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Oral-fecal transmitted Diseases

(Feces mainly in soil)

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ASCARIASIS
A helminthes infection of the small intestine generally
associated with few or no symptoms.
Migrant larvae may cause itching, wheezing and
dyspnea, fever, cough and productive of bloody sputum
may occur.
Abdominal pain may arise from intestinal or duct
(billiary, pancreatic) obstruction.
Serious complications include bowel obstruction due
to knotted or intertwined worms.

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Mode of transmission
• Ingestion of infective eggs (embryonated) from soil
contaminated with human feces or uncooked produce
contaminated with soil containing infective eggs but
not directly from person to person or from fresh
faeces.

• Occasionally inhalation of contaminated dust

• Children playing in contaminated soil may acquire the

parasite from their hands.
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Life cycle
Transmission
1. Infective eggs ingested in food or from
contaminated hands

Human host
2. Larvae hatch. Env’t
3. Migrate through liver 7. Eggs become infective
and lungs (embryonated) in soil in
4. Pass up trachea and are
swallowed 30-40 days
5. Mature worm in small 8. Infective eggs
intestine contaminate the env’t
6. Eggs produced and
passed in feces 4

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Cont…
Diagnosis
Microscopic identification of eggs in stool
sample
Adult worms pass from anus, mouth or
nose
Treatment
Albendazole
Mebendazole
Piperazine
Levamisole

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Prevention and control

Treatment of cases

Sanitary disposal of feces

Prevent soil contamination in areas where

children play

Promote good personal hygiene (hand washing).

Health Education and Deworming

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Trichuriasis (whip worm)

Trichuriasis is an infection of the human
intestinal tract caused by the nematode
Trichuris trichiura
Reservoir- Humans
M/t – feco – oral
I/p – indefinite
P/c: several years in untreated carriers.
S & R: susceptibility is universal
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Mode of transmission
• Indirect, particularly through ingestion of
contaminated vegetables.

• Not immediately transmissible from person to

person.

• Children are more susceptible to infection than

adults due to their nature of playing with
faecally contaminated soil.
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Clinical Manifestation
• Most infections are asymptomatic.

• Large worm burden may be associated,

especially in children, with diarrhea of long
duration, dysentery
dysentery, mucoid stools, abdominal
pain and tenderness, dehydration, anemia,
weight loss and weakness.

• Rectal prolapse may occur, particularly in

children.

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Cont….
Diagnosis
Demonstration of eggs in feces

Treatment
Albendazole or Mebendazole

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Prevention and control

• Sanitary disposal of feces

• Maintaining good personal hygiene (i.e.

washing hands and vegetables and other soil
contaminated foods)

• Cutting nails especially in children

• Treatment of cases.

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Enterobiasis (Pin worm)

• D/n:- Enterobiasis is an infection of the human
intestinal tract by the pin worm Enterobius
vermicularis.
• C/ A: Enterobius vermicularis
• M/T: direct transfer of infective eggs by hands
from anus to mouth of the same or another
person or indirectly through clothing, bedding,
food or other articles contaminated with eggs of
the parasite.
• I/p. 2-6 weeks
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Epidemiology

• Enterobiasis is found all over the world. It is more

common in temperate countries than tropics.

• Prevalence is highest in school-aged (5-10 yrs)

children followed by preschools is lower in adults
except for mothers of infected children.

• Infection usually occurs in more than one family

member.
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Mode of transmission

• Direct transfer of infective eggs by hands from

anus to mouth of the same or another person
or

• Indirectly through clothing, bedding, food or

other articles contaminated with eggs of the
parasite.

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Clinical Manifestation
Nocturnal Perianal itching

Insomnia

Irritability

Sometimes secondary infection of the scratched

skin (bacteria)

Female genital tract, causing vulvovaginitis

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Cont…
Diagnosis
Stool microscopy for eggs or female
worms
Treatment
Mebendazole 100mg po stat or
Albendazole-400mg po

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Prevention and control

• Educate the public about hygiene (i.e. hand
washing before eating or preparing food,
keeping nails short and discourage nail biting).

• Treatment of cases

• Reduce overcrowding in living

accommodations.

• Provide adequate toilets.

