CLINICAL PARASITOLOGY (LECTURE)

Introduction to Nematodes
- Phylum Nemathelminthes (Nematoda)
- Nematodes are the most worm-like of all the
helminths because they resemble the common
earthworm appearance, which is considered as the
prototype of the worms.

GENERAL CHARACTERISTICS
- The name nematode came from “nema” which
means thread. “Thread-like”
- Free-living forms found in soil and water
- Shape: elongated, cylindrical or filariform in shape,
unsegmented worms with tapering ends.
- Sensory organs (with exception – some nematodes
don’t have sensory organs): amphids (anterior) and
phasmids (posterior)
o Amphids – these are cuticular depressions
present on the lips surrounding the mouth
of the nematode and it serves as
chemoreceptors.
o Phasmids – useful in grouping the
nematodes and it is found at posterior part
or at the caudal portion of the parasite.
They are neurons that were recently
shown to function in in the modulation of
hemo hemoricotion? Behavior in your
nematodes
- Locomotion: move by contraction of the
longitudinal muscles
- Body wall: covered with a tough outer cuticle
(smooth, striated, bossed, or spiny), middle layer is
hypodermis and the inner layer is the somatic
muscular layer
- Sexes: Diecious (separate sexes)
o Some are parthenogenic (Sexually
production in which the oofspring
develops from the unfertilized egg or
female worm is capable of fertilizing her
own eggs without the benefit of the male)
o Male is generally smaller than female and
its posterior end is curved or coiled
ventrally. One of the distinguishing feature
Presence or Absence of Chemoreceptors
of your male nematodes is that they have
coiled or curved tail.
o Female nematodes may be oviparous
(producing eggs), viviparous (producing
larvae) or ovoviviparous (producing eggs
that will hatch out to become larvae).
LIFE CYCLE
- Consists typically of 4 larval stages and the adult
form
- The cuticle is shed while passing from one stage to
the other
- Man is the optimum host for all the nematodes.
(humans are the definitive or final host)
- They pass their life cycle in one host, except for the
Filarial worms and Dracunculus medinensis where
two hosts are required.
- May exception sa dalawang parasite na’to, yung
mga filarial worms and the Dracunculus medinensis
we have intermediate host for that.
- Nematodes localize in the intestinal tract and their
eggs pass out with the feces of the host.
- Generally, they are seen in you small intetsine, large
intestine, and the eggs or the ova are being passed
out in the feces.
CLASSIFICATION OF NEMATODES
➢ Phasmid nematode (very useful in grouping your
nematodes, phasmids are chemoreceptoars that
are seen at the posterior end of the parasite) – with
caudal chemoreceptors
➢ Aphasmid nematode – without caudal
chemoreceptors.
o Examples: Trichuris trichiura, Trichinella
spiralis, Capillaria philippinensis

Infective stages and Mode of Transmission

• Ingestion of embryonated eggs: Ascaris, Trichuris,
Enterobius
• Ingestion of infective larva: Capillaria, Trichinella,
Angiostrongylus
• Ingestion of encysted larvae in muscle: Trichinella
 CLINICAL PARASITOLOGY (LECTURE)

Filarial Worms
• Skin penetration of L3: Hookworms and ➢ Nocturnal periodicity: when the largest number of
Strongyloides microfilariae occur in blood at night.
• Vector-borne: Wuchereria and Brugia (Insect o Wuchereria bancrofti
vectors - particulary mosquito vectors) ➢ Diurnal periodicity: when the largest number of
• Autoinfection: Strongyloides and Enterobius microfilariae occur in blood during day.
• Transmission through inhalation: Enterobius and o Loa loa
Ascaris ➢ Nonperiodic: when the microfilariae circulate at
constant levels during the day and night.
Habitat (can be seen in the intestine or other parts of the o Onchocerca volvulus
body) ➢ Subperiodic or nocturnally subperiodic: when the
Intestinal Human Nematodes (Some resides on small microfilariae can be detected in the blood
intetsine, some in large intetsine) and Somatic Human throughout the day but are detected in higher
Nematodes (outside the intetsine; lymphatics, numbers during the late afternoon or at night.
subcutaneous tissue, etc) o Brugia malayi
Intestinal Human Somatic Human
Nematodes Nematodes COVERING AND HABITAT
Small intestine Lymphatics Covering of filarial worms
• Ascaris lumbricoides • Wuchereria bancrofti Sheathed microfilaria
• Ancylostoma • Brugia malayi (used for protection of
duodenale • Brugia timori parasite, they retain the Unsheathed microfilaria
• Necator americanus egg membrane which
• Strongyloides Skin/subcutaneous tissue envelop them as a sheath.
stercoralis • Loa loa Outer covering)
• Trichinella spiralis • Onchocerca volvulus • Wuchereria bancrofti • Onchocerca volvulus
• Capillaria • Dracunculus • Brugia malayi • Mansonella perstans
philippinensis medinensis • Loa loa • Mansonella ozzardi

Large intestine Mesentery Habitat of filarial worms

• Trichuris trichiura • Mansonella ozzardi Lymphatic
• Enterobius vermicularis • Mansonella perstans Filariasis (seen
in lymphatics or
Conjunctiva Subcutaneous Serous cavity
in the lymphativ
• Loa loa filariasis filariasis
system, in your
lymph nodes or
lymph channels)
GENERAL CHARACTERISTICS • Wuchereria • Loa loa • Mansonella
bancrofti • Onchocerca perstans
- Came from the Latin word filum (thread)
• Brugia volvulus • Mansonella
- Slender thread-like worms
- Mode of Transmission: By the bite of blood-sucking
malayi • Mansonella ozzardi
insects (or insect bite) (vectors (also considered as • Brugia timori streptocerca
intermediate host) are mosquitoes)
- Female worms are viviparous (the mode of
reproduction concerning your females, and Wuchereria bancrofti and Brugia malayi
nilalabas nila ay larvae) and give birth to larvae - One of the "most debilitating disease" in tropical
known as microfilariae (seen in the peripheral countries
blood). - Filariasis – parasitic infection caused by
microscopic threadlike worms acquired through a
mosquito bite (vector borne)
- Has its social and economic impact (since kapag
tinamaan ka ng filariasis, in some cases hinid ka na
pwede ka na magwork or you cannot do things you
normally do because of the disease)
o With the adult worms being lodge in the
lymphatic system, these worms will cause
lymph edema, lymphangitis, and
elephantiasis (nagcocause would be
lymphatic filarial parasite, particularly
PERIODICITY
 CLINICAL PARASITOLOGY (LECTURE)

Wuchereria bancrofti and Brugia malayi) in

chronic cases.
- Mode of Transmission: Skin penetration through a
vector
- Habitat: Lymphatic vessels (lymph nodes)
- Vector (Different species of mosquito depending on
the parasite they carry):
o Aedes spp., Culex spp. and Anopheles spp.
(W. bancrofti)
o Mansonia spp.
▪ Examples: M. bonnae and M.
uniformis (B. malayi)
- Infective stages:
o L3 larva or filariform larva (man) –
pinapasa from the mosquito vector
o Microfilariae (mosquito) - Definitive host is man. No animal host or reservoir
- Diagnostic Stage: microfilariae in the blood host is known for Wuchereria bancrofti
(peripheral blood of the human host) - Intermediate host (and vector) is female
- Definitive Host: Man mosquitoes. Different species acts as vectors in
different geographic area.
Wuchereria o The major vector in India and most other
Parameter Brugia malayi
bancrofti parts of Asia is Culex (most common).
Bancroft's filarial Malayan filarial - Infective forms are motile and very infective to
Common name
worm worm humans. Infective stage – L3 larvae, ayan yung
Culex spp. iniinject ng mga vector sa ating skin. Morphologies
Vector Anopheles spp. Mansonia spp. that are being injected by the vector in the human
Aedes spp. host.
Lower Upper - Infective stage – L3 larvae also known as the
Area affected lymphatics lymphatics filariform larvae, they are being injected in the skin
(waist down) (waist up) through mosquito bite. After that, the adult worms
Nocturnal (8PM- they will develop in the lymphatic, sa’ting mga
Periodicity Subperiodic lymph nodes or in the lymph channels, and if there
2AM)
Is a fertilization occuring, reproduction of filarial
Bancroftian filariasis worms so the adults produce sheathed
microfilariae that migrate into the lymphatic and
- Vector Biology:
peripheral blood circculation. Dito na natin sila
o Anopheles flavirostris
o Aedes poecillus nadadaiagnose in the peripheral blood. Our
diagnostic stage would be the microfilariae seen in
- Aquatic habitat: axils of abaca and banana plant
blood.
(watery) since mosquitos prefers aquatic habitat.
- MOT – mosquito bite, from the mosquitos that are
- Adult biting: day and night biting, indoor and
carrying the infective filariform larva.
outdoor
- The adult worms are usually localized in the lymph
- Adult resting: base of abaca plants (cool, shady
area) vessels of lower extremities (Wuchereria bancrofti),
inguinal lymph nodes, epididymis of male and the
labia of female.
- If another mosquito takes a blood meal to an
infected human host, ang makukuha niya is yung
mga microfilaria. Inside the mosquito, the
microfilariae they shed the sheaths and penetrate
to the mosquito’s midgut And migrate to the
thoracic muscle of the mosquito where they
develop to become L3 larvae – will migrate to the
head and proboscis of mosquito, dun na magiging
infective yung mosquito.
Life Cycle of Brugia malayi

