PREMID COVERAGE – PARASITOLOGY

UNIT 2-NEMATODES
INTRODUCTION
GEOGRAPHICAL DISTRIBUTION
 Helminthology is concerned with the study  Cosmopolitan: warm, moist climates; rarely found
of helminthes or parasitic worms. Helminthes in arid areas and at high altitudes.
are trophoblastic metazoan (multi-cellular HABITAT
organisms).

The sources of the parasites are different. Exposure

of humans to the parasites may occur in one of the
following ways:

1. Contaminated soil (Geo-helminthes), water

(cercariae of blood flukes) and food (Taenia
in raw meat).
2. Blood sucking insects or arthropods (as in
filarial worms).  Eggs: Feces; not
3. Domestic or wild animals harboring the infective when passed
parasite (as in echinococcus in dogs). (After 14 to 21 days, the
4. Person to person (as in Enterobius eggs mature and enter an
vermicularis, Hymenolopis nana). infective stage.)
5. Oneself (auto-infection) as in Enterobius  Humans:
vermicularis. o Larvae hatch in
small intestine
The helminthes are classified into three major groups. o Move into the
cecum & penetrate
1. Nematodes (round worms) mucosa (adults)
2. Cestodes (tape worms) SYMPTOMS
3. Trematodes (Flukes)  Dysentery (blood & mucus in stool together with
tenesmus)
A. APHASMID (ADENOPHOREA) NEMATODES  Rectal prolapse
1. TRICHURIS TRICHURIA
2. TRICHINELLA SPIRALIS LABORATORY DIAGNOSIS
3. CAPILLARIA PHILIPPINENSIS  Microscopic identification of whipworm eggs
in feces
1. TRICHURIS TRICHURIA (WHIP WORM)  Kato-katz technique

HOST LIFE CYCLE

 Humans only

MODE OF TRANSMISSION:
 Ingestion of eggs containing larvae with
contaminated raw vegetables.

MORPHOLOGY
 Adult worm is divided into:
o Thin whip-like anterior part, measures
3/5 of the worm
o Thick fleshy posterior part of 2/5 the
length.
o 1yr life span
 Male- Posterior end is coiled; single cubicle
 Female- posterior end straight (thick tail)
o In the cecum, shed 3k-20k eggs/day
 Egg
o Unembryonated when passed in stool
o Shape: Barrel-shaped, colorless
protruding polar/mucoid plugs at each
end
o Shell: thick smooth with 2 layers; bile
stained
o Color: yellow brown
o Content: Central granular mass which is
segmented ovum (Egg Larvae Adult)
o Atypical: round 1. Unembryonated eggs passed with the stool
2. In the soil, eggs develop into 2-cell stage

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 PREMID COVERAGE – PARASITOLOGY
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3. Eggs embryonate bronchopneumonia etc.
4. Infective in 15-30 days
5. If ingested, eggs hatch in S.I and release larvae LABORATORY DIAGNOSIS
that matures in the colon (lives in cecum and  Muscle Biopsy
ascending colon)  Detection of larvae in blood or CSF
6. Adult worms are fixed in that location, with the  Detection of larvae and adult worms in stool
anterior portions threaded into the mucosa. (rare)
 ELISA
 Infective stage: embryonated egg
 Diagnostic stage: unembryonated egg PREVENTION

2. TRICHINELLA SPIRALIS  Pork must be stored at -150C for 20 days.

MODE OF TRANSMISSION
 Ingestion of immature form of larvae in raw or
undercooked meat
HOSTS
 Vertebrae can acts as both definitive (infected
host) and intermediate host
 A second host is required to perpetuate the life
cycle of Trichinella
 Reservoir host: pigs cats, dogs, mice

GEOGRAPHICAL DISTRIBUTION
 Temperate regions

HABITAT/ MORPHOLOGY
 Egg: no eggs passed in feces
 Male: long, more flat anteriorly than posteriorly;
large copulatory pseudobursa on each side; dies
after mating
 Female:
o Gives birth to larvae
o Begins to deliver embryos 4-7 days after
the infection
 Adult worms
o Minute thread-like worms, white in
color, attenuated anterior end
o Cellular esophagus
o Viviparous
LIFE CYCLE
o Small intestine: Embedded by its anterior
part in mucosa of muscular epithelium of
duodenum and Jejunum of Man, Dog,
Rate, Cat, Pigs and many wild Carnivores.
 Live within the intestine (up to 2
mons), migrate to skeletal
muscle and diaphragm
 Larvae
o Thick and lies along the muscle fibers
o Shape: usually seen coiled inside a
lemon-shaped cyst
o Color: appear black
o Released in duodenum or jejunum ,molt
4x and become adults
o Encysted in the striated muscle of the
body of meat eating animals including
man.
SYMPTOMS
 The intestinal phase: lasting 1-7 days -
asymptomatic; sometimes cause nausea,
vomiting, diarrhea, constipation, pain, etc,
and
 The muscle phase: which causes
myalgia, palpebral edema, eosinophilia,
1. Ingestion of raw or uncooked meat containing encysted
fever, myocarditis, meningitis,
larvae of Trichinella species
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 PREMID COVERAGE – PARASITOLOGY
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2. Exposure to gastric acid &pepsin = larvae are released
from cysts HABITAT
3. Invade the small bowel (4 weeks) mucosa where they  Hatches in the intestine of the fish and
develop into adult worms develops into infected larva
4. Ater 1 week, females release larvae that migrate to o develops in the small intestines into an
striated muscles where they encyst adult worm (burrow in intestinal mucosa,
jejunum)
 Infective stage: encysted larvae  Larviparous females produce larvae resulting
 Diagnostic stage: encysted larvae in in autoinfection (Some eggs hatch within the
striated muscle human intestine)
 Oviparous females produce eggs that are then
3. CAPILLARIA PHILIPPINENSIS released into the environment through the feces.
(INTESTINAL CAPILLARIASIS)
SYMPTOMS
 Discovered in Northern Luzon, Philippines in  Abdominal pains, diarrhea, weight loss,
1964 anorexia
 Loss of proteins, electrolytes and
HOSTS malabsorption of fats and sugars
 Intermediate hosts: fish
 Definitive hosts: fish-eating birds, human LABORATORY DIAGNOSIS
 Tissue Biopsy from the S.I
MODE OF TRANSMISSION  Severe: Stool Examination (adult worms and
 Ingestion of raw or undercooked eggs)
contaminated fish (freshwater)
LIFE CYCLE
GEOLOGICAL DISTRIBUTION
 Philippines, warm moist