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Strongyloidiasis
• Definition: - is an infection by the nematode
strongyloides stercoralis, the female of which
usually is embedded in the mucosa of the
small intestine of humans.

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Etiology - nematode strongyloides stercoralis

• S. stercoralis is distinguished by its ability—
unusual among helminths—to replicate in the
human host.
• This capacity permits ongoing cycles of
autoinfection as infective larvae are internally
produced.
• Strongyloidiasis can thus persist for decades
without further exposure of the host to
exogenous infective larvae.
• In immunocompromised hosts, large numbers of
invasive Strongyloides larvae can disseminate
widely and can be fatal.
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Epidemiology:
• Mainly distributed in tropical areas,
particularly in South East Asia, sub-Saharan
Africa, and Brazil.

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Mode of transmission

• Humans acquire strongloidiasis when

filariform larvae in faecally contaminated soil
penetrate the skin or mucous membranes.

• The larvae then travel to the lungs from the

bloodstream to reach the epiglottis. They are
then swallowed to the small intestine

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S. stercoralis: Rhabditiform larva (First stage larva)

• The larvae are immediately hatched out of the

eggs laid by the gravid female in the mucosa of
the small intestine, hence are found frequently in
the faeces.

• They are actively motile, unsheathed and

measure 200 to 300 µm in length and 16 µm in
breadth.

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Strongyloides stercoralis: Filariform larva

• The filariform larvae are the infective stages

of the parasites developed from the
rhabditiform larvae.

• They cause infection by penetration of the

skin.

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Strongyloidiasis:
Reservoir, sources & transmission of infection

The soil contaminated with human faeces is the main

source of infection for man.

• Reservoir host is the infected man, less commonly dog.

Man acquires infection:

• Commonly by penetration of the skin by the filariform larvae.

• Less commonly, by transmission of the larvae from mother to the

infant through the milk (transmammary transmission).

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TRANSMISSION ....
• Unusually, by ingestion of food and drink contaminated
with larvae (oral transmission), and
• By organ transplants such as kidney transplant to a new
host.
• The warm and moist soil, and humid climate favour the
rapid multiplication by free-living generations of
parasites and spread of the disease in tropics and
subtropics.

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Strongyloides stercoralis: Life cycle

• Parasitic female inhabits the mucosa of the small intestine
(especially duodenum and upper jejunum) of man.

• Life cycle is completed in a single host, man (Fig. 8).

• No intermediate host is needed.

• Unlike other helminths, no change of host is required as the

parasite undergoes a hyperinfection form of development.

• Man acquires infection mainly through penetration of the skin

and occasionally, the buccal mucosa, by the infective
filariform larvae.
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• These larvae localize in the small blood vessels and are carried
by circulation to the heart and then to lungs.

• They leave pulmonary capillaries, enter the alveoli and move

upward to trachea.

• They then are swallowed back to the small intestine.

• In the duodenum and jejunum, they are transformed into

parthenogenic females, which then burrow deep into the
mucosa and begin to produce the eggs in about 28 days.

• The rhabditiform larvae hatch out of the eggs and migrate back
to the lumen of the intestine, from where they are passed out in
the faeces.

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Types of development undergone by the rhabditiform

larvae of S. stercoralis

Direct cycle (host-soil-host)

• The first stage rhabditiform larvae passed in the faeces may

develop in the soil → moult into the second stage rhabditiform
larvae and then finally into the third-stage filariform infective
larvae within 3 to 4 days.

• In this cycle, each rhabditiform larva gives rise to only one

filariform larva.

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Indirect cycle outside the host

• In this cycle, each rhabditiform larva, through a free-living
sexual generation, develops into free-living males and females
within a short period of 24 to 30 hours.

• The males then fertilize the females.

• The gravid females subsequently begin to lay the eggs that

hatch to the second batch of rhabditiform larvae.

• These larvae within 3 to 4 days are transformed into the

infective filariform larvae.

• Each pair from the first batch of rhabditiform larvae gives rise
to nearly 30 filariform larvae.

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Autoinfection

• In this condition, the rhabditiform larvae before

being excreted out in the stool develop into
infective filariform larvae in the intestinal
mucosa.

• They penetrate the intestinal wall and cause the

infection.