Life Cycle of Wuchereria bancrofti

 CLINICAL PARASITOLOGY (LECTURE)
- Same life cycle with Wuchereria bancrofti but it
prefers the upper lymphatic. Nagkakaiba lang sa
intermediate host or in the vector.
- Intermediate host of Brugia: genera of Mansonia
Pathology
Classical Filariasis
- Due to blockage of lymph vessels and lymph nodes
by the adult worms.
- The blockage could be due to mechanical factors or
allergic inflammatory reaction to worm antigens
and secretions.
- Prefers lymph because it is less aggressive than
blood. No platelets, complement system,
incomplete coagulation system, no granulocytes
and the flow is less violent than in blood.
- Pinakaunang reaction is pupunthan ng mga
macrophages your phagocyte, lymphocytes yung
locality or habitat which is on the lymph node or
lymph vessels.
- Pwede magkaroon ng edema on the area affected,
and in chronic cases pwedeng tumigas yon –
calcification
- Since mayroon ka ngang nakabara in lymph nodes
or lymph vessels hinid nagfoflow ng maayos yung
lymph fluid, and it causes lymph edema or
accumulation of the fluid. If the fluid is
accumulating on a certain part maglkakaroon ng
edema and it can cause leakage of protein rich
lymph into the tissue.
- Why is there a lymphatic lozalization?
• Of all the body bakit yung lymph mas
napiling ng parasite because lymph is less
aggressive than blood. Because in your
lymph node or lymph fluid there ano
platelets, complement system, incomplete
coagulation system. There are also no
gregulocytes??? and the flow is much less
violent as you compare it with blood kaya
mas gusto nila sa’ting mga lympm nodes
kasi mas payapa ang buhay nila don and
they can able to survive in the
environment of lymhpatic because it’s less
aggressive and less violent than the blood.
➢ Acute Filarial Disease
o Adenolymphagitis (ADL) or
Dermatolymphangioadenitis (DLA)
o Characterized by sudden onset high-grade
fever with rigors and last for 2 or 3 days,
lymphatic inflammation (lymphangitis and
lymphadenitis), and transient local edema.
o Lymphangitis: inflamed lymph vessels
seen as red streaks underneath the skin
(arrows on pic).
o Acute lymphangitis: usually caused by
allergic or inflammatory reaction to filarial
infection. May be often associated with
Streptococcal infection as well.
o Lymphatics of the testes and spermatic
cord are frequently involved, with
epididymo-orchitis (pagkabaog) and
funiculitis
o Lymphadenitis: inflammation of lymph
nodes.
▪ Most commonly affected lymph
nodes: inguinal nodes followed by
axillary nodes.
▪ Lympn node become enlarge,
tender and painful. Fo rxample
we have lymph nodes – may mga
lymph channels kung saan for
example nagfoflow yung lymp
fluids. Kapag affected ormay
inflammation is yung mga lymph
channel kung saan nagfoflow
yung lymph or yung lymph fluid,
that is your lymphangitis, kapag
yung mismo na lymph node
naman yung may problema,
that’s lymphadenitis.
➢ Chronic Filarial Disease – more commonly
encountered than its acute form
o Lymphedema: follows successive attacks
of lymphangitis and usually starts as
swelling around the ankle, spreading to
 CLINICAL PARASITOLOGY (LECTURE)

the back of the foot and leg. It may also with secondary bacterial and fungal
affect the arms, breast, scrotum, vulva, or infections.
any other parts of body. The edema is o Lower limbs are commonly affected but
pitting in nature but in the course of time, upper limb and male genitalia may be
it becomes hard and non-pitting. involved. Breast and genitalia of females
▪ Edema: forms because there is may be affected but relatively uncommon.
fibrosis and cellular hyperplasia in o Kaya nga siya tinawag na elephantiasis, it
and around the lymphatic walls, resembles the feet of the elephant
postulated to render the o Disabling and disfiguring of lymph edema
lymphatic endothelial cells less of the limbs, breast and genitals
effective in transporting the accompanied by a mark thickening of the
interstitial fluid and forming skin.
abnormal accumulation of the o Pinaka manefestation ng filariasis
lymph and the tissues causing
swelling of the arms, legs,
breasts, and the genitals. Since
meron kang mga bara doon sa
lymph vessels or they are
inflammed, hindi nila
natatras+nsport ng maayos yung
lymph fluid causing accumulation
of fluid and nagkakaroon nga ng
paglaki. ➢ Hydrocoele – accumulation of fluid occurs due to
▪ Pitting edema: when a swollen obstruction of lymph vessel of the spermatic cord
part of the body has a dimple or and also by exudation from the inflamed test and
pit after pressing it for a few epididymis. Lumalaki yung testis or testicular area
seconds. For example, may ng males
edema ka, pag pinindot mo siya o The fluid is usually clear and straw colored
babaon yung pinindutan, babalik but may sometimes be cloudy, milky, or
siya some time, but at some cases hemorrhagic.
the edema becaome hard and
non pitting – kapag pinindit mo
yung part na affected hindi na
bumabaon yung daliri mo
because of the hardness of the
affected are.
o Lymphoangiovarix: Dilatation of lymph
vessels commonly occurs in the inguinal,
scrotal, testicular, and abdominal sites.
➢ Lymphorrhagia – chylocele, milky appearance
▪ The lymphangitis and the
caused by the presence of lymph, rupture of lymph
lymphadenitis can involve the
varices leading to release of lymph or chyle and
upper and lower extremities in
resulting in chyluria (kidney damage: “milky
both Bancroftian and Bruigian
urine”), chylous diarrhea, chylous ascites, and
filariasis, but the involvement of
chycothorax, depending on the involved site. If
genital lymphatics occurs
kidneys are involve – nagmamanifest sa urine
exclusively with Wuchereria
(chyluria)
bancrofti infection. Amas prefer
ng Wuchereria bancrofti yung
lower lymphatics natin lalo na
genital lympathics.
▪ Genital involvement can be in the
form of funiculitis, epididymitis
and hydrocoele formation
➢ Elephantiasis
o Delayed sequel to repeated lymphangitis,
obstruction, and lymphedema.
➢ Expatriate Syndrome – occurs to migrants who
o There is non-pitting (hard) brawny edema
were infected from endemic regions. It is
with growth of the new adventitious tissue
characterized by clinical and immunologic
and thickened skin, cracks, and fissures
hyperresponsiveness to maturing worms. Exhibits
 CLINICAL PARASITOLOGY (LECTURE)

acute manifestations and allergic reactions (hives, lymphatic system,

Organs lymphatic vessels
rashes, and blood eosinophilia). lung, liver, spleen,
involved and lymph node
joints
Present in tissues but
Microfilaria Present in blood
not in blood
Complement fixation
Complement test highly sensitive
Serological
fixation test not (since meron tayong
test
so sensitive nangyayaring
Occult Filariasis hypersensitivity)
- Occult - hidden Prompt response to
- Synonyms: Weingartner's syndrome, Meyer's- Therapeutic
No response DEC
Kouwenaar syndrome, Pseudotuberculosis of the response
(diethylcarbamazine)
lung, Eosinophilic pseudo-leukemia, Tropical
eosinophilic asthma, and Frimödt-Möller and Staging System for Chronic Lymphedema
Barton syndrome. (Dreyer et. al 2002)
- Hypersensitivity reaction to microfilarial antigens,
• Stage 1: swelling increases during day but
not directly due to lymphatic involvement.
reversible once the patient lies flat in bed. Dito
- Microfilariae are not found in blood, as they are
meron kang edema on your feet pero kapag humiga
destroyed by the tissues. Dito mostly kung makikita
ka matatanggal yung pamamaga na’yon or the
mo sila they are seen in the tissues but they are not
inflammation or the swelling is reversible
found in the found – kaya occult
• Stage 2: irreversible swelling. All the way through
- Clinical manifestations: massive eosinophilia (30-
your feet are swelling
80% - mataas count), hepatosplenomegaly,
• Stage 3: presence of shallow skinfolds
pulmonary symptoms (dry nocturnal cough,
dyspnea, and asthmatic wheezing) • Stage 4: knobs, lumps and protrusions
- Has also been reported to cause arthritis, • Stage 5: deep skin folds
glomerulonephritis, thrombophlebitis, • Stage 6: mossy lesions with leaking of translucent
tenosynovitis, etc. fluid. Napakadami na talagang accumulation doon
sa affected area kaya naglileak na yung transluscent
Tropical pulmonary eosinophilia fluid
- Manifestation: low-grade fever, loss of weight, and • Stage 7: foul-smelling infected area, patient is
pulmonary symptoms unable to adequately or independently perform
- Children and young adults are more commonly activities of daily living. Kaya nga cinonsider siya as
affected in areas of endemic filariasis including the one of the most debelitating? Disease kasi meron
Indian subcontinent. siyang social and economical impact for example,
- There is a marked increase in eosinophil count meron kang elepahntiasis hindi mo na magagawa
(>3000 um which may go up to 50,000 or more) yung mga normal work that you can do before.
- Chest X-ray shows mottled shadows similar to Kahit na paglalakad mahihirapan kana kasi malaki
miliary tuberculosis. (lung is involved) na limbs mo.
- It is associated with a high level of serum lgE and
filarial antibodies. In the case of parasitic infection,
yung mataas na antibody is IgE and also your filariar
antibodies.
- Serological tests with filarial antigen are usually
strongly positive.
- The condition responds to treatment with
diethylcarbamazine (DEC).
Diagnosis
Difference between Classical and Occult Filariasis ➢ Microscopy
Classical o “wet smears” – demonstrate motile
Occult Filariasis microfilariae
Filariasis
o "thick blood smears”
Hypersensitivity
Due to adult and ▪ Giemsa stain
(intense allergic
Cause developing ▪ demonstration of the microfilaria
reaction) to
worms ▪ most practical diagnostic
microfilaria antigen
procedure
lymphangitis, Eosinophilic
Basic lesion ▪ pinaggagamitan natin ng
lymphadenitis granuloma formation
diagnosis for Plasmodium and
other sporozoans
 CLINICAL PARASITOLOGY (LECTURE)

