Round worms

Helminthology
HELMINTS
Flat Worms Roundworms

Phylum Phylum
Platyhelminthes Nemathelminthes

The Trematoda Nematoda

class:
Cestoda (Tape worms)
(Flukes)

Nematodes are invertebrate roundworms that inhabit marine, freshwater, and terrestrial environments.

Some 5,000 species of nematodes are estimated to be parasites of vertebrate animals and humans.
 Characteristics of Nematoda
• Nematodes are commonly referred to as roundworms
• Some are parasites and others are free living in soil or water
• Body of nematodes is slender cylindrical un-segmented with resistant,
complex cuticle
• Body wall contains longitudinal muscles
• Feed on just about everything.
 Characteristics of Nematoda
• The alimentary tract – extending from the mouth to the anus at the
posterior end.
• They have a nervous system with pharyngeal nerve ring.

• Sexes are separate. Sexual dimorphism is present. Males are smaller with
curver posterior end
• They possess cloaca (anus) with one or two copulatory spicules

curver posterior end

 Characteristics of Nematoda
• There are four stages of a nematodes life:
egg stage , four larval or juvenile stages, and an adult stage.
• Development involves four moults of the cuticle
• (L1, L2, L3, L4 - first, -second, -third, -fourth- stage larvae)
• Each of four larval stages is followed by a molt in which the cuticle is
shed.
The nematode formed at the fifth stage is the adult.
 Characteristics of Nematoda
The methods of obtaining food:
• sucking with ingestion of blood (Ancylostoma)
• ingestion of lysed tissues by embedded worms (Trichuris)
• feeding on the intestinal contents (Ascaris)
• ingestion of nourishment from the body fluids (filarial worms)
 Nematoda - Roundworms
Organism Disease of… Epidemiology

Ascaris lumbricoides hominis Gut, lungs worldwide

Toxocara canis Different tissues worldwide

Enterobius vermicularis Anal pruritis worldwide

Trichuris trichiura Ano-rectal, anemia worldwide, tropical
Trichinella spiralis muscular cells worldwide
Strongyloides stercoralis Gut, lung, skin worldwide, tropical
Hookworms Gut worldwide, tropical
Loa loa Skin, eye tropical
Dirofilaria repens Skin, eye Endemic

Wuchereria bancrofti Lymphatic system tropical

 Ascaris lumbricoides hominis
Scope of the Problem

• Ascariasis is one of the most common human parasitic infections

• Up to 10% of the population of the developing world is infected with intestinal
worms – a large percentage of which is caused by Ascaris
• Severe Ascaris infections cause approximately 60,000 deaths per year, mainly in
children
• Ascaris, hookworm, and whipworm are known as soil-transmitted helminths
(STH)(parasitic worms)
• The adult female may produce 200 thousand eggs per day
• The eggs are very hardy and can survive extreme environmental conditions like
freezing, extreme heat and they are resitant to desiccation
• Eggs can survive potentially for 15 years
• Ascaris derived from pigs (often referred to as A. suum) may also infect humans
 Ascaris lumbricoides hominis

• Distribution: Worldwide, with greatest frequency in tropical and subtropical

regions, and in any areas with inadequate sanitation.
• Adult females: 20 to 35 cm; adult male: 15 to 30 cm.
• Disease: ascariasis
• Location of adult: adult stage in the small intestine
• Infective stage: infective egg (containing developed larvae)
• Mode of transmission: Ingestion eggs containing infective larvae from soil
contaminated with human feces or contaminated vegetables and water
• Transmission from human to human by direct contact is impossible!!!
 Ascaris lumbricoides hominis

The larvae migrate and moult

twice in the lungs (10 to 14 days).

