‭Clinical Parasitology (Lec)‬

‭MODULE 2: Nematodes‬

‭Taxonomic Classification‬

‭‬ M
● ‭ ale (right) vs Female (left)‬
‭●‬ ‭The spicule allow the male worms to latch on to the‬
‭ ETAZOANS‬
M ‭females‬
‭-‬ ‭Eukaryotic multicellular organisms: have body‬
‭systems‬ ‭Classification of Adult Female Worms‬
‭-‬ ‭Kingdom Animalia.‬
‭-‬ ‭Lays eggs in unsegmented stage‬
‭-‬ ‭Bilaterally symmetrical: left and right parts of the‬
‭(unembryonated); eggs need to‬
‭body are the same‬
‭OVIPAROUS‬ ‭develop when released in soil‬
‭-‬ ‭They show division of labour: have males and‬
‭-‬ ‭“HAT”: Hookworm, Ascaris,‬
‭females‬
‭Trichuris‬
‭-‬ ‭Cells lack a cell wall‬
‭-‬ L ‭ ays eggs in segmented stage‬
‭NEMATODES (ROUNDWORMS)‬ ‭(embryonated); usually causes‬
‭OVOVIVIPA-‬
‭autoinfection‬
‭ROUS‬
‭ orphology‬
M ‭-‬ ‭“ES”: Enterobius vermicularis,‬
‭●‬ ‭Have elongated, cylindrical,unsegmented bodies‬ ‭Strongyloides stercoralis‬
‭tapering on both ends‬ ‭VIVIPAROUS/‬ -‭ ‬ L
‭ ays full developed larva‬
‭●‬ ‭Sexes are separated (dioecious)‬ ‭LARVIPAROUS‬ ‭-‬ ‭All tissue nematodes‬
‭●‬ ‭With definite antero-posterior axis (imaginary line‬
‭that separates the worm)‬
‭●‬ ‭Complete digestive & reproductive system; no‬ ‭ hemoreceptors‬
C
‭circulatory and respiratory system‬ ‭-‬ ‭Uses sensory organs, no eyes and ears, to detect‬
‭chemical signal around them‬
‭-‬ ‭Cephalic chemoreceptors (all‬
‭AMPHID‬ ‭nematodes have amphid)‬
‭-‬ ‭At the anterior (mouth region)‬
‭-‬ C ‭ audal chemoreceptors (all‬
‭nematodes have phasmid EXCEPT:‬
‭ HASMIDS‬
P ‭“TCT”- Trichuris-Capillaria-‬
‭Trichinella (aphasmids)‬
‭-‬ ‭At the posterior (tail region)‬

‭ ife cycle‬
L
‭●‬ ‭Morphological Forms (Eggs → Larvae → Adult)‬
‭●‬ ‭Host requirement: Homoxenous (1 host only) &‬
‭Heteroxenous (2 or more host)‬
‭●‬ ‭Host requirement: Direct & Indirect‬

‭Irish Sabile‬ ‭1‬

‭Habitat‬ ‭OVA EXAMINATION‬
I‭ntestinal tract of man, tissues &‬
‭Main Habitat‬
‭other sites‬
‭Heart to Lung‬ ‭ SH - Ascaris, Strongyloides,‬
A
‭Migration‬ ‭Hookworms‬
‭Animal as Natural‬
‭no maturity in the human body‬
‭Hosts‬