Differences in Microfilariae Parameter an example of concentration technique concerning

Wuchereria blood sample). The sediment is spread on a slide to
Parameter Brugia malayi
bancrofti dry thoroughly. The slide is stained with Wright or
Mean length Giemsa stain and examined microscopically for
290 222
(um) microfilariae.
Cephalic space/ ➢ Nucleopore filtration – in the filtration methods
1:1 2:1 used at present, larger volumes of blood, up to 5 ml,
breadth
Sheath affinity can be filtered through millipore or nucleopore
Unstained Pink membranes (3 um diameter). The membranes may
to Giemsa
irregular and be examined as such or after staining, for
Body nuclei regularly spaced microfilariae. The filter membrane technique is
overlapping
Terminal nuclei none 2 nuclei much more sensitive so that blood can be collected
Appearance in smoothly or even during the day or during daytime for the
kinky screening. Disadvantage is it’s costly, you need
blood film gracely curved
- On of the distinguishing feature is the color, kung venipuncture for this – need mo ng medyo
meron bang kulay na dumidikit don sa kanilang madaming blood. Nilalagay mo lang yung blood sa
outer covering. syringe and then merong kang ilalagay na filter at
the top of the syringe tapos ieexpel out mo lang
yung content and kung ano yung masala niya sa
filter it would be subjected to staining and
ichecheck mo if there’s a presence of microfilariae
in the filter.
➢ DEC provocation test – A small dose of
diethylcarbamazine (2 mg per kg body weight)
induces microfilariae to appear in peripheral blood
even during daytime. Pinoprovoke mo or kinikiliti
mo ng konti yung mga microfilariae para lumabas
sila doon sa perophery blood.
➢ Other specimens – Microfilaria may be
demonstrated in centrifuged deposits of lymph,
hydrocele fluid, chylous urine or other appropriate
specimens.
➢ Ultrasonography – High frequency ultrasonography
(USG) of scrotum and female breast coupled with
Doppler imaging may result in identification of
motile adult worm (filaria dance sign) within the
dilated lymphatics. If yiu want to chech yung mga
buhay talaga na filarial worms inside the
lymphatiics that are exhibiting the filaria.
➢ Radiology – Dead and calcified worms can be
detected occasionally by X-ray. In tropical
pulmonary eosinophilia (TPE), chest X-ray shows
mottled appearance resembling miliary
tuberculosis
➢ Demonstration of Antibody – Complement
fixation, indirect hemagglutination (IHA), indirect
fluorescent anti-body (IFA), immunodiffusion, and
immunoenzyme tests have been described.
➢ Demonstration of Circulating Antigen – Highly
sensitive and specific test for detection of specific
circulating filarial antigen (CFA) have been
developed for detection of recent bancroftian
filariasis.
➢ Molecular Diagnostic Technique – Polymerase
chain reaction (PCR) can detect filarial DNA from
patient's blood, only when circulating microfilaria
are present in peripheral blood but not in chronic
➢ Knott's concentration technique – anticoagulated carrier state.
blood (1 ml) is placed in 9 ml of 2% formalin
(reagent) and centrifuged 500 x g for 1 minute (it’s Loa loa
 CLINICAL PARASITOLOGY (LECTURE)

- Common name: African eye worm

- Vector: Chrysops spp. (deerflies, mango flies or
mangrove flies - langaw)
- Area affected: Subcutaneous tissue
- Periodicity: Diurnal
- Madalas sa mata nakikita, yung adult worm/ yung
adult na loa loa you can see them on subcutaneous
tissue particukarly in the eyes.

Pathology
- Loaisis, Fugitive swellings or Calabar swellings
(causes localized subcutaneous edema as the
microfilaria die in the capillaries around the eye)

- The infective L3 larvae enters the subcutaneous

tissue and will develop into adult worm over 6-12
months.
- The female worms’ produces sheathed, which have
diurnal periodicity. Mas mataas yung chances na
maisolate natin siya during the day.
- The infection is transmitted to man through the bite
of the infected chrysops during their blood meal.
Ang infective stage parin natin dito is L3 larvae, so
the infective 3rd stage larvae or the filariform larvae
entered the subcutaneous tissue they mold? and
develop into mature adult worm over 6-12 months
and migrate into the subcutaneous tissues

Onchocerca volvulus
- “Convoluted filaria", "Blinding filaria", "Gale
filarienne", "Craw craw"
- Onchocerciasis, River blindness (destroys optic
nerve), Roble's disease
- Subcutaneous nodule or onchocercoma: a
circumscribed, firm, non-tender tumor, formed as a
result of fibroblastic reaction around the worms.
Life Cycle of Loa loa - Onchodermatitis (Sowdah): lesions in the skin and
eyes the affected skin darkens as a result of intense
inflammation, which occurs as result of clearing of
microfilariae from blood
- Just like loa loa, it can affect your eyes

Mansonella perstans
- Old name: Acathocheilonema perstans
- Culicoides species are the vectors
- Infection may cause dermatitis with pruritus and
hypopigmented macules
- rare parasite of man

Mansonella ozzardi
- rare parasite of man, infections does not cause any
illness. Minsan asymptomatic sa Mansonella
perstans and ozzardi.
 CLINICAL PARASITOLOGY (LECTURE)