Fertile eggs embryonate and become

infective after 18 days to several weeks ,
depending on the environmental
conditions (optimum: moist, warm,
shaded soil).
 Symptoms of ascariasis
Organ involved Symptoms

The majority of infections are asymptomatic;

Small intestine abdominal pain and intestinal obstruction, gastrointestinal
discomfort, colic and vomiting, fever, and observation of live
worms in stools
Lungs Tend to occur 1 – 2 weeks after ingestion of the eggs;
Worms destroy capillaries in the lungs, causing hemorrhage
During migration of the larvae cough, dyspnea, hemoptysis,
eosinophilic pneumonitis - Loeffler's syndrome
Allergic asthmatic reaction may occur
 Diagnosis
• DIAGNOSTIC SPECIMEN: feces
DIAGNOSTIC STAGE: undeveloped eggs in feces
•
DIAGNOSTIC METHODS: microscopic demonstration of eggs in stool
specimens.
• During pulmonary disease larvae may be found in fluids aspirated from
the lungs.
• White blood cells counts may demonstrate peripheral eosinophilia
 Prevention

https://www.cdc.gov/parasites/ascariasis/prevent.html
• Avoid ingesting soil that may be contaminated with human or pig feces, including
where human fecal matter (“night soil”), wastewater, or pig manure is used to fertilize
crops.
• Wash your hands with soap and water before handling food.
• Wash your hands with soap and water after touching or handling pigs, cleaning pig
pens, or handling pig manure.
• Teach children the importance of washing hands to prevent infection.
• Supervise children around pigs, ensuring that they do not put unwashed hands in their
mouths.
• Wash, peel, or cook all raw vegetables and fruits before eating, particularly those that
have been grown in soil that has been fertilized with manure.
• Not defecating outdoors.
• Effective sewage disposal systems
 Trichuris trichiura
• Whipworm is a soil-transmitted helminth (STH) and is the third most common
roundworm of humans
• An estimated 604-795 million people in the world are infected with whipworm
• The female deposits up to 5000 egs daily

• Adult Trichuris trichiura – the anterior portion of the body is long and slender, the
posterior portion widens abruptly and thickenes, giving the worm the appearance
of a bullwhip („whipworm”);

barrel-shaped with two polar plugs

eggs 50x22 m

30-50 mm length
 Trichuris trichiura
whipworm
• Distribution: Worldwide, highest prevalence in tropical and subtropical
regions
• Disease: Trichuriasis (Whipworm Infection)
• Location of adult: large intestine
• Infective stage: infective egg (containing developed larvae)
• Mode of transmission: Ingestion eggs containing infective larvae from soil
contaminated with human feces or contaminated vegetables and water
Larval development is complited within 2 weeks in
soil (miosture and shade)

The larvae hatch in the small

intestine, enter the
Liberkuhn’crypts and mature,
undergoing two molts (3-10 days);
Reenter the intestinal lumen,
migrate to the large intestine and
maturate in about 3 months

Unembrionated barrel-
shaped egg

Trichuris trichiura
 Symptoms of Trichuriasis
(Whipworm infection)

Organ involved Symptoms

People with light infections usually have no symptoms.
Large intestine People with heavy symptoms can experience frequent, bloody
stool, pain in the lower abdomen, weight loss, rectal prolapse,
nausea, anemia.
Children with heavy infections can become severely anemic
and growth-retarded.

http://takeyourbreathaway.weebly.com/whipworms.html
 Diagnosis

• DIAGNOSTIC SPECIMEN: feces

• DIAGNOSTIC STAGE: undeveloped eggs in feces
• DIAGNOSTIC TECHNIQUES: microscopic
demonstration of barrel-shaped with two polar plugs
eggs
 Trichuris trichiura
Prevention
• Avoid ingesting soil that may be contaminated with human feces,
including where human fecal matter ("night soil") or wastewater is used to
fertilize crops.
• Wash hands with soap and warm water before handling food.
• Teach children the importance of washing hands to prevent infection.
• Wash, peel, or cook all raw vegetables and fruits before eating,
particularly those that have been grown in soil that has been fertilized
with manure.
 Enterobius vermicularis
Pinworm
• It is mainly seen in children, pinworm cases have been documented in
adults, especially in households where infected children transmit the
infection to the rest of the family.
• Mode of transmission: the fecal-oral route, that is by the transfer of
infective pinworm eggs from the anus to someone’s mouth

• The eggs are deposited around the anus by the worm and can be carried
to common surfaces such as hands, toys, bedding, clothing, and toilet
seats.
 Enterobius vermicularis
Pinworm
• Distribution: Worldwide
• Disease: Enterobiasis (also known as pinworm infection, oxyuriasis))
• Location of adult: adult stage (8-13 mm long) in the large intestine

adult Egg 50-60 m

• Infective stage: infective egg (containing developed larvae)

• Humans are considered to be the only hosts of E. vermicularis.