MORPHOLOGY
 Egg
o Peanut-shaped
o Produced by typical female
o Moderately thick striated egg sheath
(striated shell)
o Prominent flatted bipolar plugs
o Similar to TT but slightly smaller
o Unembryonated when passed in
feces
o Becomes embryonate in soil (12
days)
 Female
o Typical F: egg in uterus in single row
o Atypical Female: viviparous,
larvivapous, 40-45 eggs, arranged in
2-3 rows
 Male
o Chitinized picule and a long spicule
sheath

1. Unembryonated eggs passed in human stool

2. Become embryonated in the environment
3. Ingestion by fish causes larvae to hatch,
penetrate the intestine and migrate to tissues
4. Ingestion of raw or uncooked+ infection of the
human host
5. Adults reside in S.I, burrow in mucosa
Female deposite unembryonated eggs in the
intestine, and release larvae that cause auto
infection (leads to hyperinfection)

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 PREMID COVERAGE – PARASITOLOGY
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 May be either indirect (involving an intermediate
host) or direct (complete in one host).
Indirect Life Cycle:
1. Fish-eating birds harbor C.P in their intestines, shed
embryonated eggs in their feces
2. If eggs are fed to uninfected fish are recovered in the
intestines of the fish
2.1 If eggs are fed to uninfested birds, larvae develop into
adults in the intestinal tract of the birds.
3. Larvae recovered from the fish also developed into
adults when fed to gerbils or monkeys, with eggs shed
in the feces of these mammalian hosts.
Direct Life cycle:
Researchers also found that feeding just a few dozen
larvae from the intestines of fish to Mongolian gerbils
(Meriones unguiculatus) or monkeys (Macaca sp.) led to
infestations with thousands of adult worms through
"autoinfection." Autoinfection is when the offspring
produced by adults can reinfest the same host, allowing
the infestation to multiply within a single host animal.
Both oviparous (egg-laying) and larviparous (giving birth
to active larvae) adult female C. philippinensis were found
in Mongolian gerbils and some birds.
 Infective stage: Larva in I.H
 Diagnostic stage: Unembryonated eggs
or larvae in stool
B. PHASMID NEMATODES
 Un-segmented, elongated and cylindrical.
 Have separate sexes with separate appearances.
 Have a tough protective covering or cuticle.
 Complete digestive tract with both oral and anal
openings.
 The nematodes are free living (Majority) or
parasites of humans, plants or animals.
INTESTINAL NEMATODES WITH TISSUE
STAGE
1. ASCARIS LUMBRICOIDES
HOSTS
 Definitive host: human,swine
MODE OF TRANSMISSION
 Ingestion of larva contaminated raw
veggies
GEOGRAPHICAL DISTRIBUTION
 Cosmopolitans: one of the common and most
wide spread of all human parasites
 moist, warm, shaded soil
MORPHOLOGY
 Adult
□ Color: pinkish/white
□ 3 lips at the anterior end of the body
 Male
□ Curved tail posterior end ventrally, 2
copulatory spicules o unequal size
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 Female
□ Straight tail (posterior end)
□ Produce approx. 200k eggs/day
 Eggs
1. Fertilized Corticated Egg
 Size: oval, or sometimes round
 Shell: The two layer are distinct, rough,
brown bile, covered with little lumps
external (mammillated layer) shell and
smooth, thick, colorless internal shell,
double-shelledColor: Brown external
shell, and the contents are colorless or
pale yellow
2. Unfertilized Corticated Egg
 Shape; more elongated (elliptical), larger
 Shell: brown, puffy external shell and thin
internal shell, with large protuberances
or practically none
 Content: full of large round very refractile
granules
3. Semi-decorticated Fertilized Egg Similar
to Type A but Without the External Shell
 Shell: single, smooth, thick and colourless or
very pale yellow.
 Content: a single rounded colourless granular
central mass.
4. Semi-Decorticated Unfertilized Egg
 Shell: a single smooth thin colourless shell
(double line)
 Content: large rounded colourless refractile
granules.
HABITAT
 Adult: small intestine (duodenum)
 Egg: feces
 The larvae penetrate the intestinal wall and
circulate in the blood. From the heart they
migrate to the lungs, ascend to the trachea,
descend to the esophagus and finally reach the
small intestine to become adult. The female pass
immature eggs which pass to the soil and mature
in 2 weeks.
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UNIT 2-NEMATODES
 Both F & M: 2 broad, arrowhead-shaped
LAB DIAGNOSIS lateral cervical alae at the interior end, 3
 Stool Exam for eggs by direct saline smear lips
method  Eggs
 Demonstration of adult worms o Color: Golden
o Shape: spherical or slightly pear-
LIFE CYCLE shaped
o Shell: Thick, pitted surface

Unembryonated egg of T. canis

1. Adult worms live in lumen of S.I

2. Female lay eggs 200k, passed in feces
3. Unfertilized eggs may be ingested but not infective Embryonated egg of T. canis (90 by 75
4. Fertile Eggs embryonate and become infective (18 μm
days-several weeks)
5. If infective swallowed, larvae hatch and invade
intestinal mucosa are carried via the portal, then systemic
circulation to the lungs
6. The larvae mature further in the lungs (10 to 14 days),
penetrate the alveolar walls, ascend the bronchial tree to
the throat, and are swallowed
7. Upon reaching the small intestine, they develop into
adult worms
8. Between 2 and 3 months are required from ingestion
of the infective eggs to oviposition by the adult female.
Adult worms can live 1 to 2 years

 Infective stage: Embryonated egg with

L3 larva
 Diagnostic stage: Un/Fertilized egg

2. TOXOCARA CANIS/CATI

HOSTS
o Accidental: Humans
o Definitive: domestic cats/dogs
o Paratenic: mammals & birds

MODE OF TRANSMISSION
 Humans are accidental hosts who become
infected by ingesting infective eggs or
undercooked meat/viscera of infected paratenic
hosts

GEOPRAGHIC DISTRIBUTION LAB DIAGNOSIS

 Cosmopolitan parasites of dogs and cats  Serology
 Antibody detection
MORPHOLOGY  ELISA

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 PREMID COVERAGE – PARASITOLOGY
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LIFE CYCLE HOOKWORMS