M. M. ozzardi DEC, and use of abdominal binders. Surgery is

Parameter O. volvulus
perstans required for hydrocele. Kung asymptomatic.
Small flies Small flies
Black flies
(gnats) (gnats) Prevention and Control
Vector Simulium
damnosum
Culicoides Culicoides • Detection and treatment of carriers. We have to
austeni furens detect many as possible yung ating mga carries para
Subcutaneous Body Body hindi na sila maging future source of infection and
Habitat
tissue cavities cavities eradication of vector mosquito.
Onchocerciasis, Non- Non- • Eradication of Vector Mosquito
Pathology
River blindness pathogenic pathogenic o Antilarval measures: The ideal method of
Specimen Skin snips - - vector control would be elimination of
breeding places by providing adequate
sanitation and underground waste water
disposal system Yung mga stagnant water
natin kung saan nagtathrive yung mga
vectors for example kailangan matanggal
or madispose.
o Chemical control: Using antilarval
- Madalas kasi maisoiate yung mga microfilariae chemicals (Mosquito larvicidal oil,
concerning onchocerca volvulus in the skin snip, Pyrosene oil-E, Organophosphorous
dito kukuha ng part of your skin and then it will be larvicides like temephos and enthion)
stained and check for the presence of microfilariae. • Removal of Pistia plant: mainly restricted to control
Treatment of Mansonia mosquitoes leading to brugian
- Diethylcarbamazine citrate (DEC) is the drug of filariasis.
choice. Following treatment with DEC severe • Personal prophylaxis: using mosquito nets and
allergic reaction (Mazzotti reaction) may occur due mosquito repellants is the best method.
to death of microfilariae.
- Administration:
o Mass therapy: In this approach, DEC is - "Guinea worm", "Worm of Medina", "Dragon
given to almost everyone in community worm" or "Fiery serpent"
irrespective of whether they have - Longest nematode to man (1 meter)
microfilaremia disease manifestation or - Causes "Dracunculiasis" or "Guinea worm disease"
no signs of infection except those under 2 (GWD)
years of age, pregnant women, and - Mature female worms migrate along the
seriously-ill patients. Lahat don sa subcutaneous tissue to reach the skin below the
community na’yon ay mabibigyan with a knee, forming a painful ulcerating blister
little exception - Can also emerge to the head, torso, upper
o Selective treatment: DEC is given only to extremities, buttocks, and genitalia
those who are microfilaria-positive. - Common symptoms: rashes, fever, nausea,
o DEC medicated salts: Common salt vomiting, diarrhea, dizziness
medicated with 1-4 g of DEC per kg has - Until there is formation of blister and causes a
been used for filariasis control in burning sensation. Kadalasan malalaman mo nalnag
Lakshadweep Island, after an initial na ifected ka nitong parasite na’to kapag lumaba
reduction in prevalence had been sna yung mga ulcerated blisters on your skin, that’s
achieved by mass or selective treatment of 1 year after your exposure to the parasite. Yung
microfilaria carriers. Yung asin is mga blisters na’yon since sugat yon it can be
hinahaluan ng DEC to serve as a treatment secondarily infected by your bacteria. When there’s
to parasite bacterial infection nagkakaroon ng cellulitis,
- Ivermectin: In doses of 200 ug/kg can kill the abscess, sepsis, lock jaw, or kapag nagkaroon ng
microfilariae but has no effect on adults. tetanus toxin brought by some of your bacteria.
- Tetracyclines: Also have an effect in the treatment - Complications: cellulitis, abscess, sepsis, lock jaw
of filariasis by inhibiting endosymbiotic bacteria (tetanus)
(Wohlbachia species) that are essential for the - Host:
fertility of the worm o Definitive Host: man
- Supportive therapy: elevation of the affected limb, o Intermediate host: Cyclops
use of elastic bandage, and local foot care reduce - Infective form: third-stage larva present in the
some of the symptoms of elephantiasis. Medical hemocoel of infected cyclops
management of chyluria includes bed rest, high - Mode of transmission: drinking unfiltered water
protein diet with exclusion of fat, drug therapy with containing infected cyclops
 CLINICAL PARASITOLOGY (LECTURE)
- Incubation period: about 1 year (after your
exposure to parasite, dun palang lalabas yung mga
blisters around your body
Life Cycle of Dracunculus medinensis
- The conculu medenensis kung pano siya kinukuha –
isolated manually yung mga adult conculus
medeneis.
- It has been suggested that the Rod of Asclepius
(which represents the medical practice since
ancient times) once represented a worm wrapped
around a rod; parasitic forms such as Dracunculus
medinensis were common in ancient times, and
were extracted from beneath the skin by winding it
slowly around the stick.
- According to this theory, physicians might have
advertised this common service by posting a sign
depicting a worm on a rod.
- The technique of extracting the worm by twisting it
on the stick, still practiced by patients in endemic
areas, is devised by Moses.
- The picture of “serpent worm” on a stick may have
given rise to the physician’s symbol, the Caduceus.
Ayan yung mga sinisymbol ng dracunculus
medenensis, it has been suggested na dracunculus
medenensis yung nasa mga rods. At present time
pag nainfect ka ng parasite na’to ganto mo ren siya
iaisolate in order for us to isolate female parasite,
ididikit or itatali mo siya in matchstick tas iikot ikotin
– be careful
- The human drinks unfiltered water containing the
copepods or cyclops with l3 larvae. Larvae are
released when copepods die. Larvae penetrate the
host’s stomach and intestinal wall. They mature and
reproduce. Fertilize female worm migrates to
surface of skin, causes a blister, and discharges
larvae. Dito they are lerviparous ang nilalabas ng
Conculus medinensis would be larvae na kaso ang
gagawin niya is it will migrate from your stomcah or
intestine down to surfaces of body para dun siya
maglelay ng larvae. Female worms begins to
emerge from skin 1 year (incubation period) after
infection. L1 larvae are released into the water from
the emerging female worm, Kailangan
maramdaman muna nung female worm na ansa
wate ryung area affected bago niya ilabas yung mga
larva. L1 larvae consumed by a copepod and they
develop into filariform larvae which is the infective
stage of the parasite
Treatment and Management
• Immersion of affected body part to water (to
provoke the female na lumabas sa blister)
• Wound is cleaned
• Worm extraction
• Topical antibiotics are given to prevent
infection
• Aspirin and Ibuprofen are given to ease the
pain
• Antihistamines and steroids are of help in the
initial stage of allergic reaction
• Metronidazole, niridazole, and thiabendazole
are useful in treatment.
Prevention and Control
• Surveillance and case containment (kelangan
yung mga positive dito is mapinpoint and
matreat agad para hinid na maging source of
infection.
• Provision of protected piped water supply is
the best method of prevention or else boiling
of filtering water through a cloth and then
consuming water. Para hindi makuha yung
cyclops or copepods that can contain the
infective stage of parasite.
• Destroying cyclops in water by chemical
treatment with Abate (temephos).
• Not allowing infected persons to bathe or
wade in sources of drinking water. Para hindi
maprovoke yung female parasite na maglay ng
larva in bodies of water.
 CLINICAL PARASITOLOGY (LECTURE)

Nematode I

Common name Giant intestinal/round worm

Final Host man
Habitat small intestine
Diagnostic stage fertilized and unfertilized egg
Infective stage embryonated egg
Source of exposure to
soil-transmitted helminth
infection
Mode of Transmission Ingestion
Pathology Ascariasis
Stool Exam, Concentration technique
Diagnosis **since we are dealing with ova or eggs that are
being shed on the stool samples.
Albendazole (most common)
Drug of choice (Others: Mebendazole and Pyrantel
Pamoate)
** Ascaris suum – Ascaris of Pigs