 Enterobius vermicularis
Transmission

Via ingestion of Through inhalation Retroinfections

infectious eggs Autoexoinfection when L3 larvae hatch
of aerosolized eggs
from perianally located
egg
 Enterobius vermicularis

The embryonated eggs complete

their development within 6 hours Adult pinworms live in
the large intestine

Gravid females actively migrate during the night down the colon and leave by the anus
where the eggs, containing developed embryos are deposited on the perianal skin.
The females die soon after oviposition.
 Symptoms of Enterobiasis
Organ involved Symptoms
Large intestine Symptoms of pinworm infection usually are mild and some
infected people have no symptoms.
Anus - frequent and strong itching of the anal area
- restless sleep due to the itching and discomfort
- pain, rash, or other skin irritation around the anus
- the presence of pinworms in the area of child’s anus
- the presence of pinworms in stools
 Enterobius vermicularis
Diagnosis

DIAGNOSTIC SPECIMEN: Perianal sample

DIAGNOSTIC STAGE: Eggs on perianal region

Microscopic identification of eggs collected in the perianal area

• This must be done in the morning, before defecation and washing, by pressing
transparent adhesive tape ("Scotch test", cellulose-tape slide test) on the perianal
skin and then examining the tape placed on a slide.
• Eggs can also be found, but less frequently, in the stool, and occasionally are
encountered in the urine or vaginal smears.
• Adult worms are also diagnostic, when found in the perianal area, or during ano-
rectal or vaginal examinations.

„Scotch test", cellulose-tape slide test

 The following groups are more susceptible
for Pinworm infections
• children who attend day-cares, preschool, or elementary school
• family members or caregivers of infected children and adults
• individuals who live in institutions or other crowded accommodations
• children who don’t practice regular and careful hand washing prior to eating

Children who have a habit of sucking their thumbs

 Enterobius vermicularis
PREVENTION
• Change and wash underwear each day.
• Frequent changing of night clothes are recommended.
• Because the eggs are sensitive to sunlight, open blinds or curtains in bedrooms
during the day.
• Personal hygiene: washing hands after going to the toilet, before eating and after
changing diapers.
• Trim fingernails short.
• Discourage nail-biting and scratching bare anal areas. These practices help reduce
the risk of continuous self reinfection.
 https://www.cdc.gov/dpdx/toxocariasis/index.html
Toxocara canis
• Toxocariasis is an infection transmitted from animals to humans (zoonosis) caused by the
parasitic roundworms commonly found in the intestine of dogs
• Epidemiological risk factors of human toxocariasis.
• contamination of the environment by Toxocara eggs (soil and water)
• social/ecological aspects (animal ownership, education and/or occupation)
• genetic factors (e.g.,age, gender and/or health status)

• A One Health strategy should improve our knowledge base and enhance the prevention and
control of toxocariasis

• Distribution: Worldwide (cosmopolitan)

• Disease: toxocariasis
• Humans are intermediate hosts
• Infective stage: infective egg (containing developed larvae)
• Diagnosis: antigenic and serological test; in some cases biopsy may be performed
•
 Toxocara spp.
egg

• Gardens
• Unwashed hands
• Raw vegetables
• Direct contact with fur of
pets
 Toxocariasis: Clinical Aspects, Epidemiology, Medical Ecology, and Molecular Aspects. CLINICAL MICROBIOLOGY
Toxocara canis/cati
Larvae do not undergo any further development in human body, they can cause local
reactions and mechanical damage that causes clinical toxocariasis.

toxocariasis

REVIEWS, 2003;16, 265–272

T. canis larva hatching.
 Toxocara canis/cati
Clinical features
Various clinical forms of human toxocariasis have been recgnised:

• visceral larva migrans (VLM) also known as toxocaral larva migrans which are caused by
the movement of the worms through the body, include fever, coughing, asthma, or
pneumonia

• ocular larva migrans (OLM), an eye disease that occurs when a worm enters the eye; it
may cause inflammation and formation of a scar on the retina
• Each year more than 700 people infected with Toxocara experience permanent partial
loss of vision