‭Intestinal Roundworms‬

‭Tissue & Extra-Intestinal Roundworms‬

‭ DULT GROSS EXAMINATION‬

A
‭●‬ ‭Elongated, cylindrical bodies with‬
‭ hape &‬
S
‭tapered ends‬
‭Color‬
‭●‬ ‭Whitish or pinkish worms‬
‭Cuticle‬ ‭●‬ ‭with visible fine striations‬
‭INTESTINAL ROUNDWORMS (PHASMIDS)‬ ‭Mouth‬ ‭●‬ ‭Triangular, trilobate lips‬
‭‬M
● ‭ ales: 10-31 cm, curved posterior ends‬
‭ SCARIS LUMBRICOIDES‬
A ‭Sexes‬ ‭●‬ ‭Females: 22-35 cm, straight posterior‬
-‭ ‬ ‭the most common & largest intestinal nematode‬ ‭ends‬
‭-‬ ‭AKA“giant roundworm” “large intestinal roundworm”‬
‭Mouth‬ ‭●‬ ‭Triangular, trilobate lips‬
‭“Eelworm”‬
-‭ ‬ ‭soil-transmitted helminth (STH)‬
‭-‬ ‭Produces PI-3 (Pepsin Inhibitor 3 = prevents it from‬
‭being digested) & phosphorylcholine (prevents‬
‭lymphocyte proliferation, mechanical protection)‬
‭-‬ ‭Forms: Egg/ova → Larva → Adult‬

‭ IFE CYCLE‬
L
‭●‬ ‭MOT: Ingestion of embryonated eggs‬
‭ ‬ ‭Habitat: Small intestine (“C-NASA”)‬
●
‭●‬ ‭Infective stage: Embryonated eggs‬

‭ClinPara Lec M2‬ ‭2‬

‭●‬ D ‭ iagnostic stage: Adult worms, Fertilized &‬ ‭ ethods‬
M
‭Unfertilized egg‬ ‭1.‬ ‭Direct Fecal Smear‬
‭●‬ ‭Humans are the ONLY definitive host‬ ‭2.‬ ‭Kato Katz & Kato Thick: preferred since more stool‬
‭●‬ ‭No intermediate host‬ ‭sample is analyzed‬
‭3.‬ ‭Concentration techniques‬
‭●‬ ‭Formalin-ether/ ethyl acetate concentration‬
‭technique‬

‭TREATMENT‬

‭ ntihelminthic drugs‬‭(prevent the uptake of glucose‬

A
‭by the parasite = no energy)‬
‭1.‬ ‭Albendazole (400 mg single dose)‬
‭2.‬ ‭Mebendazole (500 mg single dose)‬
‭ ATHOGENESIS AND CLINICAL MANIFESTATIONS‬
P ‭3.‬ ‭Pyrantel pamoate (10 mg/kg single dose)‬
‭●‬ ‭Ascariasis (“Sandbox Infection”)‬
‭●‬ ‭Pulmonary = Ascaris pneumonitis, Loeffler’s‬ ‭PREVENTION‬
‭Syndrome‬
‭●‬ ‭Intestinal = Pot belly, Ascaris bolus (obstruction)‬ ‭WASHED Framework‬
‭●‬ ‭Extra-intestinal = Biliary‬ ‭●‬ ‭Access to potable water‬
‭ascariasis, acute appendicitis‬ ‭●‬ ‭Drainage and disposal/re-use/‬
‭Water‬
‭or pancreatitis, acute‬ ‭recycling of household wastewater‬
‭peritonitis‬ ‭(also referred to as gray water)‬
‭●‬ A ‭ ccess to safe and sanitary‬
‭ SCARIS PNEUMONITIS‬
A ‭sanitation facilities‬
‭-‬ ‭Due to larval migration as they enter the air sacs‬ ‭●‬ ‭Safe collection, storage, treatment,‬
‭causing immune hypersensitivity‬ ‭ anitation‬
S
‭and disposal (feces and urine)‬
‭-‬ ‭Initial symptoms: difficulty of breathing, fever,‬ ‭●‬ ‭Management/re-use/recycling of‬
‭eosinophilia‬ ‭solid waste‬
‭-‬ ‭Severe: dyspnea, dry productive cough, X-ray‬
‭scattered infiltration,‬ ‭●‬ A ‭ ppropriate information regarding‬
‭-‬ ‭occasional hemoptysis‬ ‭prevention and treatment of STH‬
‭infections‬
‭ OEFFLER’S SYNDROME‬
L ‭●‬ ‭Dissemination of key messages to‬
‭promote the following practices:‬
‭-‬ ‭Symptoms:‬ ‭Hygiene‬
‭a.‬ ‭Safe water storage‬
‭1.‬ ‭Marked eosinophilia + pneumonitis‬ ‭Education‬
‭b.‬ ‭Safe handwashing and bathing‬
‭2.‬ ‭Mild respiratory symptoms‬
‭practices‬
‭3.‬ ‭Transient migratory pulmonary infiltrates‬
‭c.‬ ‭Safe treatment of foodstuffs‬
‭d.‬ ‭Latrine use‬
‭ OT BELLY/ASCARIS BOLUS‬
P
‭e.‬ ‭Use of footwear‬
‭-‬ ‭Obstruction of adult worms in the intestine‬
‭-‬ ‭Common complaint: vague abdominal pain‬ ‭●‬ R
‭ egular mass drug administration‬
‭Deworming‬
‭-‬ ‭Moderate infections: lactose intolerance and‬ ‭(twice a year for school-age children)‬
‭vitamin A malabsorption‬
‭-‬ ‭Heavy infections: bowel obstruction,‬ ‭EPIDEMIOLOGY‬
‭intussusception, bowel infarction and intestinal‬ ‭●‬ G ‭ eographical distribution: Cosmopolitan but occurs‬
‭perforation.‬ ‭more in tropical regions (Southeast Asia, Africa,‬
‭Central & South America)‬
‭ XTRA-INTESTINCAL ASCARIASIS‬
E ‭●‬ ‭Age Group: Children ages 5 to 15 years have the‬
‭-‬ ‭Biliary ascariasis, acute appendicitis or pancreatitis,‬ ‭highest intensities of infection‬
‭acute peritonitis‬ ‭●‬ ‭1.2 billion individuals are infected, (70% from Asia)‬
‭●‬ ‭2,000 die annually‬
‭LABORATORY DIAGNOSIS‬