- Most common intestinal nematode of man (occurs

most frequently in tropics)
- Its specific name “lumbricoides” is derived from its
resemblance with the earthworm.
- Lumbricus – means earthworm in Latin.
- Soil-transmitted helminth (along with T. trichiura and
hookworms)
- The soil plays a major role in the development and
transmission of the parasite.
- The children are particularly vulnerable since they are
at risk in ingesting the embryonated Ascaris eggs ** Ascaris has been showed to produce pepsin inhibitor III that
while playing in soil contaminated with human feces. protects the worm from digestion in the intestines, and
- Soil-transmitted helminth – considered as disease of phosphoryl choline that suppresses lymphocyte proliferation.
the poverty and may contribute to malnutrition and
impairment of cognitive performance. Egg
** This is why merong programs sa mga schools which is ➢ Fertilized eggs
namimigay ng anthelminthic drugs (pampurga). o laid by females, inseminated by mating with
a male
** Infective Stage: Ova (embryonated eggs) o embryonated and develop into the infective
** Most of these parasites (3 parasites within this discussion) have eggs
their ova as their infective stages.
o round or oval
** There are diff kinds of eggs associated with ascaris lumbricoides.
o always bile-stained, golden brown in color
The eggs can be fertilized, unfertilized, or embryonated.
** Ascaris lumbricoides is the most common intestinal nematode of (kahit walang iodine sa direct fecal smear)
man, which occurs in tropics and it is soil-transmitted. o surrounded by thick smooth translucent
shell with an outer coarsely mamillated
MORPHOLOGY albuminous coat, a thick transparent middle
layer and the inner lipoidal vitelline
Worm
membrane (covering-corticated egg, no
➢ Adult Worm covering-decorticated egg)
o Large cylindrical worms, with tapering ends, ➢ Unfertilized eggs
the anterior end being more pointed than o laid by uninseminated female
the posterior o non-embryonated and cannot become
o Pale pink or flesh colored when freshly infective
passed in stools but become white outside o Elliptical in shape, narrower and longer
the body. o has a thinner shell with an irregular coating
o The mouth at the anterior end has 3 finely of albumin
toothed lips, 1 dorsal and 2 ventrolateral o longer and narrower than fertilized egg
(trilobate lips – most distinguishing factor)
➢ Male Worm
o Smaller than female, measures 10-31 cm in
length
o Posterior end is curved ventrally to form a
hook and carries 2 copulatory spicules.
o copulatory spicules: used for mating
➢ Female
o Larger than male, measuring 22-35 cm in
length
o Posterior extremity is straight and conical
o Vulva is situated mid-ventrally
o A distinct groove is often seen surrounding
the worm at the level of the vulvar opening
(genital girdle or vulvar waist)
** It is believed to facilitate in the mating of
parasite.
** Some of the eggs found in the feces has an outer laminated
globulin. So, they are considered corticated eggs.
- Corticated – has outer globulin
- Decorticated – no outer globulin
 CLINICAL PARASITOLOGY (LECTURE)
** 1st pic (corticated, unfertilized egg) - they have thin shells
and irregular laminated coating that is filled with refractile
granules. They may be difficult to identify because they
resemble some fecal debris.
** 2nd pic (corticated fertilized egg) – kapag sinabing
corticated they have coarsely laminated albuminous covering.
So, makikita mo the surrounding/periphery of the ova has
rough edges.
** 3rd pic (decorticated, fertilized egg) – smooth; it doesn’t
have the albuminous covering.
** 4th pic (embryonated egg) – infective stage of parasite.
Super evident yung larva inside.
** Both fertilized and unfertilized are not infective.
Life Cycle of Ascaris lumbricoides
** When embryonated, the eggs are ingested. They hatch in
the lumen of the small intestine, releasing the larvae.
** The larvae will migrate to the cecum or proximal colon
(where they penetrate the intestinal wall).
** They enter the venules to go to the liver through the portal
vein or to the heart and the pulmonary vessels.
* REMEMBUR: In the case of Ascaris lumbricoides,
nagttravel yung kaniyang larva. So if the larva is hatched in
the lumen of the small intestine, it will go on your venules,
and it will circulate in other parts of your body (heart or
pulmonary vessels).
** The larvae is coughed-up and swallowed, re-entering the
GIT. Then, the maturation proceeds in the small intestine.
* So ang mangyayari kapag na-ingest mo siya, maghahatch
lang siya in the small intestine, lalabas lang siya ulit sa
circulation, then you will cough it up and swallow it again
para mabalik sa small intestine or re-entering your GIT (the
maturation of the adults is seen in small intestine).
** After the mating of the adults, they will produce the eggs
(ova), which can be fertilized or unfertilized egg.
** The fertilized egg will further develop to become
embryonated eggs in the soil, which is the infective stage.
* Female A. lumbricoides produces about 200,000 eggs
per day. The eggs are deposited into the soil, and it
takes about 2-3 weeks for the eggs to develop under
favorable condition with suitable temperature,
moisture, and humidity.
** After that the larvae will undergo to molds?? to reach the
third stage within the egg, and they become embryonated.
** Only when this infective egg is swallowed can humans be
infected with ascaris lumbricoides.
* Walang problem if fertilized or unfertilized yung
naswallow. It cannot initiate the infection. You have to
ingest the embryonic stage to initiate the infection.
- Can survive the acidity of the stomach because of
pepsin inhibitor 3 (protein).
PATHOLOGY
Due to larva
- Ascaris pneumonitis or Loeffler's Syndrome: occurs
during lung migration resulting in allergic reactions
such as lung infiltration, asthmatic attacks and edema
of the lips, similar symptoms of pneumonia, vague
abdominal pain. Eosinophilia is present
- If there is lung involvement because of the migration
of larva from small intestine to lungs, there is sputum
production.
- Sputum – often blood-tinged and may contain
Charcot-Leyden crystals.
- The larvae may occasionally be found in the sputum
but are seen more often in gastric washing
Due to adult worm
➢ Spoliative or nutritional effects: enormous numbers
occupying a large part of the intestinal tract interferes
with proper digestion and absorption of food.
Ascariasis may contribute to protein-energy
malnutrition and vitamin A deficiency.
➢ Toxic effects: due to hypersensitivity to the worm
antigens and may be manifested as fever, urticaria,
angioneurotic edema, wheezing, and conjunctivitis.
➢ Mechanical effects: most important manifestations
of ascariasis, worms may be clumped together into a
mass, filling the lumen, leading to worm bolus,
intestinal obstruction and intestinal perforation.
** With a large number of ascaris adults accumulating
in your intestine, pwede silang magbuhol-buhol, leading
to worm bolus (that ball obstructs your intestine).
➢ Ectopic ascariasis (Wanderlust): worms may wander
causing acute biliary obstruction or pancreatitis, liver
abscesses, respiratory obstruction or lung abscesses
and obstructive appendicitis. The wandering is
enhanced when the host is ill – febrile (If the
temperature is above 39C it may provoke the worms
to wander around).
** Worms are restless wanderers (gala sila), pwede sila
magtravel outside GIT/intestines.
➢ Erraticity: if worm migrates to ectopic sites
(gallbladder, hepatobiliary tree, appendix and
pancreas), maybe regurgitated and vomited, may
escape through the nostrils or inhaled to the trachea
maybe due to medication, spicy-diet and fever. Usually
observed in male worms.
** There are cases na pwede magkaroon erraticity (you can
isolate the parasite from its natural habitat/ area na
normally niya pinaparasitize before).
** Your male and female worms are concentrated in your
small intestine, but due to erraticity they may go to other
parts of your body. In severe cases, pwede rin siya lumabas
sa mouth (vomited) or sa ilong due to medication
(anthelminthic drugs), spicy diet, or fever.
 CLINICAL PARASITOLOGY (LECTURE)

o Albendazole – 400 mg once in the 2nd

** Larvae = bilog bilog sa trimester or
lungs (1st pic upper left).
o Mebendazole – 500 mg once in the 2nd
** 2nd pic upper right worm
bolus sa tinanggal na trimester
bowel coz it’s filled with - Where hookworm prevalence is > 50%, repeat
worms. treatment in the 3rd trimester
** 3rd pic lower left – worm
bolus din
** 4th pic lower right - 4. Special groups, e.g., food handlers and operators,
erraticity soldiers, farmers, and indigenous people
DIAGNOSIS - Selective deworming is the giving of anthelminthic
✓ The clinical diagnosis should be confirmed or drug to an individual based on the diagnosis of
established by microscopic examination of stool current infection. However, certain groups of people
sample. should be given deworming drugs regardless of their
✓ Direct fecal smear is less sensitive compare to Kato- status once they consult the health center.
thick and Kato-katz. - Special groups like soldiers, farmers, food handlers
✓ Stool Examination and operators, and indigenous people are at risk of
o Direct Fecal Smear morbidity because of their exposure to different
** less sensitive than kato-thick and kato-katz intestinal parasites in relation to their occupation or
o Kato-thick (qualitative) cultural practices.
o Kato-katz - For the clients who will be dewormed selectively,
**provides a quantitative diagnosis in terms of treatment shall be given anytime at the health
intensity of the helminth infection in eggs/gram of centers
the stool. Both kato are useful in monitoring the
efficacy of the treatment in the clinical trials
✓ Concentration Technique
o Formalin Ether/Ethyl Acetate Concentration Common name Whipworm
Technique (FECT) Final Host man
o Merthiolate Iodine Formaldehyde Habitat large intestine
Concentration technique (MIFCT) Diagnostic stage egg
o Brine floatation Infective stage Embryonated egg
o Zinc sulfate floatation technique Source of exposure
soil-transmitted helminth
✓ X-ray (extra-intestinal ascariasis: lungs) to infection
✓ CBC (demonstrate eosinophilia) Mode of
Ingestion
Transmission
PREVENTION AND CONTROL Pathology Rectal prolapse, IDA, diarrhea
• Sanitary disposal of human feces Stool exam, Concentration
Diagnosis
• Health education technique
• Mass chemotherapy Mebendazole (Albendazole as
Drug of choice
• Avoid using night soil alternative drug)
• Proper food preparation Usually observed occurring together with Ascaris lumbricoides

INTEGRATED HELMINTH CONTROL PROGRAM MORPHOLOGY

Target and Doses Worm
**The ff are just additional infos. NO NEED TO MEMORIZE :)) ➢ Adult Worms
1. Children aged 1 year to 12 years old o Flesh-colored
- For children 12 —24 months old o Resembles a whip with the anterior three-
o Albendazole - 200 mg, single dose every 6 fifth thin and thread-like and the posterior
months. Since the preparation is 400mg, the two-fifth is thick and fleshy, appearing like
tablet is halve and can be chewed by the the handle of a whip. (parang latigo)
child or taken with a glass of water or o Attenuated anterior portion, which contains
o Mebendazole – 500 mg, single dose every 6 the capillary esophagus is embedded in the
months mucosa
- For children 24 months old and above
o Albendazole – 400 mg, single dose every 6
months or
o Mebendazole – 500 mg, single dose every 6
months
- Note: If Vitamin A and deworming drug are given
simultaneously during the GP activity, either drug can
be given first.

2. Adolescent females
- It is recommended that all adolescent females who
consult the health be given anthelminthic drug
o Albendazole – 400 mg once a year or
o Mebendazole – 500 mg once a year

3. Pregnant women Comparison of Male and Female worm of T. trichiura

- It is recommended that all pregnant women who MALE FEMALE
consult the health be given anthelminthic drug once 30-45 mm 35-50 mm
in the 2nd trimester of pregnancy. Coiled posterior with a Rounded/blunt posterior
- In areas where hookworm is endemic: Where single spicule and 3,000-20,000 eggs/day
hookworm prevalence is 20 — 30% rectractile sheath
 CLINICAL PARASITOLOGY (LECTURE)

• Attenuated anterior 3/5 – slender, hair-like,

transversed by a narrow esophagus resembling
"string of beads" (used for attachment)
• Robust posterior 2/5 – contains the intestines and
single set of reproductive organs
Egg
- brown in color being bile-stained
- triple shell, the outermost layer of which is stained
brown
- barrel-shaped with a projecting mucus plug at each
pole containing an unsegmented ovum
- resembles Capillaria philippinensis – peanut shape
ova with flattened bipolar plug
PATHOLOGY
➢ Rectal prolapse – Condition in which the rectum (the
lower end of the colon, located just above the anus)
becomes stretched out and protrudes out of the anus.
Weakness of the anal sphincter muscle is often
associated with rectal prolapse at this stage, resulting
in leakage of stool or mucus.
➢ Appendicitis and granulomas – Due to irritation and
inflammation brought by the worms.
➢ Blood streaked diarrheal stools, abdominal pain,
tenderness, anemia (associated with IDA) and weight
loss