2 SPECIES OF HOOKWORM
1. Ancylostoma duodenale (Ancylostoma
braziliense)
2. Necator americanus

ADULTS- SMALL INTESTINE OF MAN

1. ANCYLOSTOMA DUODENALE

HOSTS
 Definitive- humans
 Paratenic- canids and felids

MODE OF TRANSMISSION
 Walking barefoot on contaminated soil
 Ingestion of larvae

MORPHOLOGY

Parasite Hosts Oral Geographic

species structur distribution
es
Necator humans 2 cutting Africa, India, Asia,
1. The Toxocara canis life cycle normally involves
americanus plates China, central
dogs; humans are infected only accidentally.
Unembryonated eggs are passed in feces of dogs America
(the definitive host). Europe,
Ancylosto humans 2 pairs
2. In the environment, eggs embryonate (a period of Africa,
ma teeth
1 to 4 weeks) and become infective (L3). India,
duodenale
3. After eggs are ingested by a dog, they hatch and China,
release larvae, which penetrate the intestinal wall. Asia,
4. In younger dogs, the larvae migrate through the patchy
lungs and bronchial tree; larvae are coughed up, distributi
swallowed, and returned to the small intestine, on in
where they mature. Adult female worms deposit North
eggs in the small intestine. Although older dogs may and
be infected in the same way, larvae are more likely South
to encyst in tissues. America
5. Encysted stages are reactivated in female dogs
during late pregnancy and infect the puppies via the Ancylostoma dogs, cats 2 pairs
Brazil,
braziliense (humans? Africa,
transplacental or transmammary route. teeth
) India, Sri
6. As a result, adult worms become established in Lanka,
the small intestine of the puppies (a major source Indonesia,
of environmental contamination). Philippines
7. T. canis can also be transmitted through ingestion of
Ancylostoma dogs, humans 3 pairs worldwide
transport hosts. Eggs ingested by small mammals (eg,
caninum teeth
rabbits) hatch into larvae, which penetrate the
 Larvae- rod-shaped
intestinal wall and migrate into various tissues where
 Male
they encyst.
o Posterior end is broadened into a
8. The life cycle is completed when dogs eat these
membranous copulatory bursa that is
hosts, and the larvae develop into egg-laying
provided with two long needle-like
adult worms in the small intestine.
spicules.
9–10. Humans are accidental hosts who become
 Female- The posterior
infected by ingesting infective eggs in contaminated
end is straight.
soil or infected transport hosts. After ingestion, the
 Adult
eggs hatch into larvae.
o Male- long, are
11. The larvae penetrate the intestinal wall and are
bursate, 2 spicules
circulated to various tissues (eg, liver, heart, lungs,
that do not fuse at
brain, muscle, eyes).
their distal ends
 Adults of both sexes
HABITAT
 Small intestine (lumen) of the definitive host have a buccal capsule
containing sharp teeth.
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 PREMID COVERAGE – PARASITOLOGY
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 Longer & thicker than N.Am A.Duo N.Am
 Creamy/grayish white appearance
 Large mounth cavity (Buccal capsule); broader
than long
 S-shaped worm
 Club shaped esophagus
 Female lays 20,000 eggs/day

RHABDITIFORM LARVAE (L1)

 long buccal canal and an inconspicuous
genital primordium

HABITAT
 Adult M & F: Small Intestine (Jejunum and less often
FILARIFORM LARVAE (L3) in the duodenum of man)
 Pointed tail, striated sheath  Eggs: In the feces; not infective to man
 Found in the environment  Infective larvae: free in soil and water

GEOGRAPHICAL DISTRIBUTION
 Warm, moist areas (Tropical)
 Temperature, moisture, oxygen

LAB DIAGNOSIS
o Eggs in feces

LIFE CYCLE

 Eggs- oval thin-shelled, colorless, 4 cell-stage,

surrounded by thin hyaline membrane

A B C

1. Eggs are passed in stool

2. Larvae hatch in 1-2 days (moisture, warmth,
shade)
3. Rhabditifrom grows in the feces/soil
4. 5-10 days= filariform (molts 2x)
-Infective larvae can survive 3-4 weeks
under favorable conditions
5. The larvae penetrate the skin and enter small blood
vessels and following a heart-lung migration.
6. They penetrate into the pulmonary alveoli, ascend
the bronchial tree to the pharynx, and are swallowed
7. The larvae reach the small intestine, where they
reside and mature into adults. Adult worms live in

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 PREMID COVERAGE – PARASITOLOGY
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the lumen of the small intestine, where they attach
to the intestinal wall with resultant blood loss by the LAB DIAGNOSIS
host  Stool Examination by direct saline smear
8. Most adult worms- eliminated in 1 to 2 years, but
the longevity may reach several years. LIFE CYCLE
-Some A. duodenale larvae, following
penetration of the host skin, can become dormant (in
the intestine or muscle).

 Infection by A. duodenale may probably also

occur by the oral and transmammary route.
 N. americanus, however, requires a
transpulmonary migration phase.

 Infective stage: Filariform larvae (L3)

 Diagnostic stage: Unembryonated egg

2. NECATOR AMERICANUS (AMERICAN

HOOKWORM)

HOST
 Definitive-Man is the only known host

MODE OF TRANSMISSION
 The filariform larva infects by skin penetration.

GEOGRAPHICAL DISTRIBUTION Egg LarvaeAdult

 Predominant species in all parts of the tropics. F
1. The larvae penetrate the skin and enter small blood
HABITAT vessels and following a heart-lung migration.
 Adult: Jejunum and less often in the duodenum 2. After migrating up the trachea, the larvae are
of man swallowed. In the small intestine they develop and mate.
 Eggs: In the feces; not infective to man 3. The worm attach to the wall of the small intestine by
 Infective larvae: free in soil and water sucking part of the mucus and blood from the host.
MORPHOLOGY 4. Female worms lay eggs which are passed in the faeces.
 Male In the external environment the egg develop and hatch
o Posterior end is broadened into a the rhabditiform larvae. It feeds and moult twice to
membranous copulatory bursa, which is become infective larvae.
provided with two long spicules fused
distally.  Infective stage: Filariform larvae (L3)
 Female  Diagnostic stage: Unembryonated egg
o The posterior end is straight
 Adult LARVA MIGRANS
o Short & 1. Cutaneous LM (Creeping Eruption)
thinner
than A. HOST
duodenale  Accidental: human
o Buccal 3. Ancylostoma Braziliense ( both cats and dogs)
capsule 4 Ancylostoma Caninum (only Dogs)
longer than
broad GEOGRAPHICAL DISTRIBUTION
 Egg  Tropics and sub-tropical regions
o Similar to A. duodenale MODE OF TRANSMISSION
o Shape: oval  The filariform larva infects by skin
o Shell: very thin and penetration. but the larvae are then unable
appears as black line to complete their migratory cycle. Trapped
o Colour: the cells inside larvae may survive for weeks or even
are pale gray months, migrating through the
o Content: varies subcutaneous tissues. They may evokea
according to the degree fairly severe reaction - pruritus and
of maturity. It contains dermatitis.
an ovum which appears
segmented usually 4-8
stage.

