laying in 3 months.examine stool (standard techniques) . dysentery. albendizole Problems .lack of cost effective control methods in LDC (least developed countries) Enterobius vermicularis (Pinworm) Epidemiology -very common in all geographic areas . 52 mu long Clinical .clinical: 99% assymptomatic .20%+ in Toronto's children .oral.pathognomonic egg Treatment . rectal prolapse Diagnosis .heavy load gives diarrhea.infected by swallowing egg which hatches after contact with stomach acid and matures to adult which then resides in lumen of caecum (from egg to adult . adult female. approx. 45 mm eggs approx. eggs can survive days to weeks in environment Biology .

10 mm long.e. egg very resistant. egg approx. Transmission is faecaloral. can survive years Biology -egg ingested.mebendizole. -best is pinworm swab . hatches in duodenum. Ascaris lumbricoides (Roundworm) Epidemiology -About 650 million infected worldwide mainly tropics. not a useful examination. .cellophane tape swab. larvae penetrate intestine wall.insensitivity of pinworm swabs (intermittent deposition of eggs) : eradication of infection from rest of family. 55 �m long pinworm egg 50-60 �m pinworm adult 8-13 mm Clinical .maturation in 15-43 days) . They then migrate into airspaces. albendazole. or sticky paddle Treatment . Female migrates onto perianal skin to lay eggs at night. i.most asymptomatic <10% anal pruritus. enter blood vessels and embolize through liver to lungs. rarely vaginitis Diagnosis -less then 10% found in stools. .organism: adult female approx. pyrantel pamoate Problems .

up trachea and are swallowed. taking up permanent adult residence in the small intestine. ~ 2 months from egg to mature adult adult female 20-35 cm eggs ~68 m� long adults from one child long .

Fertile eggs embryonate and become infective after 18 days to several weeks 3. they develop into adult worms 1. Adult worms can live 1 to 2 years. invade the intestinal mucosa.Adult worms1 live in the lumen of the small intestine. Upon reaching the small intestine. shaded soil). (CDC 1999) . warm. which are passed with the feces 2. depending on the environmental conditions (optimum: moist. then systemic circulation to the lungs 6 .000 eggs per day. and are swallowed 7. A female may produce up to 240. and are carried via the portal. Between 2 and 3 months are required from ingestion of the infective eggs to oviposition by the adult female. the larvae hatch 5. penetrate the alveolar walls. After infective eggs are swallowed 4. The larvae mature further in the lungs (10 to 14 days). ascend the bronchial tree to the throat.

Organism: female adult . Small numbers of larvae get into blood vessels and circulate again to produce more adults (internal autoinfective cycle) or invade perianal skin and enter blood vessels to eventually produce new adults (external autoinfective cycle).38 mm. are swallowed. They deposit eggs in submucosa and these hatch and migrate into intestinal lumen.related to number of worms. Mainly a tropical parasite because requires warm moist soil for transmission.Clinical . 0. small numbers asymptomatic . invade airspace. Can exist for months in soil "free living" by completing life cycle without contact with human host man. 0. Biology Larvae passed into soil in human feces where mature in several days to skin invasive (filariform) larvae.large numbers of adults in intestine -. Special problem in immunocompromized because of this. and then penetrate small intestinal mucosa where they mature to adults in submucosa.at times adults migrate into bile duct. pains . filariform larvae approx. move via blood vessels to lung.obstruction.cause malnutrition if in large numbers Diagnosis: stool examination for eggs Treatment: mebendizole.2. Larvae penetrate skin.7 mm long.6 mm long . albendazole Strongyloides stercoralis (Threadworm) Epidemiology The only important helminth that can complete its life cycle in the human host and hence increase its numbers. move up bronchi. up esophagus or through surgical anastomoses of intestine . Transmission: skin contact with invasive larvae in soil. rhabditiform larvae approx.

spread of larvae to peritoneum. cutaneous larvae currens (trunkal itchy dermatitis) hyperinfection (disseminated strongyloides) in immunocompromised. Filariform larvae penetrate skin of host (e. transmural small intestine spread of larvae and bacteria with necrosis of intestine Diagnosis stool examination .peptic ulcer like symptoms.g. bare feet). Biology: eggs in feces hatch and mature as larvae in warm moist soil. circulate to lungs where they penetrate alveoli. CNS with contamination of those organs with gram negative bacteria. move up .adult filariform (invasive) larva Clinical most asymptomatic GI . ivermectin Problems: diagnostic techniques not sensitive untreated it persists for life Ancylostoma duodenale and Necator americanus (Hookworm) Epidemiology: transmission by contact of skin with soil contaminated with larvae. diarrhea rarely. develops into to infective (filariform) larvae in 7 days. lung. NB: difficult to find strongyloides duodenal aspirate or Enterotest duodenal string test serology (the most sensitive) culture of stool (Harada-Mori or Baerman) allows "free living" strongyloides to multiply agar plate tracking Treatment: albendazole.