• neurological larval migrans - larvae lodged in CNS (Meningitis, encephalitis, convulsions,

motor deficiencies)

https://www.cdc.gov/dpdx/toxocariasis/index.html
 Toxocara prevention

• Regularly deworming dogs and cats (especially young)

• Hygiene
• Limit contact with feces
• Clean pet’s area regularly
• Education
 Trichinella spiralis
• Distribution: Worldwide (in many carnivorous and omnivorous animals)
• Disease: Trichinellosis (trichinosis)
• Infective stage: infective larvae
• Mode of transmission: Ingestion of raw and semi raw meat from pigs or
other mammals containing encapsulated larvae

• Diagnosis: muscle biopsy, serological tests. White blood cells counts may
demonstrate peripheral eosinophilia.

The adult Trichinella female - 2.5 -4 mm

males – 1.5 mm length
 Larvae are realised from their capsules in the duodenum,
by the actio of host’s digestive enzyms.
Larvae invade the intestinal mucosa, undergoing 4 molts
within 24-30 hours.
Mature and mate. The female Trichinella deposits the larvae
which are carried by the lymphatic and blood vessels
to the right side of the heart in venous blood.
Next migrate to striated muscles, that larvae develop
into the infective stage.

A single larvae occupies

each muscle fiber

In muscle nurse cells, parasite larvae can survive for years (up to 40 years in humans
and over 20 years, e.g., in polar bears)
Trichinella spiralis
http://www.trichinella.org/bio_lifecycle.htm
 Symptoms of trichinellosis
Organ involved Symptoms
Small intestine Nausea
Initial symptoms (1-2 days) Diarrhea
Vomiting
(female 2.2 mm in length, males 1.2 mm) Abdominal pain

Muscle or other tissue High fever

Later symptoms
(2 – 8 weeks - larvae migrate to the
striated muscles where they encyst)
Muscle pain and tenderness
Swelling of the eyelids or face
Weakness, Headache, Chills
Itchy skin or rash
Cough
Sensitivity to light
Pink eye (conjunctivitis)
Eosinophilia
 Diagnosis
• DIAGNOSTIC SPECIMEN: striated muscle biopsy
DIAGNOSTIC STAGE: larvae encyst "nurse cells" in striated muscle

• DIAGNOSTIC TECHNIQUES:
• Antigenic and serological test
• In some cases a muscle biopsy may be performed
 Trichinella spiralis
Prevention
• Wash your hands with warm water and soap after handling raw meat.
• Curing (salting), drying, smoking, or microwaving meat alone does not
consistently kill infective worms; homemade jerky and sausage were the
cause of many cases of trichinellosis reported to CDC in recent years.
• Freeze pork less than 6 cm thick for 20 days at -15°C to kill any worms.
• Freezing wild game meats, unlike freezing pork products, may not
effectively kill all worms because some worm species that infect wild
game animals are freeze-resistant.
• Clean meat grinders thoroughly after each use.
• To help prevent Trichinella infection in animal populations, do not allow
pigs or wild animals to eat uncooked meat, scraps, or carcasses of any
animals, including rats, which may be infected with Trichinella.
 Strongyloides stercoralis
• Distribution: Worldwide, mainly in tropical and subtropical regions, and in rural
area.
• Disease: strongyloidiasis
• Location of adult: adult stage in the small intestine
• Infective stage: filariform larvae
• Mode of transmission: activities that increase contact with the soil such as:
walking with bare feet, contact with human waste or sewage, occupations that
increase contact with contaminated soil such as farming and coal mining;
autoinfections (larvae penetrate the human skin)

• Diagnosis: by seeing rhabditiform larvae in stool under the microscope.