DIAGNOSIS
✓ Flotac technique – more sensitive in diagnosing
✓ Stool Examination (since we’re dealing with eggs)
o Direct Fecal Smear
o Kato-thick (highly recommended)
** The ova (yung nasa pic both) has a yellowish outer and o Kato-katz
transparent inner shell. (binanggit ni maam lahat ng shape na nasa ✓ Concentration Technique
description ng pic) o FECT
** Mucoid bipolar plugs (encircled part sa pic) – distinguishing o MIFCT
feature of Trichuris trichiura.
o Brine floatation
** The fertilized egg is unsegmented at ov?? position and embryonic
development takes place outside the host when the eggs are
o Zinc sulfate floatation technique
deposited in the ___ soil. Just like A. lumbricoides, yung mga ova niya
nagdedevelop pa into embryonated eggs sa soil. PREVENTION AND CONTROL
• Treatment of infected individuals
Life Cycle of Trichuris trichiura • Sanitary disposal of human feces, construction of
toilets
• Washing of hands
• Health education (sanitation and hygiene)
• Proper food preparation practices

Pinworm, Seatworm, Society

Common name
worm*
Final Host man
Habitat (cecum) large intestine
Diagnostic stage ova
Infective stage embryonated egg
Source of exposure
contact-borne
to infection
Mode of
Ingestion, inhalation
** The embryonated eggs are passed in the stool. Transmission
** In the soil, the eggs develop into two-cell stage, an Pathology Enterobiasis or oxyuriasis
advanced cleaving?? stage. Then, they embryonate. The eggs Diagnosis Scotch tape swab
become infective in 15-30 days. Pyrantel pamoate (Mebendazole
Drug of choice
** After ingestion, the eggs hatch into small intestine, and and Albendazole as alternative)
release the larvae that mature and establish themselves as ** Society worm/ familial disease - extremely contagious and can
adults in the colon. easily spread among the members of the family or institution.
** Here, walang part ng migration. Hindi na siya lumalabas - It can cause autoinfection and retroinfection
sa intestines, but rather once ingested na yung ova tuloy-tuloy - Autoinfection – you are your own source of infection
na siya magdedevelop in your intestine. No heart-lung - Retroinfection – migration of newly hatched larvae
migration. from the anus back to the rectum.
** The Trichuris worm inhabit the cecum and colon. It secrets
pore-forming protein called TT47 which allows them to embed MORPHOLOGY
their entire whip-like portion into the intestinal wall. Worm
* TT in TT47 = stands for Trichuris trichiura ➢ Adult Worms
* If they are embedding their whip-like portions in o short, white, fusiform worms with
your intestinal wall, it can cause bleeding. This pointedalae ends, looking like bits of white
bleeding can be associated with Iron Deficiency thread
Anemia (IDA). o mouth is surrounded by 3 wing-like cuticular
** After mating, the female worms lay eggs, which are passed expansions, which are transversely striated
out with the feces and deposited in the soil, under favorable esophagus has a double-bulb structure, a
conditions the eggs will develop and become embryonated. If feature unique to this worm
swallowed, the infective embryonated eggs will go to the ➢ Male Worm
intestine and undergo four larva stages to become adult.
 CLINICAL PARASITOLOGY (LECTURE)

o posterior end is tightly curved ventrally,

sharply truncated and carries a prominent
copulatory spicule
➢ Female Worm
o posterior third is drawn into a thin pointed
pin-like tail and straight vulva is located just
in front of the middle third of the body

** The gravid adult female Enterobius vermicularis deposit

the eggs into the perianal area (@butas ng pOOhWeTh).
** Infection occurs via self-inoculation (eg. transferring of eggs
to the mouth with hands that scratched the perianal area) or
through exposure to the eggs in the environment (eg.
contaminated surfaces, clothes, or linens).
** Following the ingestion of infective eggs, the larvae will
hatch in the small intestine and the adults will establish
themselves in the colon usually at cecum.
** After the fertilization (meron nang ova), the gravid females
will migrate nocturnally outside the anus and oviposit while
crawling on the skin of perianal area.
* Madalas during night-time lumalabas yung mga
female e. vermicularis to lay their eggs to the perianal
area.
** It will then migrate down to the intestinal tract and they exit
through the anus to deposit the eggs on the perianal skin.
(usually the evening hours)
** After egg deposition, the female usually dies.
** Can be seen by the naked eye pero sobrang liit lang ** Eggs are resistant to disinfectants.
** Best time to collect sample: morning
Comparison of Male and Female E. vermicularis
MALE FEMALE PATHOLOGY
2 to 5 mm 8-13 mm • Mild catarrhal inflammation of the intestinal mucosa
Curved tail and has a single spicule long pointed tail
*rarely seen because they die after 5,000-17,000 eggs/day
• Nocturnal pruritus ani – "perianal itching" which may
copulation lead to secondary bacterial infection and lack of sleep
• Other complications: appendicitis, vaginitis,
Egg endometritis and peritonitis.
**Other ova pics: • Poor appetite, weight loss, and abdominal pain.

DIAGNOSIS
✓ Graham’s scotch adhesive tape swab (Perianal
cellulose tape swab)
o Provides the highest percentage of (+)
results
** Single female adult E. vermicularis can lay 5,000 to 17,000 eggs.

Life cycle of Enterobius vermicularis

** Since the females are laying eggs on the perianal area, doon
na natin sila deretso ma-isolate. Kaya we’re using Graham’s
scotch adhesive tape swab.
** Here, kukuha ka lang ng tape at ilalapat ‘yon in the skin
folds/perianal area. If the eggs are present, they will attach in
the adhesive part ng tape. then ready na iview sa microscope.

PREVENTION AND CONTROL

 CLINICAL PARASITOLOGY (LECTURE)

• Personal cleanliness and hygiene are essential

**Finger nails should also be cut short.
• Hand washing
** Should be done after using the toilet.
• Boiling of linen and clothing
** If there is an infected member in your family, kailangan
labhan separately yung damit niya to avoid contamination
of other clothes.
 FINALS- LESSON 1: NEMATODES II

Trichinella spiralis
MALE FEMALE
Common name Trichina worm, muscle worm
1.5 by 0.04 mm 3.5 by 0.06
Final Host or
Man, rat, dogs, pigs, bears, foxes or any Single testis mm
Intermediate
carnivore or omnivore Near its cloaca, there’s a pair of caudal appendages Single ovary
Host
and two pairs of papillae Viviparous
Small intestine (adult worm), skeletal muscle
Habitat **NOT MENTIONED.
(larva)
Diagnostic stage Encysted larva
Infective stage Encysted larva LIFE CYCLE
Source of  Optimum host: pigs
exposure to Food borne (insufficiently cooked pork meat)  Alternate host: humans
infection
Mode of
 Man is the dead end host of the parasite.
Ingestion **Infection can pass from pig to pig, rat to rat, pig to rat.
Transmission
Humans- thru ingestion of undercooked meat. After ingestion, the
Trichinosis/Trichinellosis, Muscle tissue
larva is released in small intestine where they develop to become
Pathology destruction, muscular dystrophy (since larvae is
adults and then if those adults undergo mating, they will produce the
found in skeletal muscle)
larva that are deposited in the mucosa and those encysted larva are
Muscle biopsy, Beck's Xenodiagnosis, BFT
found in skeletal muscle.
Diagnosis (Bentonite Flocculation Test), Bachman
Intradermal Test
Drug of choice Mebendazole, Albendazole

 “Trichos” – hair, “ella” – diminutive or small, “spiralis” spirally

coiled appearance of the larvae in the muscle.
 Infective stage (larva) – seen in skeletal muscle
 Beck's Xenodiagnosis – feeding the meat (muscle biopsy) to
albino rats and observe for 14 days (check for the presence of
female worm). **pero sabi ni ma’am adult worm just in case
 Bachman Intradermal Test (Skin test)– an extract of Trichinella
larvae is suspended in saline and is injected intradermally. An
immediate wheal and flare (pagpapantal) or delayed response
indicates infection.
 In mild cases of trichinosis, supportive treatment such as
bedrest, analgesic, and antipyretic are given (infection is self-
limiting if mild).

OTHER NOTES: Dito ko na insert di ko masingit before this.

**Here, we are going to tackle parasites whose infected stage is the larva.
**On the first part, the three parasites infective stage are embryonated
eggs.
MORPHOLOGY
 Adult Worm
 small white worm just visible to the naked eye, one
of the smallest nematodes infecting humans
PATHOLOGY
 The posterior end of the male has a pair of pear-
shaped clasping papillae (claspers), one on each side Enteric Phase
of the cloacal orifice that it uses to hold the female  malaise, nausea, vomiting, diarrhea, abdominal cramps
worm during mating.  similar to attack of food poisoning
**claspers- it is used during the mating of male and female
trichinella spiralis. Invasion Phase
 The female worm is viviparous and discharge larva
instead of eggs.
 myalgia, periorbital edema, and eosinophilia
**wala kang makikitang eggs; larva are seen in the muscle  Severe cases: gastric hemorrhages, myocardial and neurological
as encysted larva. complications (eg., pericardial effusion, congestive heart failure,
meningoencephalitis, and cerebral lesions)
**Larvae starts to invade the different parts of the body.