‭ pecimen‬
S
‭●‬ ‭Stool, sputum, duodenal aspirate‬

‭ClinPara Lec M2‬ ‭3‬

 ‭ NTEROBIUS VERMICULARIS‬
E ‭PATHOGENESIS AND CLINICAL MANIFESTATIONS‬
-‭ ‬ ‭“Pinworm”,“Seatworm”‬
‭-‬ ‭Old Name:Oxyuris vermicularis‬ ‭ NTEROBIASIS - PRURITUS ANI‬
E
‭-‬ ‭Nocturnal parasite‬ ‭●‬ ‭Perianal itching‬
‭-‬ ‭Causative agent of Pruritus ani (perianal itching)‬ ‭●‬ ‭Other Symptoms: insomnia, restlessness, poor‬
‭appetite, weight loss, irritability, grinding of teeth, &‬
‭ VA EXAMINATION‬
O ‭abdominal pain‬
‭●‬ ‭Asymmetrical, with one side flattened and the other‬ ‭●‬ ‭Cases are more common on children‬
‭side convex (“D shaped”)‬ ‭●‬ ‭Familial disease‬
‭‬
● ‭Translucent shell consists of:‬ ‭●‬ ‭Autoinfection is possible‬
‭●‬ ‭outer triple albuminous covering‬
‭●‬ ‭inner embryonic lipoidal membrane‬ ‭LAB DIAGNOSIS‬

‭ pecimen:‬
S
‭●‬ ‭Eggs on perianal‬
‭region, stool (adults &‬
‭ova)‬

‭ ethods‬
M
‭LARVA & ADULT EXAMINATION‬ ‭1.‬ ‭Direct Fecal Smear‬
‭2.‬ ‭Graham’s Scotch Tape‬
‭ dult‬
A ‭Swab‬
‭●‬ ‭Cuticular alar expansions (cephalic alae)‬
‭●‬ ‭Esophageal bulb‬
‭●‬ ‭Male→ 2-5 mm, w/ curved tail and‬
‭a single spicule‬
‭●‬ ‭Female → 8-13 mm, w/ long‬
‭pointed tail‬