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 PREMID COVERAGE – PARASITOLOGY
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LIFE CYCLE Toxocariasis
 T. Cati & T. Canis

LAB DIAGNOSIS
 Identification of larvae in tissue

2. Intestinal LM –rare kind

5. STRONGYLOIDES STERCORALIS (DWARF

THREAD WORM)

HOST
 Definitive: humans, dogs, cats

MODE OF TRANSMISSION
 Contact with soil that is contaminated with free-
living larvae (wet)
 Stages of infection:
o Invasion of the skin
o Migration of larvae through the lungs
o Parasitism of the small intestine by adult
worms.

1. Mature hookworms reproduce in the small intestine, GEOGRAPHICAL DISTRIBUTION

and eggs are passed in the animal definitive host’s stool ,  Tropical and sub-tropical countries
and under favorable conditions (moisture, warmth,  Sporadic in the temperate and cool climates.
shade), larvae hatch in 1 to 2 days.
2. The released rhabditiform larvae grow in the feces HABITAT
and/or the soil , and after 5 to 10 days (and 2 molts) they  Has both free living and parasitic generations
become filariform (third-stage) larvae that are infective.  Parasitic Adults: buried in the mucosal
3. These infective larvae can survive 3 to 4 weeks in epithelium of the small intestine of man.
favorable environmental conditions.  Rhabditiform larvae: Passed in the feces and
4. On contact with the animal host , the larvae penetrate external environments
the skin and are carried through the blood vessels to the o The eggs embryonate and hatch in the
heart and then to the lungs. mucosa of the small intestine of the host.
5. They penetrate into the pulmonary alveoli, ascend the  Filariform larvae: soil and water the infective
bronchial tree to the pharynx, and are swallowed. The stage
larvae reach the small intestine, where they reside  Adult male and female worms live in the small
and mature into adults. intestine.
6. Adult worms live in the lumen of the small
intestine, where they attach to the intestinal wall. MORPHOLOGY
7. Some larvae become arrested in the tissues, and serve  Adult
as source of infection for pups via transmammary (and o Male- no parasitic male
possibly transplacental) routes.  Rhabditiform esophagus
8. Humans become infected when filariform larvae  Curved posterior, 2 spicules
penetrate the skin. With most species, the larvae cannot o Female (parasitic)
mature further in the human host and migrate aimlessly  Cylindrical esophagus
within the epidermis, sometimes as much as several  Straight end
centimeters a day. Some larvae may become arrested in  Long, slender
deeper tissue after skin migration. o Female (free-living)
 Rhabditiform esophagus
Egg  Straight end
 thin-shelled, colorless,  1st Stage Rhabditiform larvae
smooth o Motility: very actively motile in stool
 oval o Tail: moderately tapered
o Short buccal cavity and rhabditiform
esophagus
o Prominent genital primordium
 Filariform Larvae
2. Visceral LM o Cylindrical esophagus
 It may be caused by transient larval migration in o tail is notched and the esophagus to
the life cycles of several parasites such as intestine ratio is 1:1
hookworm, Ascaris lumbricoides, T. spiralis, S. o Bifid tail end
strecoralis and other filarial worms.

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mucosa back to the lumen. If the environmental
conditions are favorable, the larvae will come out
Filariform (L3) larva with the stool to the soil.
of S. stercoralis in an  They transform into adults, which lay eggs, and
unstained wet mount hatching larvae get transformed to adults and so
on.
 If the environmental conditions are not favorable,
the larvae in the stool will molt and transform into
infective filariform larvae, which pierce the
Adult free- living intestine (auto-infection).
female S.  Larvae penetrating the skin from the soil or by
stercoralis. autoinfection are carried by the blood to the
Notice the row of lungs, ascend to the trachea, descend to the
eggs within the esophagus and mature in the small intestine.
female‟s body.
Free-Living Cycle
 The rhabditiform larvae passed in the stool (see
"Parasitic cycle" below) can either molt twice and
become infective filariform larvae (direct
development) or molt four times and become
Free-living adult male free living adult males and females that mate
S. stercoralis. and produce eggs from which rhabditiform
larvae hatch
 The latter in turn can either develop into a new
generation of free- living adults (as represented
in), or into infective filariform larvae .
 The filariform larvae penetrate the human host
skin to initiate the parasitic cycle

Parasitic cycle
 Filariform larvae in contaminated soil penetrate
the human skin , and are transported to the lungs
where they penetrate the alveolar spaces;
 They are carried through the bronchial tree to the
pharynx, are swallowed and then reach the small
 Egg intestine.
 Ellipsoid  In the small intestine they molt twice and become
 Thin-wall containing larva adult female worms.
 The females live threaded in the epithelium of the
LAB DIAGNOSIS small intestine and by parthenogenesis produce
 Rhabditiform larvae in stool eggs, which yield rhabditiform larvae.
 The rhabditiform larvae can either be passed in
LIFE CYCLE the stool (see "Free-living cycle" above), or can
cause autoinfection
 In autoinfection, the rhabditiform larvae become
infective filariform larvae, which can penetrate
either the intestinal mucosa (internal
autoinfection) or the skin of the perianal area
(external autoinfection); in either case, the
filariform larvae may follow the previously
described route, being carried successively to the
lungs, the bronchial tree, the pharynx, and the
small intestine where they mature into adults; or
they may disseminate widely in the body.