Convalescent Phase
 fever, weakness, and pain
 all symptoms subside
 Self-limiting but some ailments may persist

2 pics sa baba: Diagnostic and Infective Stage
DIAGNOSIS
 Muscle biopsy – definitive diagnostic exam (deltoid, biceps,
gastrocnemius, and pectoralis muscle)
**selected site for biopsy since sila yung maraming muscles.
**after we get those sample in biopsy, they can be digested with
trypsin, pepsin, and HCL. They can also be used to digest the muscle in
 FINALS- LESSON 1: NEMATODES II

order for us to count or determine the number of larvae per gram of  Some eggs are covered with vitelline membrane and does not
muscle or isolate the larvae for further testing such as molecular have a shell.
testing. **TN: For female, unembryonated thick shell eggs are passed in
 Biochemical Tests (increased creatine phosphokinase, lactate human stool and become embryonated in external environment.
dehydrogenase, aldolase, and myokinase levels) (Typical)
 evidence of muscle damage **The females can also produce eggs that are lacking with shells. They
only possess vitelline membrane. (Atypical)
 Serological Tests (Bentonite Flocculation Test-BFT, Latex
agglutination test, FAT, ELISA)
 Beck's Xenodiagnosis
 ELISA is recommended for the diagnosis of
Trichinellosis (wala sa ppt)
 Confirmatory test: western blot technique (wala sa
ppt)
 In molecular characterization, we need to digest the
muscle first in order to isolate the larvae. Trypsin,
pepsin and HCl are used to digest the muscle.
Digestion of muscle using these can also be done to
determine the number of larvae per gram of muscle.

PREVENTION AND CONTROL

 Health Education
 Proper Food Preparation
 Meat Inspections
 Keeping pigs in rat-free pen
** C. philippinensis, ova is peanut shaped with striated shell and flattened
Capillaria philippinensis bipolar plugs. T. trichiura, bipolar plugs are prominent.
Common name Pudoc worm (barrio where it discovered)
Final Host Man and other vertebrate host LIFE CYCLE
Bagsang, Birot, Bagtu, Ipon (fresh water and
brackish water fishes)  Unembryonated thick-shelled will become embryonated in the
Intermediate Host water/soil/environment and the infective larvae will develop in
**local fishes that are seen in endemic area.
the tissue of intermediate host. And in adults, if we ingest larvae
Mostly in Northern part of PH.
in raw or infected fish they can develop as adults in the intestinal
Habitat Small intestine
mucosa. (They must reach the water in order to be ingested by
Diagnostic stage Egg
the small species of fresh water or brackish water fishes)
Infective stage Filariform larva (L3) (in intermediate host)
Source of exposure to  Females may produce two types of eggs: unembryonates eggs
Food borne (passed in the feces) and embryonated eggs lacking shells (hatch
infection
inside the definitive host).
Mode of Transmission Ingestion
Pathology Borborygmi, diarrhea, malabsorption  Larvae will re-invade the small intestinal mucosa in auto
Stool exam, duodenal fluid exam (since we infective cycle and we are also producing those unembryonated
Diagnosis thick shelled eggs and the cycle goes on.
are dealing with ova/eggs.)
Drug of choice Mebendazole, albendazole

 Discovered by Nelia Salazar in 1963 (Barrio Pudoc, Ilocos Sur)

 Capillaria philippinensis was described as a mystery disease in
1998 in Monkayo Compostela Valley Province, which resulted
in the death of villagers due to misdiagnosis.
**Fish eating birds?? are believed to be the natural host and humans
as incidental host.
**Custom of people living in the North, they are into eating Kinilaw,
those are uncooked fish na nilalagyan lang ng vinegar. The filariform
larva, which is the infective stage, can survive.

MORPHOLOGY

MALE FEMALE
2.3 to 5.3 mm
Typical: oviparous
1.5 to 3.9 mm
- Producing eggs/ova
Presence of single spicule and unspined
Atypical: larviparous
sheath
- Producing larvae
-

 Some larvae are retained in the gut lumen and will develop into
adults, which leads to hyperinfection or autoinfection.
 Unembryonated shelled-egg requires environmental
contamination.
 FINALS- LESSON 1: NEMATODES II

PATHOLOGY MORPHOLOGY
 Borborygmus – gurgling sound of the stomach
Parameter A. duodenale N. americanus
 Abdominal pain
Old World
 Diarrhea Common Name
Hookworm
New World Hookworm
 Weight loss, malaise, vomiting Body curvature C shaped S shaped
 Severe protein loss
Dental Pattern 2 pairs
Semilunar cutting
 Malabsorption of fats and sugars (associated with flattened plates
intestine and duodenal villi) Male bursa Tridigitate
Bidigitate (bipartite)
(dorsal rays) (tripartite)
 Capillariasis is endemic in Ilocos Sur, Cagayan Valley, Isabela,
Copulatory
Pangasinan, Zambales, Ilocos Norte, La Union Plain, bristle-like Fused, barbed
spicule
Habitat Small intestine Small intestine
DIAGNOSIS
Diagnostic Stage Ova Ova
 Stool Examination Infective Stage L3 L3
 Direct Fecal Smear
 Kato-thick  Delicate eggshell and may be easily disintegrated in kato-thick
 Kato-katz and kato-katz (not recommended).

 Duodenal aspiration  Manner of reporting: presence of hookworm eggs/ova

PREVENTION AND CONTROL

 Avoid eating raw fish
 Good sanitary practices
 Health education
 Proper food preparation

HOOKWORMS
 Necator americanus (human hookworm)
 Ancylostoma braziliense (cat hookworm)
 Ancylostoma caninum (dog hookworm)
 Ancylostoma duodenale (human hookworm)
**Hookworms- soil-transmitted helminths, like T. trichiura and A.
lumbricoides. They are blood sucking nematodes that attached to the
mucosa of intestine. Since they suck blood, the infection is associated with
iron deficiency anemia (involvement of microcytic hypochromic anemia)

Dental Pattern
Necator americanus a pair of semilunar cutting plates Bursa- ginagamit para sa mating ng parasites.
Ancylostoma braziliense 1 pair of teeth
Ancylostoma caninum 3 pairs of teeth **In the ova, it is difficult to distinguish the egg of these two. That’s why
Ancylostoma duodenale 2 pairs of teeth when reporting this we are only indicating the hookworms. The eggs have
bluntly rounded ends and a single thin transparent hyaline shell and very
 Habitat: Small intestine delicate, therefore, they are easily disintegrated. that is why it is not
 Diagnostic stage: Ova/Egg recommended to use kato thick and kato katz.
 Infective stage: L3
**Basahin niyo yung nakasulat sa pics kasi hindi kayo sinswerte dyan para
 MOT: Skin penetration isulat k p. tnx.
 Considered as STH and blood sucking nematodes because they
attach to the mucosa of small intestine. **Unholy three: 1. Hookworm 2. Trichuris ova 3. Ascaris ova. Co-infection
 Necator americanus was identified in the specimen obtained in with soil-transmitted helminths, it is possible, and it is called as unholy
Texas, USA. The name means American Murderer. three.
**Necator means murderer.
 Ancylostoma duodenale came from the Greek word “ankulos” LIFE CYCLE
hooked and “stoma” mouth.  Humans are the only natural host. No intermediate host is
**Totoo talaga yung makakakuha ng bulati if u are not wearing required
slippers. Kasi their transmission is thru skin penetration.  The L3 will penetrate the skin and enter the venules. They will
migrate into heart, lungs, and alveoli (heart-lung migration here
in hookworms just like A. lumbricoides). The larvae will ascend to
trachea and it will pass down to small intestine. The worms will
become sexually mature and the female will start to lay eggs.
** It will penetrate your skin, go to circulation, exit on the lungs where
they are cough up and swallowed and the cycle goes on. But the adults
are seen/developed in small intestine.
 FINALS- LESSON 1: NEMATODES II

Strongyloides stercoralis
Common name Threadworm
Final Host or
Man
Intermediate Host
Habitat Small intestine
Diagnostic stage L1 (Rhabditiform larva)
Infective stage L3 (Filariform larva)
Source of exposure
STH
to infection
Mode of
Skin penetration
Transmission
Cochin China diarrhea, honey-comb ulcer, Villi
Pathology atrophy, malabsorption, pneumonitis, creeping
eruption
Stool exam, Enterotube test, Harada-Mori
Diagnosis
culture (since dealing wt larvae)
Drug of choice Mebendazole, Albendazole, Thiabendazole

PATHOLOGY  females are capable of parthenogenesis (fertilization without

**Adult worms live in lumen of small intestine typically in distal jejunum the benefit of the males)
where they attached to the intestinal wall with result in blood loss of the  Came from the word “Strongylus” round, “eidos” resembling,
host. and stercoralis means fecal.
Due to adult  Dogs can be definitive host.
 Epigastric pain, diarrhea, malnutrition, severe anemia **Infection is acquired when walking barefoot becoz MOT is skin
(microcytic, hypochromic type, IDA) penetration.