100 worms) iron deficiency anemia malnutrition from protein loss rarely itch at skin entry site Diagnosis: Stool examination for ova Treatment: mebendizole.d). as adults. Then. Prepatent period (time from skin penetration to egg production) is 4-5 weeks. ova approx. 60 mu long Adult female 10 mm long (N. Organism Adult female 12 mm long (A. Ancylostoma 0.bronchi and are swallowed. ova approx.03 ml/day. 65 mu long filariform larva h mouth of Ancylostoma duodenale egg 60 x 40 m� Clinical usually assymptomatic 90% heavy infections (20 . Adults can live 5-15 years.15 ml/day). (Necator 0. albendazole .a). they attach by mouth to small intestinal mucosa and suck blood.

zinc sulfate solution flotation .Problems: Lack of cost effective LDC (least developed country) control Cutaneous Larva Migrans Ancylostoma caninum. formal ethyl acetate sedimentation . Can be used for counting eggs/gram feces. cat etc) hookworms that penetrate human skin (as does human hookworm) but cannot go further. Ancylostoma braziliensis etc. 3. ivermectin. Concentration techniques: i. Kato technique: uses glycerin mixed with stool which "clears" (makes transparent) fecal debris making eggs visable.eggs float to top of solution ii. Laboratory procedures for diagnosing intestinal helminths Stool ova and parasite (O & P) examination 1. Treatment albendizole. Migrate and produce serpiginous itchy traits in subcutaneous tissue. Non-human (dog. Direct microscopic (without a concentration technique) examination: not very sensitive 2.

Eosinophilia Increased blood eosinophil counts are normal host response to helminth infection. Trichinellosis) . not seen in protozoan infections very high (30-80% of WBC) Trichinella Toxocara Fasciola moderate (10-30% of WBC) hookworm Strongyloides low or absent (0-10% of WBC) Enterobius Ascaris Trichuris Trichinella spiralis.only Strongyloides will multiply in an incubated stool specimen . nativa (Trichinosis.4. Culture: Harada Mori or Baerman culture or charcoal culture .increases numbers of larvae and sensitivity of microscopy.

Adult female is 5 mm. Man infected by eating Trichinella infected uncooked meat. sometimes encephalitis and myocarditis Long term (months) .myalgia. facial and periferal edema. excyst (hatch) and penetrate into small intestine submucosa where they mature to adults in 1-2 weeks producing larvae which penetrate blood vessels and diseminate to all muscles. rash.usually assymptomatic despite presence of trichinella "cysts" Diagnosis clinical picture with laboratory support (eosinophilia and raised creatine phosphokinase (CK) .This is a zoonosis infecting most carnivorous mammals. There. bear. remaining viable and quiet for many years. muscle weakness. walrus. when eaten. Biology Encysted larvae in meat. diarrhea Midterm (2-6 weeks) .Epidemiology Common in geographic areas where undercooked pork is eaten. and rats. especially pigs. they cause inflammation and encyst in muscle cells (not cardiac).long larva extracted from muscle adult from intestine wall Clinical Early (1-2 weeks) - abdominal pain. 5-15% of North American population infected at some time. in the Arctic where raw walrus is eaten and among bear hunters in North America.

Eggs in soil viable and infective for several months. Transmission is dog fecal (dog)-oral (human) . Uncommon human infection but consequences serious. hatch after stomach passage and larvae migrate through small intestinal wall into vasculature and then to liver and lungs and beyond. 5 mm long. Organism: In man larvae are 0.microscopic examination of muscle biopsy serology larva in muscle cell at biopsy Treatment: steroids and mebendizole or albendazole Problems: education of meat consumer lack of good drugs Toxocara canis (Visceral Larva Migrans) Epidemiology: This is a zoonotic roundworm with the dog as reservoir. . looks like a round Ascaris egg. Man an accidental "dead end" host. Eggs ingested by man/child. Do not mature to adults but cause local inflammation especially in liver. Dog feces especially in sandboxes and parks where children play. Biology: Adult has cycle in dog the same as Ascaris in man. egg in dog feces.

Capillaria philippinensis: small intestine nematode producing diarrhea and malabsorption (Philippines). . 4. encephalitis.Diagnosis difficult because of nonspecificity of symptoms Other Nematodes 1. 2. pneumonitis. 3.Toxocara eggs Clinical Hepatomegaly. and at times encephalomyelitis (mainly SE Asia). herring etc) roundworm that when ingested produces a nematode inflammatory mass in stomach of raw fish consumer or eosinophilic gastritis (mainly Japan. fever and eosinophilia in heavy infections Retinal lesion (similar to retinoblastoma) or focal retinitis when single larva reaches retina. Anisakis sp: Salt water fish (cod.Control of dog and cat feces in parks and sandboxes . Holland). Diagnosis Clinical syndrome with very high eosinophilia Serology Nothing in stools Treatment: Steroids and albendizole Problems: . Angiostrongylus cantonensis: nematode of amphibians producing eosinophilic meningitis (mainly SE Asia). Gnathostoma spinigerum: nematode of cat producing migratory local subcutaneous swelling.

5. Bayliascaris procyonis: Raccoon nematode in North America producing a visceral larva migrans like Toxocaris (above) but with severe encephalitis .

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