 Infective stage: Filariform larvae (L3)

 Diagnostic stage: Unembryonated egg

6. ENTEROBIUS VERMICULARIS
(PINWORM/THREADWORM)

HOST
 After fertilization, the female penetrates the
 Definitive: humans
mucosa of the small intestine and lay eggs in the
submucosa.
 The eggs hatch and the larvae penetrate the
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 PREMID COVERAGE – PARASITOLOGY
UNIT 2-NEMATODES
MODE OF TRANSMISSION
 Ingestion of eggs containing larvae with
contaminated raw vegetables.
 By direct infection from a patient (Fecal-oral
route).
 Autoinfection: the eggs are infective as soon as
they are passed by the female worm. If the
hands of the patient get contaminated with
these eggs, he/she will infect him/herself again
and again.
 Aerosol inhalation from contaminated sheets
and dust
o in the morning before the patient's
first bowel movement
LIFE CYCLE
 Man gets infection with egg containing infective
larva from contaminated hand food or drink.
Following ingestion of infective eggs, the larvae
hatch in the intestine and develop into adult
worms in the large intestine. After mating, the
female worms migrate to the rectum. the gravid
females pass out of the anus and lay their eggs
on the perianal skin, with in about six hours each
egg contains infective larva

GEOGRAPHICAL DISTRIBUTION
 Temperate and cold climates

HABITAT
 Adults: Large intestine
o Hatch: small intestine
 Gravid female: cecum and rectum
o Gravid females migrate nocturnally
outside the anus and oviposit while
crawling on the skin of the perianal
area
 Eggs : feces or deposited on perianal skin

MORPHOLOGY
 Adult
o small white worm with thread-like
appearance
 Male
o Posterior end is curved and
carries a single copulatory
spicule.
 Female
o The posterior end is straight
 Egg  Infective stage: Embryonated egg
o Shape: oval but flattened on one side,  Diagnostic stage: Eggs in perianal fold
rounded on the other side Smooth and
thin but with double shell 7. GNATHOSTOMA SPINIGERUM
o Content: either a small granular mass or
a small curved up larvae HOST
o Color: transparent  Definitive: cats, pigs,dogs, wild animals
o Partially embryonated when shed  1st intermediate: copepods
o More in the folds of skin around the  2nd intermediate: snakes, frogs, chickens
anus  Paratenic: animals that prey 2nd inter host
 Accidental: humans

MODE OF TRANSMISSION
 Ingestion of larvae in raw or undercooked flesh
from certain (freshwater) fish, frogs, snails,
snakes, chicken and pigs.
 Infection can also be acquired from
contaminated water.

GEOGRAPHICAL DISTRIBUTION
 Asia (especially Thailand and Japan) and
Mexico

LAB DIAGNOSIS
 Eggs in feces- stool exam
 Peri-anal swab- Cellulose adhesive tape from
perianal skin
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 PREMID COVERAGE – PARASITOLOGY
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 Wet tropical environment

HABITAT
 Immature worms migrating in subcutaneous
tissue
o Swellings (cutaneous larva migrans)
o Migration to other tissues (visceral lm)
 Tightly coiled within tumors of the
intestinal walls of the definitive hosts

MORPHOLOGY
 Egg
o Ovoid, transparent, mucoid plug on one
end, unembryonated
 Larvae
o Body spines
o Long esophagus
o Head bulb with 4-8 rows of hooklet
o Stout, reddish, slightly transparent
o Curved at both ends
 Male
o Red tails  Infective stage: third-stage larvae (L3)
 Female  Diagnostic stage: larval or immature
o Curved tails than males, larger adults, brain cross section(?)

8. ANGIOSTRONGYLUS CANTONENSIS

HOST
 Definitive: rats/rodents
 Intermediate: snail/slug
 Paratenic: crabs, freshwater shrimps
 Accidental: humans

MODE OF TRANSMISSION
 Eating food contaminated by the larval stage of
A. cantonensis worms