‭TREATMENT‬
‭‬ M
● ‭ ebendazole (100 single dose)‬
‭ arva‬
L ‭●‬ ‭Albendazole (400 mg PO single dose)‬
‭●‬ ‭has the characteristic esophageal bulb, but has no‬ ‭●‬ ‭Pyrantel pamoate‬
‭cuticular expansion on the anterior end‬
‭ revention‬
P
‭LIFE CYCLE‬ ‭●‬ ‭Personal cleanliness and personal hygiene‬
‭●‬ M ‭ OT: Ingestion of embryonated eggs (fecal-oral‬ ‭●‬ ‭WASHED framework‬
‭route), inhalation, retroinfection‬
‭●‬ ‭Habitat: Large intestine (E.T)‬ ‭EPIDEMIOLOGY‬
‭●‬ ‭Infective stage: Embryonated eggs‬ ‭●‬ O ‭ ccurs in both temperate and tropical regions of‬
‭●‬ ‭Diagnostic stage: Eggs on perianal folds‬ ‭the world‬
‭●‬ ‭Humans are the ONLY definitive host‬ ‭●‬ ‭The only intestinal nematode infection that cannot‬
‭●‬ ‭No intermediate host‬ ‭be controlled through sanitary disposal of human‬
‭feces‬
‭●‬ ‭208.8 million infected persons in the world‬
‭●‬ ‭Locally, prevalence is consistently higher in‬
‭females(16%)compared to males (9%). Eggs were‬
‭found in nail clippings of school children.‬

‭ClinPara Lec M2‬ ‭4‬

 ‭ OOKWORMS‬
H ‭ADULT MALE HOOKWORM‬
‭●‬ ‭Necator americanus: New World Hookworm,‬
‭American murderer‬ ‭ ale copulatory bursa‬
M
‭●‬ ‭Ancylostoma duodenale:‬ ‭●‬ ‭N. americanus →‬
‭Old World Hookworm,‬ ‭Bipartite: fused &‬
‭Germ of Laziness‬ ‭barbed spicules‬
‭‬
● ‭Soil-transmitted helminths‬ ‭●‬ ‭A. duodenale → Tripartite: unfused & not barbed‬
‭●‬ ‭Blood-sucking nematodes‬ ‭spicules‬

‭OVA EXAMINATION‬
‭‬ S
● ‭ ame for all species‬
‭●‬ ‭bluntly rounded ends‬
‭●‬ ‭single thin, transparent‬
‭hyaline shell‬
‭●‬ ‭“Morula ball” (2-8 cell‬
‭stages‬

‭LARVAE EXAMINATION‬
‭HOOKWORM ADULT BUCCAL CAPSULE‬
‭ arvae/Juvenile Worms‬
L
‭●‬ ‭Rhabditiform Larvae &‬
‭Filariform Larvae‬
‭●‬ ‭difficult to differentiate‬

‭ habditiform Larvae(L1)‬
R
‭●‬ ‭feedingstage‬
‭●‬ ‭long oral cavity (buccal‬
‭cavity/capsule)‬
‭●‬ ‭Small genital primordium‬

‭ ilariform Larvae (L3)‬

F
‭●‬ ‭infective, nonfeeding‬
‭stage‬
‭●‬ ‭shorter esophagus‬
‭●‬ ‭pointed tail‬

‭ uccal Spears‬
B
‭●‬ ‭N.americanus → conspicuous and parallel‬
‭throughout their lengths‬
‭●‬ ‭A. duodenale → inconspicuous buccal spears and‬
‭transverse striations on the sheath in the tail region‬

‭ADULT GROSS EXAMINATION‬

‭LIFE CYCLE‬
‭‬ M
● ‭ OT: Skin penetration of filariform larva‬
‭●‬ ‭Habitat: Small intestine‬
‭(“C-NASA”)‬
‭●‬ ‭Infective stage:‬
‭Filariform larva (L3)‬
‭●‬ ‭Diagnostic stage:‬
‭Egss, adults, larvae‬
‭●‬ ‭Humans are the ONLY‬
‭definitive host‬
‭●‬ ‭No intermediate host‬