• The rhabditiform larvae in the faeces deposited in

the perianal skin can also grow into filariform
larvae and cause infection by penetration of the
skin.

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Clinical features
• Mild infections are usually asymptomatic.
• Recurrent urticaria (skin rash), often involving the
buttocks and wrists, is the most common
cutaneous manifestation.
• Adult parasites burrow into the duodeno-jejunal
mucosa and can cause abdominal (usually
midepigastric) pain, which resembles peptic ulcer
pain.
• Nausea, diarrhea, GI bleeding, mild colitis and
weight loss can occur.

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Disseminated strongyloidiasis/Hyperinfection syndrome

1. Disseminated strongyloidiasis is caused by S. stercoralis in

persons, whose immune status is reduced by either
administration of immunosuppressive therapy such as
corticosteroid drugs, or by underlying illness such as
lymphocytic leukemia, malignancy, malnutrition, leprosy etc.
2. It is characterized by massive larval invasion of the lung or any
other organs including the central nervous system (CNS).
3. It manifests as intense abdominal pain, Gram-negative
septicemia and often shock.
4. Eosinophilia characteristically, is absent.
5. These cases respond poorly to specific treatment with
thiabendazole and
6. Mortality is high despite treatment. It is, therefore, important to
screen and treat the cases for strongyloidiasis before
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Diagnosis

• In uncomplicated stongyloidiasis, the finding

of rhabditiform larvae in feces is diagnostic.

• Serial stool examination may be necessary to

detect the larvae.

• Eggs are almost never seen in stool because

they hatch in the intestines.
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Treatment:
• Thiabendazole, which is still the drug of
choice, is given in a dose of 25mg/kg BID
(max. 3g/day) for 3 days.
• Ivermectin 200μg/kg as a single dose daily for
1 or 2 days is better tolerated.
• Albendazole 400 mg can also be used in
simple infections and produces 80% reduction
in egg count and 200mg/day oral dose for 3
days gives 100% cure.

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Prevention and control

• Proper disposal of human excreta (feces)

• Personal hygiene including use of footwear.

• Case treatment.

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Hook worm disease

A common chronic parasitic infection with a
variety of symptoms usually in proportion of
the degree of anemia.
I/Agent
Ancylostoma duodenale
Necator americanus
Ancylostoma ceylanicum
Ancylostoma cininum

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Cont…
Reservoir-Humans and cats
M/t - through skin penetration by the
infective larvae
I/ p - few weeks - many months -iron
intake of the host
P/c - infected people can contaminate
the soil for several years in the absence
of treatment
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Clinical Manifestation
Larval migration to the skin
Produces transient (short lasting)
localized maculopapular rash
associated with itching called
ground itch
Larval migration to lungs
Produces cough, wheezing and transient pneumonitis
Blood sucking
Light infection – no symptom
Heavy infection – result in symptoms of like epigastric
pain and tenderness
Further loss of blood leads to anemia manifested by
exertional dyspnea, weakness.
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Cont...
Diagnosis: Demonstration of hookworms in
stool specimen
Specific treatment
Mebendazole, Albendazole, Levamisole are
recommended
Prevention and control
Sanitary disposal of feces
Wearing of shoes
Case treatment.
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NURSING RESPONSIBILITIES IN THE MANAGEMENT

OF Feco - Oral transmitted diseases:
• Control of diarrheal diseases including dysentery is only
possible when the problem of stool disposal is solved
(deep pit latrines in rural areas).
• Providing hand washing facilities at toilets: wash hands
after going to toilet, wash hands before cooking or eating.
• Fly control by proper refuse disposal and proper disposal
of feces.
Screen toilets, cover latrines
Screen kitchens and food stores
Store left-over food where flies cannot reach it
Spray with residual insecticides

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• Food should always be properly cooked.

• Raw vegetables and fresh fruits without intact skins
should be avoided.
• Milk should be boiled or pasteurized.
• Protection, purification and chlorination of public water.
• Health education based on dangers of bottle–feeding;
encourage cup/spoon feeding methods and encourage
prolonged breastfeeding.
• Demonstrate prevention of dehydration by homemade
soup or salt solution.
• Appropriate treatment of cases

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