GEOGRAPHICAL DISTRIBUTION
LAB DIAGNOSIS  Southeast asia and pacific islands
 Eosinophilia
 Serology test HABITAT
 Biopsy  Rat lungworm- pulmonary arteries (mature
 Adults are found in the right ventricles of hearts
LIFE CYCLE and the pulmonary arteries.
 The females release their eggs in these arteries.
 In natural definitive hosts, the adult worms reside
in tumor which they induce in the gastric wall MORPHOLOGY
 They deposit eggs that are unembryonated when
passed in the feces. Eggs become embryonated
in water, and eggs release first-stage larvae
 If ingested by a small crustacean (Cyclops, first
intermediate host), the first-stage larvae develop
into second- stage larvae
 Following ingestion of the Cyclops by a fish, frog,
or snake (second intermediate host), the second-
stage larvae migrate into the flesh and develop
into third-stage larvae
 When the second intermediate host is ingested by
a definitive host the third-stage larvae develop
into adult parasites in the stomach wall
 Alternatively, the second intermediate host may
be ingested by the paratenic host (animals such
as birds, snakes, and frogs) in which the third-
stage larvae do not develop further but remain
infective to the next predator
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 PREMID COVERAGE – PARASITOLOGY
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 Females: produced fertilized eggs that develop
into first-stage larvae
 Males
o small copulatory bursa
o very long spicules
 Larvae
o pointed terminal projection on the end
of the tail
LAB DIAGNOSIS
 CSF
LIFE CYCLE
 Adult worms of A. cantonensis live in the
pulmonary arteries and right ventricle of the
normal definitive host image
 The females lay eggs that hatch in the terminal
branches of the pulmonary arteries, yielding first-
stage larvae.
 The first-stage larvae migrate to the pharynx, are
swallowed, and passed in the feces. They
penetrate or are ingested by a gastropod
intermediate host image.
 After two molts, third-stage larvae are produced
image which are infective to mammalian hosts.
When the infected gastropod is ingested by the
definitive host, the third-stage larvae migrate to
the brain where they develop into young adults
image.
 The young adults return to the venous system
and then the pulmonary arteries where they
become sexually mature.
o Of note, various animals act as paratenic
(transport) hosts: after ingesting the
infected snails, they carry the third-stage
larvae which can resume their
development when the paratenic host is
ingested by a definitive host. Humans
can acquire the infection by eating raw or
undercooked snails or slugs infected with
the parasite; they may also acquire the
infection by eating raw produce that
contains a small snail or slug, or part of
one image.
o There is some question whether or not
larvae can exit the infected gastropods in
slime (which may be infective to humans
if ingested, for example, on produce).
Infection may also be acquired by
ingestion of invertebrate paratenic hosts
containing L3 larvae (e.g. crabs,
freshwater shrimp). In humans, larvae
13 | P a g e [ A Y S H A F E I R U Z C . S I S S A Y - B S M T 2 A ]
migrate to the brain, or rarely to the
lungs, where the worms ultimately die
image. Larvae may develop to fourth or
fifth stage in the human host, but seem
to be incapable of maturing fully.
 Infective stage: 3rd stage larva (L3)
 Diagnostic stage: larvae inbrain
FILARIAL WORMS
 The filarial worms have complex life cycles
involving a developmental stage in an insect
vector.
 require an arthropod vector for their
transmission.
 The worms inhabit either the lymphatic system or
the subcutaneous tissues of man.
 The female worm gives rise to a young worm
called microfilaria.
o The microfilariae, when taken by the
arthropod intermediate host during
biting, develop into filariform larvae,
which are the infective stages. Humans
get infected when bitten by the infected
arthropod intermediate host.
9. WUCHERERIA BANCROFTI- NOCTURNAL
(10PM-2AM)
HOST
 Definitive: man
 Intermediate: species of female Culex,
Anopheles, Mansonia and Aedes mosquitoes
MODE OF TRANSMISSION
 Infected female mosquito vector takes a blood
meal. The larvae penetrate the skin through the
bite
GEOGRAPHICAL DISTRIBUTION
 Periodic form is the most widely distributed of
the filarial worms in subtropics and tropics, Asia,
Africa, America, Middle East, Far East, Including
Ethiopia.
 Sub-periodic form is found in Eastern Pacific,
 PREMID COVERAGE – PARASITOLOGY
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Thailand and Vietnam
HABITAT
 Adults: Coiled in lymphatic glands, or lying in
lymphatic vessels, superficial abscesses, or
wandering in retroperitoneal tissues. Found
usually in lymphatic of the lower limb.
 Microfilariae: In lymphatic vessels, and in the
peripheral blood normally at night but during day
in lung and other internal organs (pulmonary
circulation).
 Infective larvae: In the gut and muscles
including mouth parts of certain species of
mosquitoes
MORPHOLOGY
 Adults: Creamy white with smooth surface
o Male
 Gently curved body, Tapered and
rounded swollen head
 Sharply curved tail with two
spicules.
 Unequal spicules
o Female
 Curved tail, tapered front end
and Vulva at cervical area
 Microfilaria
o Sheathed
o Body nuclei are fewer and more distinct
than in other species
o There are no nuclei in the end of the
pointed tail
o Body curves are smooth and few with
Smooth cuticle
o Bluntly rounded anteriorly and pointed
caudally
o Nuclear column (the cells that
constitute the body of the
microfilaria) is loosely packed; the
cells can be visualized individually
and do not extend to the tip of the tail.
LAB DIAGNOSIS
 Blood film examination
o stained by Giemsa or Leishman stain
o The film should be taken by night
LIFE CYCLE
 During a blood meal, an infected mosquito
introduces third-stage filarial larvae onto the skin
of the human host, where they penetrate into the
bite wound
 The microfilariae migrate into lymph and blood
channels moving actively through lymph and
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blood. A mosquito ingests the microfilariae
during a blood meal.
 After ingestion, the microfilariae lose their
sheaths and some of them work their way
through the wall of the proventriculus and
cardiac portion of the mosquito's midgut and
reach the thoracic muscles
 There the microfilariae develop into first-stage
larvae and subsequently into third-stage infective
larvae.
 The third-stage infective larvae migrate through
the hemocoel to the mosquito's prosbocis and
can infect another human when the mosquito
takes a blood meal
 Infective stage: 3rd stage larva (L3)
 Diagnostic stage: Sheathed
Microfilariae
10. BRUGIA MALAYI- NOCTURNAL
HOST
 Definitive: humans
 Intermediate: female Aedes and mansonia
mosquitoes
MODE OF TRANSMISSION
 Bite of infected insect vector when it takes a
blood meal.
GEOGRAPHICAL DISTRIBUTION
 Asia, Malaysia, India, Philippines, Vietnam, China,
and Korea.
 The nocturnal periodic form is the most widely
spread in swamps and rice growing areas
whereas the;
 Nocturnal sub-periodic form is found in fresh
water swamps and forests along major rivers
HABITAT
 Adult: In dilated lymphatic Vessels of man;
usually in the upper limb.
 Microfilariae: Lymph and peripheral blood at
night, and in the lung and internal organs during
day time (pulmonary circulation)
 Infective filariform larvae: In the gut of
 PREMID COVERAGE – PARASITOLOGY
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mosquitoes.
MORPHOLOGY
 Microfilariae
o Body is usually coiled and kinked (has
small angular curves)
o Has a sheath which stains dark pink with
Giemsa and pink- mauve with
hematoxylin & eosin.
o Body nuclei are dense and stain darkly.
o There are two discrete nuclei in the end
of the tail which tapers irregularly.
LAB DIAGNOSIS
 Stained blood films
LIFE CYCLE
 During a blood meal, an infected mosquito
introduces third-stage filarial larvae onto the skin
of the human host, where they penetrate into
the bite wound
 They develop into adults that commonly reside in
the lymphatics . The adult worms resemble those
of Wuchereria bancrofti but are smaller.
 Adults produce microfilariae, which are sheathed