• White blood cells counts may demonstrate peripheral eosinophilia.

rhabditiform larvae
 Strongyloides stercoralis
LIFE CYCLE- 3 phases

Free living phase Parasitic Autoinfection

Folowing oviposition Filariform penetrate Some of the

rhabditiform larvae molts
and develop into sexually
mature adult.
Eggs hatch in the soil;
larvae feed on organic
debris;
Rhabditiform larvae molt
twice to be nonfeeding
filariform larvae
the skin → veins → rhabditiform larvae
heart →lung alveoli develop into filariform in
→molt third time digestive tract
→trachea →after →following the same
swolowing →small route of migration return
intestine to the duodenum and
mature

Heterogonic or indirect life cycle Homogonic or direct life cycle (human)

Strongyloides stercoralis
 Symptoms of strongyloidiasis
Organ involved Symptoms
Abdominal diarrhea, stomachache, bloating, and heartburn
nausea and loss of appetite

Respiratory dry cough

throat irritation
Skin itchy, red rash that occurs where the worm entered the
skin
recurrent red rash typically along the thighs and buttocks

Hyperinfection syndrom disseminated strongyloidiasis can occur;

In hyperinfection and dissemination, complete disruption
of the mucosal patterns, ulcerations, and paralytic ileus
have been observed.
The disease are more common in people who are on
immunosuppressive therapies or who are infected with
HIV. In this situation, people become critically ill;
Infection may be severe and even life-threatening.
 Diagnosis

• DIAGNOSTIC SPECIMEN: feces, sputum

• DIAGNOSTIC STAGE: first stage larvae (rabditiform) in feces or sputum
• Microscope - seeing rhabditiform larvae in stool
• Agar plate culture method
 Strongyloides stercoralis
prevention
• An estimated 30–100 million people are infected worldwide;
precise data on prevalence are unknown in endemic
countries.
• The best way to prevent Strongyloides infection is to wear
shoes when you are walking on soil, and to avoid contact with
fecal matter or sewage.
• Proper sewage disposal and fecal management are keys to
prevention.
 Hookworms
Ancylostoma duodenale, Necator americanus
• Geographic distribution:: a worldwide distribution, mostly in areas with moist,
warm climates where larvae can survive in the environment. Both Necator
americanus and Ancylostoma duodenale are found in Africa, Asia, Australia and the
Americas. Only N. americanus is found in south India and predominates in the
Americas, while only A. duodenale is found in the Middle East, North Africa, and
northern India.
• Disease: hookworm infection
• Location of adult: Adult worms live in the lumen of the small intestine, typically
the distal jejunum, where they attach to the intestinal wall with resultant blood
loss by the host
• Infective stage: filariform larva (L3)
• Mode of transmission: filariform larva (L3) penetrates skin
• Diagnosis: microscopic demonstration of eggs in stool specimens
• Disease: Most people infected with hookworms have no symptoms or
gastrointestinal symptoms, blood loss leading to anemia, in addition to protein loss
 Hookworms
Ancylostoma duodenale, Necator americanus
 • Infective stage
larva L3 – by mosquito

• Endemic - Sub-Saharan Africa (excluding the southern portion of the continent), Madagascar, several
Western Pacific Island nations and territories and parts of the Caribbean. Bancroftian filariasis also occurs
sporadically in South America, India, and Southeast Asia.
• 859 million people in 50 countries worldwide remain threatened by lymphatic filariasis
• The global baseline estimate of people affected by lymphatic filariasis was 25 million men with hydrocele
and over 15 million people with lymphoedema. At least 36 million people remain with these chronic
disease manifestations.
• Adult worms nest in the lymphatic vessels and disrupt the normal function of the lymphatic system. The
worms can live for approximately 6–8 years and, during their lifetime, produce millions of microfilariae
(immature larvae) that circulate in the blood.
Symptoms of lymphatic filariasis (LF)
Lymphatic filariasis (elephantiasis) infection involves asymptomatic, acute,
and chronic conditions. The majority of infections are asymptomatic

Organ involved Symptoms

lymphatic system Acute episodes of local inflammation involving skin, lymph nodes
and lymphatic vessels
Chronic conditions leads to lymphoedema (tissue swelling) or
elephantiasis (skin/tissue thickening) of limbs and hydrocele
(scrotal swelling).
It usually affects the lower extremities.
However, the arms, vulva, breasts and scrotum (causing
hydrocele formation) can also be affected.
The oedema in the extremities, breast or genital area can result
in the part becoming several times its normal size and is due to
blockage of the vessels of the lymphatic system.
 Diagnosis

Microscopic examination :

• identification of microfilariae in a blood smear

the microfilariae that cause lymphatic filariasis circulate in the blood at night
(called nocturnal periodicity)

• Serological examination
Thank you