‭ClinPara Lec M2‬ ‭5‬

‭PATHOGENESIS AND CLINICAL MANIFESTATIONS‬ ‭ REVENTION‬
P
‭●‬ ‭Access to potable water‬
‭ NTRY SITE‬
E ‭●‬ ‭Drainage and disposal/re-use/‬
‭●‬ ‭Maculopapular lesions, localized erythema‬ ‭Water‬
‭recycling of household wastewater‬
‭●‬ ‭S/S: Itching, edema, erythema, and later‬ ‭(also referred to as gray water)‬
‭●‬ ‭papulovesicular eruptions‬
‭●‬ ‭“Dew itch” “Ground itch”‬ ‭●‬ A ‭ ccess to safe and sanitary‬
‭sanitation facilities‬
‭ ULMONARY‬
P ‭●‬ ‭Safe collection, storage, treatment,‬
‭ anitation‬
S
‭and disposal (feces and urine)‬
‭●‬ ‭Loeffler’s Syndrome‬
‭●‬ ‭Management/re-use/recycling of‬
‭●‬ ‭Symptoms‬
‭solid waste‬
‭1.‬ ‭Marked eosinophilia + pneumonitis‬
‭2.‬ ‭Mild respiratory symptoms‬ ‭●‬ A ‭ ppropriate information regarding‬
‭3.‬ ‭Transient migratory pulmonary infiltrates‬ ‭prevention and treatment of STH‬
‭●‬ ‭Cases are rare in the tropics‬ ‭infections‬
‭●‬ ‭Dissemination of key messages to‬
I‭NTESTINAL‬ ‭promote the following practices:‬
‭Hygiene‬
‭●‬ ‭Always chronic‬ ‭f.‬ ‭Safe water storage‬
‭Education‬
‭●‬ ‭S/S: abdominal pain, steatorrhea, diarrhea with‬ ‭g.‬ ‭Safe handwashing and bathing‬
‭blood and mucus, eosinophilia‬ ‭practices‬
‭h.‬ ‭Safe treatment of foodstuffs‬
‭ UE TO BLOOD LOSS:‬
D ‭i.‬ ‭Latrine use‬
‭●‬ ‭“Iron Deficiency Anemia” = main pathology‬ ‭j.‬ ‭Use of footwear‬
‭●‬ ‭“Hypoalbuminemia”‬ ‭●‬ R
‭ egular mass drug administration‬
‭Deworming‬
‭(twice a year for school-age children)‬
‭LABORATORY DIAGNOSIS‬
‭EPIDEMIOLOGY‬
‭ pecimen‬
S
‭●‬ G ‭ eographical distribution: Tropical and subtropical‬
‭●‬ ‭Stool, sputum, duodenal aspirate‬
‭countries‬
‭●‬ ‭Age Group: Farmers, paramilitary personnel,‬
‭ ethods:‬
M
‭indigenous and school children‬
‭1.‬ ‭Direct Fecal Smear‬
‭●‬ ‭576 to 740 million are infected, (50,000 deaths due‬
‭2.‬ ‭Kato Katz & Kato Thick‬
‭to anemia)‬
‭3.‬ ‭Concentration Techniques‬
‭●‬ ‭Zinc sulfate floatation‬
‭●‬ ‭Formalin-ether/ethyl acetate concentration‬ ‭STRONGYLOIDES STERCORALIS‬
‭4.‬ ‭Harada Mori CultureTechnique: for the visualization‬ ‭‬ A
● ‭ KA “Threadworm”‬
‭of larva‬ ‭●‬ ‭“Smallest intestinal nematode”‬
‭(1-2.2mm by 0.4mm)‬
‭●‬ ‭Soil-transmitted helminth (STH)‬

‭ acultative nematode: (changes‬

F
‭depends on their need)‬
‭●‬ ‭Parasitic female only: small intestine‬
‭●‬ ‭Free-living male & female: soil‬