and have nocturnal periodicity. The microfilariae
migrate into lymph and enter the blood
stream reaching the peripheral blood.
 A mosquito ingests the microfilariae during a
blood meal . After ingestion, the microfilariae lose
their sheaths and work their way through the wall
of the proventriculus and cardiac portion of the
midgut to reach the thoracic muscles .
 There the microfilariae develop into first-stage
larvae and subsequently into third-stage larvae
 The third-stage larvae migrate through the
hemocoel to the mosquito's prosbocis and can
infect another human when the mosquito takes a
blood meal.
 Infective stage: 3rd stage larva (L3)
 Diagnostic stage: Sheathed
Microfilariae
Collection Time for B.malayi Microfilariae
 Periodic B.malayi Microfilariae: Collect blood
between 22.00-04.00 hours (time of peak density
is 24.00 hour)
 Subperiodic B.malayi Microfilariae: Collect blood
between 20.00-22.00 hours (time of peak density
is 21.00 hour)
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11. LOA LOA (EYE WORM)- DIURNAL (10AM-4PM)
HOST
 Definitive: man & monkeys
 Reservoir host: simian host
MODE OF TRANSMISSION
 Repeated bites of deerflies (also known as mango
flies or mangrove flies) of the genus Chrysops (C.
Silacea/Dimidiata)
GEOGRAPHICAL DISTRIBUTION
 Central and West Equatorial Africa
 Abundant rubber plantations provide a
favorable environment for the vector to
transmit the disease.
HABITAT
 Adults
o In connective tissues under the skin, in
the mesentery and the parietal
peritoneum.
o They commonly migrate rapidly in the
body and may be seen in the
subconjunctival tissue of the eye or in
thin skinned areas.
 Microfilariae
o In peripheral blood of man during day
time.
o Infective larvae: In the gut, mouth parts
and muscles of tabanide flies of the
genus Chrysops.
 Incubation period is about one year
MORPHOLOGY
 Microfilariae
o Has several curves and kinks
o Has a SHEATH which stains best with
hematoxylin & eosin
o Body nuclei are not distinct and appear
more dense than those of W.bancrofti
o Nuclei extend to the end of the tail which
is TAPERED.
 PREMID COVERAGE – PARASITOLOGY
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LAB DIAGNOSIS
• Detection of microfilaria in peripheral blood,
urine, sputum, CSF - stained with Giemsa or
unstained.
• Eosinophilia
LIFE CYCLE
 During a blood meal, an infected fly introduces
third-stage filarial larvae onto the skin of the
human host, where they penetrate into the bite
wound
 The larvae develop into adults that commonly
reside in subcutaneous tissue
 Adults produce microfilariae which are sheathed
and have diurnal periodicity. Microfilariae
have been recovered from spinal fluids, urine,
and sputum.
 During the day they are found in peripheral blood,
but during the non-circulation phase, they are
found in the lungs
 The fly ingests microfilariae during a blood meal.
After ingestion, the microfilariae lose their
sheaths and migrate from the fly's midgut
through the hemocoel to the thoracic muscles of
the arthropod
 There the microfilariae develop into first-stage
larvae and subsequently into third-stage infective
larvae
 The third-stage infective larvae migrate to the
fly's proboscis and can infect another human
when the fly takes a blood meal
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 Infective stage: 3rd stage larva (L3)
 Diagnostic stage: Sheathed
Microfilariae
12. ONCHOCERCA VOLVULUS
HOST
 Definitive: humans
 Intermediate: black Simulium fly (s. damnosum)
MODE OF TRANSMISSION
 Spread by the bite of an infected FEMALE
Simulium blackfly
GEOGRAPHICAL DISTRIBUTION
 Fast-running rivers in the forests and Savannah
areas of west and central Africa.
HABITAT
 Adults:- Subcutaneous nodules and in skin
 Microfilariae: subcutaneous tissue fluids
and not in blood.
 Infective larvae: In the gut, mouth parts and
muscles of Simulium black fly.
MORPHOLOGY
 Adults
o Male: curved and bulbous tail
 Microfilariae
o Non-sheathed and head end is slightly
enlarged
o Anterior nuclei are positioned side by side
o There are no nuclei in the end of the tail
which is long and pointed.
o Present in the subcutaneous tissue
fluids and not in blood.
LAB DIAGNOSIS
 Skin snips (Superficial Biopsy)
 Heavy infections: urine, blood, body fluids
 Peripheral blood, urine, and sputum but are
typically found in the skin and in the
lymphatics of connective tissues
LIFE CYCLE
 During a blood meal, an infected black fly
(genus Simulium) introduces third-stage
filarial larvae ontothe skin of the human host,
where they penetrate into the bite wound
 In subcutaneous tissues the larvae develop
into adult filariae, which commonly reside in
nodules in subcutaneous connective tissues
 Adults can live in the nodules for
approximately 15 years.
 In the subcutaneous nodules, the female
 PREMID COVERAGE – PARASITOLOGY
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worms are capable of producing
microfilariae for approximately 9 years.
 The microfilariae, unsheathed, have a life
span that may reach 2 years.
 A black fly ingests the microfilariae during a
blood meal .After ingestion, the microfilariae
migrate from the black fly's midgut through
the hemocoel to the thoracic muscles
 There the microfilariae develop into first-
stage larvae and subsequently into third-
stage infective larvae.
 The third-stage infective larvae migrate to
the black fly's proboscis and can infect
another human when the fly takes a blood
meal
 Infective stage: 3rd stage larva (L3)
 Diagnostic stage: NONSheathed
Microfilariae
13. MANSANELLA OZZARDI
HOST
 Definitive: Man
 Intermediate host: Simulium and Culicoides
species
MODE OF TRANSMISSION
 Infective larvae are transmitted by the bite of
culicoides and simulium
GEOGRAPHICAL DISTRIBUTION
 West Indies and South America.
HABITAT
 Adults: In the mesentery, retroperitoneal tissue,
abdominal wall, and lymphatic vessels of man.
 Microfilariae: In peripheral blood or skin of man
any time.
 Infective larvae: In the gut, and mouth parts
of culicoides and simulium black flies
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MORPHOLOGY
 Microfilariae
o Unsheathed and body nuclei are not
distinct but the anterior nuclei are
positioned side by side.
o There are no nuclei in the end of the tail
which is long and pointed,
o End of tail is bent, small hook-like shape
o Non-periodic
M. ozzardi
LAB DIAGNOSIS
 Stained blood films
 Skin snip (occasional)
LIFE CYCLE
 During a blood meal, an infected arthropod
(midges, genus Culicoides, or blackflies,
genus Simulium) introduces third-stage filarial
larvae onto the skin of the human host, where
they penetrate into the bite wound
 They develop into adults that commonly reside in
subcutaneous tissues Adult worms are rarely
found in humans.
 Adults produce unsheathed and non-periodic
microfilariae that reach the blood stream
 The arthropod ingests microfilariae during a
blood meal .After ingestion, the microfilariae
migrate from the arthropod's midgut through
the hemocoel to the thoracic muscles
 There the microfilariae develop into first- stage
 PREMID COVERAGE – PARASITOLOGY
UNIT 2-NEMATODES
larvae and subsequently into third-stage infective where they penetrate into the bite wound
larvae  They develop into adults that reside in body
 The third-stage infective larvae migrate to cavities, most commonly the peritoneal cavity
arthropod's proboscis and can infect another or pleural cavity, but less frequently in the
human when the arthropod takes a blood meal pericardium
 Adults produce unsheathed and subperiodic
 Infective stage: 3rd stage larva (L3) microfilariae A midge ingests microfilariae
 Diagnostic stage: NONSheathed during a blood meal
Microfilariae  After ingestion, the microfilariae migrate
from the midge's midgut through the
14. MANSANELLA PERSTANS hemocoel to the thoracic muscles of the
arthropod
HOST  There the microfilariae develop into first-
 Definitive: man stage larvae and subsequently into third-
 Intermediate: female Culicoides stage infective larvae
 The third-stage infective larvae migrate to
MODE OF TRANSMISSION the midge's proboscis and can infect another
 Bite of infected Culicoides. human when the midge takes a blood meal