Due to larva MORPHOLOGY

 Creeping eruptions or Cutaneous Larval Migration (CLM)
 Ground itch or dew itch extra intestinal larval
migration or due to skin penetration
 most common cause is nonhuman species of
hookworm (A. braziliense and A. caninum)
Adult Worms
 Favorable conditions: free-living
 Unfavorable conditions: parasitic
 Males have no purpose (usually passed out in the feces after
development to L3)
 Females are ovoviviparous.
** Producing eggs inside. They fertilize their own eggs and then release
larvae.
 The individual worm has a lifespan of 3 or 4 months, but because
it can cause autoinfection, the infection may persist for years.
(Hyperinfection is possible)

 Wakana Disease
 Pneumonitis
 characterized by nausea, vomiting, dyspnea,
pharyngeal irritation, cough, and hoarseness of voice
 ingested larvae will develop into mature worms
DIRECTLY in the intestine without migrating in the
lungs.

DIAGNOSIS
 Stool exam (DFS)- since dealing with ova
 Culture Technique: Harada Mori Technique Differences in morphology
 Filter-paper culture method utilizes the water L1 or Rhabditiform larva L3 or Filariform larva
tropism of larvae to concentrate them. Fresh feces Open mouth
are deposited on the filter paper, which is soaked Short and stout Closed mouth
with water. Feeding Long and slender
Long narrow buccal cavity Non-feeding
 Incubate for 10 days at 30°C
Flask-shaped esophagus **Parasitic
 Check for the formation of larvae **Free-living forms

PREVENTION AND CONTROL

 Proper Sanitation
 Personal hygiene
 Health education
 Chemotherapy
 FINALS- LESSON 1: NEMATODES II

Rhabditiform larva the bottom). If the larvae are present, they will go out on the
Parameter Hookworm S. stercoralis muslin bag and they will sink at the bottom of the funnel.
Buccal cavity Long Short
Genital primordium Small Prominent PREVENTION AND CONTROL
**Excreted in the stool  Proper Sanitation
Filariform larva
 Personal hygiene
Parameter Hookworm S. stercoralis
 Health education
Esophagus Short Long
Tail-end Pointed Forked/notched  Chemotherapy
Sheath Sheathed Unsheathed
**Penetrates the skin Angiostrongylus/ Parastrongylus cantonensis
Common name Rat lung worm
**The tables above are just additional info of their difference in Final Host Rattus rattus var. rattus, Rattus norvegicus
morphology since they are both soil-transmitted helminths and MOT is skin Achantina fulica (giant African snail),
penetration. Intermediate Host
Hemiplecta macrostoma, Vaginilus plebeius,
(slugs and snails)
Veronicella altae
Accidental host Man
Habitat CNS-brain
Diagnostic stage adult worms
Infective stage L3
Source of exposure
food borne
to infection
Mode of
Ingestion
LIFE CYCLE Transmission
Acute severe intermittent occipital or
Pathology
bitemporal headache ; associated with CNS
Diagnosis Travel history, CSF analysis, CT scan
Anthelminthic treatment is not
Drug of choice recommended, as the disease is due to dead
larvae.

 It is known to cause eosinophilic meningoencephalitis in

humans.
**We can get this by ingestion of snails that are the intermediate
host which are infected with L3 larvae or if we will ingest leafy
vegetables contaminated with the mucous secretion of snail
carrying the infective stage or ingestion of parathenic? host such
as fresh water prawns or crabs and drinking contaminated
water.
 In some countries, (China, Thailand, Taiwan) mebendazole and
albendazole have been demonstrated to effectively treat
Angiostrongylus cantonensis infection.

MORPHOLOGY

MALE FEMALE
21 to 25 mm
**Dogs may also serve as a definitive host of the parasite. 16 to 19 mm
"barber's pole" uterine tubules
Kidney shaped, single-
(uterine tubules wound spirally around
lobed bursa
PATHOLOGY the intestines)
 Cochin China Diarrhea or Vietnam Diarrhea (intermittent
diarrhea characterized by numerous episodes of water and
bloody stool)
 Honey comb ulcer
 Skin allergy due to larval penetration
 Larval migration which causes pneumonia

DIAGNOSIS
 Stool Examination
 Direct Fecal Smear LIFE CYCLE
 Kato-thick  In humans, the larvae may remain in the brain for a longer period
 Kato-katz and do not develop into adult stage. Dead end host is man. We
 Concentration Techniques are just considered as accidental/incidental host.
 Harada-Mori culture – since dealing with larvae  May infect the brain and eye chamber.
**When human got infected, the larvae pass thru the stomach into
 Baermann Funnel Gauze Method (a muslin bag/pouch
the intestine, enter the circulatory system and migrate to the brain or
containing the fecal sample is submerged in water in a funnel
spinal cord or occasionally migrate to the eye chamber.
and sealed in a lower end by a rubber tube or clip. Being heavier
than water, the nematodes pass through the muslin and sink to
 FINALS- LESSON 1: NEMATODES II

LIFE CYCLE

Anisakis spp.
(Anisakis simplex, Anisakis physeteris)
Common name Codworm, Herring worm, Anisakine
Marine mammals (sea lion, sperm whale,
Final Host
dolphin)
Micro crustaceans (Cyclops)
Intermediate Host
A wide variety of fishes
**The definitive host excrete an unembryonated egg in the feces so
Accidental host Man
definitive host will be the marine mammals. They ingest the fish or squid
Habitat alimentary canal and tissues
parathenic host? And L3 larvae developed into the adults in gastric
Infective stage third larval stage (L3) mucosa. They are producing the unembryonated eggs that become
Source of exposure embryonated in water. So those larvae will be ingested by crustaceans, and
food borne
to infection these crustaceans are being eaten by the fish. The parathenic host
Mode of maintained the L3 larvae in tissue which are infected in definitive host. So it
Ingestion of raw or semi-raw fish (sashimi)
Transmission can be transmitted via raw or undercooked seafood consumption.r
Herring's disease, Eosinophilic granuloma,
Pathology
Gastrointestinal Anisakiasis
Toxocara spp.
Gastroscopic/Endoscopic examination, ELISA
Diagnosis (Toxocara cati and Toxocara canis)
and Radioallergosorbent test
Adult worms: Smaller than Ascaris (trilobite Common name Cat or Dog Ascaris aka Ascarids
Morphology Accidental host Man
lips) may be seen macroscopically
Visceral Larva Migrans (VLM), Ocular Larva
Pathology
**This is common in Japan and other places where fresh or under treated Migrans (OLM), Covert Toxocariasis (CoTOX)
fish is popular food. Since they are fan of eating sushi/raw fishes/sashimi. Mode of
ingestion of embryonated eggs
Transmission
 Curing techniques may not be effective because some Anisakis
detection or larvae from biopsy tissues,
can still survive.
Diagnosis Commercial lgG ELISA for the detection of Toxocara
excretory antigens (TES) and Western Blot
Treatment Albendazole or Mebendazole
Paratenic host other mammals and birds
Toxocara cati for cats and Toxocara canis for dogs

**Strabismus (pagkaduling), invasion of retina, and blindness

LIFE CYCLE
 The infection is acquired in puppies by transmission of larvae
transplacentally or lactogenically (breastmilk).
 In kittens, it is acquired only by breastfeeding
 Can also be transmitted to non-canid animals such as rabbits,
chicken, cattle, or sheep.
 The L3 larvae can migrate on the different tissues of the human
including the lungs, liver, and brain. (Diagnostic Stage)
**In humans eto lang talaga nakikita that causes nung mga pathology
sa taas. (basahin niyo malaki na kayo nasa table yung tatlo)
 Infective stage: Food-borne transmission or ingestion of
embryonated eggs
 FINALS- LESSON 1: NEMATODES II

LIFE CYCLE

PATHOLOGY
 Visceral Larva Migrans – there is eosinophilic granuloma in the
tissues of liver, lungs, CNS, and eyes.
 Ocular larva migrans – may cause unilateral visual impairment,
strabismus, invasion of retina and blindness.
 Covert toxocariasis – less specific syndrome, asymptomatic, and
eosinophilia is less frequent
 Neurological Toxocariasis – can cause encephalitis
**wala to pero aralin niyo pa rin coz why not

Dirofilaria immitis
Common name Dog heart worm
Final host Dogs
Accidental host Man
Heart and lungs of dogs
Habitat
Blood vessels
Infective stage 3rd larval stage
Source of exposure to
vector borne
infection
Vector Mosquito
Coin lesions in the lungs, obstruction of
Pathology
the heart
Microfilaria is unsheathed, no terminal
Morphology
nuclei

 In humans, the worm lodges in the heart or in the branches of

pulmonary artery. (DIAGNOSTIC STAGE)
 The dead worm becomes an embolus blocking a small branch of
the pulmonary artery producing pulmonary infarcts.
**Microfilaria can be seen in peripheral blood.