‭OVA EXAMINATION‬
‭‬ W
● ‭ ith clear thin shell‬
‭●‬ ‭Similar to those of‬
‭hookworms except that‬
‭TREATMENT‬ ‭they measure only‬
‭about 50 to 58 μm by‬
‭ ntihelminthic drugs‬
A ‭30 to 34 μm. (smaller)‬
‭1.‬ ‭Albendazole (400 mg single dose)‬ ‭●‬ ‭“Chinese lantern ova”:‬
‭2.‬ ‭Mebendazole ( 500 mg single dose)‬ ‭causes Cochin-China Disease‬
‭3.‬ ‭Pyrantel pamoate (10 mg/kg single dose)‬

‭ClinPara Lec M2‬ ‭6‬

 ‭FREE-LIVING LARVAE EXAMINATION‬
‭●‬ ‭genital primordium = immature sex organs‬
‭PARASITIC/FILARIFORM FEMALE‬
‭●‬ S ‭ ize & Appearance: 2.2 mm by 0.04 mm, colorless,‬
‭semi-transparent, with a finely‬
‭striated cuticle (outer covering,‬
‭skin)‬
‭●‬ ‭Anterior: slender tapering‬
‭anterior end‬
‭●‬ ‭Buccal cavity: Short with four‬
‭indistinct lips‬
‭●‬ ‭Posterior: short conical pointed tail‬
‭FREE LIVING MALE & FEMALE ADULT WORM‬
‭ ree Living (Female)‬
F ‭newborns)‬
‭●‬ ‭smaller than the parasitic female‬
‭●‬ ‭muscular double-bulbed esophagus‬
‭●‬ ‭intestine is a straight cylindrical tube‬
‭ ree Living (Male)‬
F ‭●‬ ‭intermittent vomiting, diarrhea, constipation, and‬
‭●‬ ‭smaller than the females‬
‭●‬ ‭has a ventrally curved tail‬
‭●‬ ‭two copulatory spicules‬
‭●‬ ‭gubernaculum‬
‭●‬ ‭not usually identified‬
‭LIFE CYCLE‬
‭‬ M
● ‭ OT: Skin penetration of filariform larva‬
‭●‬ ‭Habitat: Small intestine‬
‭(“C-NASA”)‬
‭●‬ ‭Infective stage:‬
‭Filariform larva (L3)‬
‭●‬ ‭Diagnostic stage:‬
‭Rhabditiform larvae‬
‭●‬ ‭Humans & Dogs are‬
‭the definitive hosts‬
‭●‬ ‭No intermediate host‬
‭PATHOGENESIS AND CLINICAL MANIFESTATIONS‬
‭ TRONGYLOIDIASIS/ENTRY SITE‬
S ‭●‬ ‭Baermann funnel gauze method (Sedimentation‬
‭●‬ ‭due to larval invasion of the skin‬
‭●‬ ‭S/S: erythema (reddening of the skin), pruritic‬
‭elevated hemorrhagic papules (itchy and bloody)‬
‭PULMONARY STRONGYLOIDIASIS‬
‭○‬ ‭Due to larval migration causing destruction and‬
‭systemic hypersensitivity‬
‭●‬ ‭Lobar pneumonia with hemorrhage‬
‭○‬ ‭One or 2 lobes in the lungs are affected‬
‭○‬ ‭Symptoms: blood in lungs, cough, tracheal‬
‭irritation, hemoptysis (blood in stool)‬
‭●‬ ‭Loeffler's Syndrome‬
‭○‬ ‭Symptoms‬
‭1.‬ ‭Marked eosinophilia + pneumonitis‬
‭2.‬ ‭Mild respiratory symptoms‬
‭3.‬ ‭Transient migratory pulmonary infiltrates‬
I‭NTESTINAL STRONGYLOIDIASIS‬
‭●‬ ‭Adult female worms reside in duodenum & jejunum‬
‭●‬ ‭Moderate S/S: diarrhea alternating with‬
‭constipation‬
‭●‬ ‭Heavy infection (Cochin-China Diarrhea)‬
‭○‬ ‭painless, intermittent diarrhea‬
‭○‬ ‭episodes of watery and bloody stools‬
‭ YPERINFECTION‬
H
‭●‬ ‭accelerated autoinfection‬
‭●‬ ‭occurs in immunocompromised px (people living‬
‭with AIDS, people of old age, children especially‬
‭●‬ ‭mix of pulmonary & gastrointestinal symptoms‬
‭●‬ ‭Inc. larvae in stool & sputum‬
‭ HRONIC STRONGYLOIDIASIS‬
C
‭borborygmi, anal pruritus, urticaria, and larva‬
‭currens rashes‬
‭●‬ ‭Recurrent asthma and nephritic syndrome‬
‭LABORATORY DIAGNOSIS‬
‭ pecimen:‬
S
‭●‬ ‭Stool, sputum, urine,‬
‭duodenal aspirate (Beale’s‬
‭String Test)‬
‭ ethods:‬
M
‭1.‬ ‭Direct Fecal Smear‬
‭2.‬ ‭Concentration techniques‬
‭-‬ ‭separates fecal debris from parasites‬
‭●‬ ‭Sedimentation‬‭= uses lower specific gravity‬
‭solution (e.g. Ethyl acetate) against an‬
‭increased specific gravity of parasite‬
‭●‬ ‭Floatation‬‭= uses higher specific gravity‬
‭against an decreased specific gravity‬
‭technique)‬
‭3.‬ ‭Modified Harada Mori Culture Technique‬
‭4.‬ ‭Nutrient Agar Plate Technique‬
‭5.‬ ‭Serologic Testing (serum)‬
‭ClinPara Lec M2‬ ‭7‬
‭ eale’s String Test‬
B ‭ emale‬
F
‭-‬ ‭Done when the patient cannot defacate‬ ‭●‬ ‭35 to 50 mm long‬
‭-‬ ‭The patient swallow the capsule with the string‬ ‭●‬ ‭blunt posterior end‬
‭attached at the cheek‬
‭-‬ ‭The capsule absorbs the fluid for analysis‬ ‭ oth‬
B
‭●‬ ‭attenuated anterior three-fifths traversed by a‬
‭TREATMENT & PREVENTION‬ ‭narrow esophagus resembling a string of beads‬
‭●‬ ‭robust posterior two-fifths contain the intestine and‬
‭ ntihelminthic drugs‬
A ‭a single set of reproductive organs‬
‭1.‬ ‭Albendazole‬
‭2.‬ ‭Thiabendazole‬
‭3.‬ ‭Ivermectin‬