GEOGRAPHICAL DISTRIBUTION
 South America and tropical Africa

HABITAT
 Adults: In the serous cavities, mesentery, and
connective tissue, especially the retroperitoneal.
 Microfilariae: In peripheral blood at any time
because non-periodic guts mouth parts
 Adults: In connective tissues under the skin, in
the mesentery and the parietal peritoneum. They
commonly migrate rapidly in the body and may
be seen in the subconjunctival tissue of the eye
or in thin skinned areas.
 Microfilariae: In peripheral blood of man during
day time.
 Infective larvae: In the gut, mouth parts and
muscles of chrysops fly

MORPHOLOGY
 Microfilariae
o Nonsheathed, body nuclei are irregular  Infective stage: 3rd stage larva (L3)
Large nucleus in tip vectors  Diagnostic stage: NONSheathed
o Nuclei extend to the end of the tail Microfilariae
(blunt) which is rounded and there is a
large nuclei at the tip. 15. MANSANELLA STREPTOCERCA
o Nonperiodic- found in day and night
blood. HOST
 Definitive: Man
 Intermediate: Culicoides

MODE OF TRANSMISSION
 Bite of infected Culicoides.

GEOGRAPHICAL DISTRIBUTION
 Found only in the rain forest of Africa especially
in Ghana, Nigeria, Zaire and Cameroon.

M. perstan HABITAT
 Adults: In cutaneous connective tissues of the
LAB DIAGNOSIS chimpanzee
 Stained blood films  Microfilariae: In the skin of man by day and by
night, but are not found in the blood
LIFE CYCLE
 During a blood meal, an infected midge (genus
Culicoides) introduces third-stage filarial
larvae onto the skin of the human host,
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 PREMID COVERAGE – PARASITOLOGY
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 Infective larvae: In the gut, muscle tissue and
mouth parts of Culicoides midges

MORPHOLOGY
 Adults: are recovered only in animal hosts and
in man only microfilariae is known.
 Microfilariae
o Nuclei extends to tip of the tail
o unsheathed
o When immobile, the tail usually appears
hook-shape and its tip is rounded. In
fresh preparations, the tip of the tail may
appear forked.
o Microfilariae are found in skin and do
not circulate in the blood

M. streptocerca

LAB DIAGNOSIS
 Skin snip any time
 Differentiation from O.volvulus is by its smaller
size, single file anterior nuclei and tail features.
 Less motile than O.volvulus in wet prepare

LIFE CYCLE
 During a blood meal, an infected midge (genus
Culicoides) introduces third-stage filarial larvae
onto the skin of the human host, where they
penetrate into the bite wound
 They develop into adults that reside in the
dermis, most commonly less than 1 mm from the
skin surface
 Adults produce unsheathed and non-periodic
microfilariae, which reside in the skin but can also
reach the peripheral blood
 A midge ingests the microfilariae during a blood
meal
 After ingestion, the microfilariae migrate from the
midge's midgut through the hemocoel to the
thoracic muscles.
 There the microfilariae develop into first- stage
larvae and subsequently into third-stage larvae .
 The third-stage larvae migrate to the midge's
proboscis and can infect another human when the
midge takes another blood meal
 Infective stage: Filariform larvae (L3)
 Diagnostic stage: Unembryonated egg
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16. DRACUNCULUS MEDINENSIS (GUINEA OR
MEDINA WORM)
HOST
 Definitive: man
 Intermediate: Cyclops or related crustaceans
MODE OF TRANSMISSION
 Drinking unfiltered or not boiled water that
contains Cyclops species.
HABITAT
 Adults: thread like
o Female in the subcutaneous tissues and
intermuscular connective tissues the of
the lower extremities; especially around
the ankle.
o Male resides in the retroperitoneal
connective tissues and dies shortly after
copulation
 First stage larvae: In the ulcers or blisters.
 Infective Filariform larvae: In the hemocoel
of Cyclops .
MORPHOLOGY
 Adults: White with smooth surface
o Male: coiled posterior end.
 PREMID COVERAGE – PARASITOLOGY
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o Female emerges and releases larvae. The larvae are
 The longest nematode of man ingested by a copepod and after two weeks
 Has cylinderical esophagus (and two molts) have developed into
 Viviparous infective larvae. Ingestion of the copepods
o Gravid Female Worms closes the cycle
 body cavity is almost fully
occupied by a uterus
distended with rhabditiform
larvae
 Larva:
o Rounded anterior end
o Long and pointed tail
o Has Rhabiditiform esophagus

 A digestive tube and cuticular annulations

distinguish the larvae from microfilariae

LAB DIAGNOSIS
1. Clinical: Observation of blister, worm or
larvae
2. Histologic features of subcutaneous sinus
tract
3. Eosinophilia and radiographic evidence

LIFE CYCLE
 The larvae are released in the stomach,
penetrate the intestinal wall and find their way
to the subcutaneous tissue.
 Mating takes place in the axillary or inguinal
regions 3 months after infection.
 The male worms then die in the tissue and the
female worms move down to the limbs within  Infective stage: 3rd stage larvae (L3)
10 months.  Diagnostic stage: L1 larvae
 In about 1 year, female worms in the
subcutaneous tissue provoke the formation of
a burning blister in the skin of the legs.
 When in water, the blister bursts, and about 5
cm of the worm is extruded from the resulting
ulcer - thus releasing many thousands of first
stage larvae
 The larvae swim in water and are ingested by the
intermediate host - Cyclops species- within about
4 days.
 Inside the Cyclops, the larvae molt twice and
become infective in 2 weeks

 Humans become infected by drinking

unfiltered water containing copepods (small
crustaceans) which are infected with larvae
of D. medinensis
 Following ingestion, the copepods die and
release the larvae, which penetrate the host
stomach and intestinal wall and enter the
abdominal cavity and retroperitoneal space
 After maturation into adults and copulation,
the male worms die and the females (length:
70 to 120 cm) migrate in the subcutaneous
tissues towards the skin surface
 Approximately one year after infection, the
female worm induces a blister on the skin,
generally on the distal lower extremity, which
ruptures.
 When this lesion comes into contact with
water, a contact that the patient seeks to
relieve the local discomfort, the female worm
20 | P a g e [ A Y S H A F E I R U Z C . S I S S A Y - B S M T 2 A ]