‭ revention‬
P
‭●‬ ‭WASHED Framework‬

‭EPIDEMIOLOGY‬
‭●‬ C ‭ osmopolitan distribution (tropics & subtropical,‬ ‭ IFE CYCLE‬
L
‭europe, USA)‬ ‭‬
● ‭MOT: Ingestion of embryonated egg‬
‭●‬ ‭50 to 100 million people affected‬ ‭●‬ ‭Habitat: Large intestine (“E.T”)‬
‭●‬ ‭Rare in the Philippines‬ ‭●‬ ‭Infective stage: Embryonated egg‬
‭●‬ ‭Age Group: more common on male children 7 to 14‬ ‭●‬ ‭Diagnostic stage:‬
‭years old‬ ‭Unembryonated egg,‬
‭adults‬
‭ actors that affect transmission‬
F ‭●‬ ‭Humans are the‬
‭●‬ ‭poor sanitation‬ ‭definitive hosts‬
‭●‬ ‭indiscriminate disposal of human feces‬ ‭●‬ ‭No intermediate host‬
‭●‬ ‭Autoinfection (>30 years)‬
‭‬ L
● ‭ 1 = mitosis (2 cells)‬
‭INTESTINAL ROUNDWORMS (APHASMIDS)‬ ‭●‬ ‭L2 = cleavage‬
‭●‬ ‭L3 = infective stage‬
‭ RICHURIS TRICHIURA‬
T
‭‬
● ‭“Trichocephalus trichiurus”‬ ‭PATHOGENESIS AND CLINICAL MANIFESTATIONS‬
‭●‬ ‭AKA “whipworm”‬
‭●‬ ‭Aphasmid: no caudal‬ I‭NTESTINAL TRICHURIASIS‬
‭chemoreceptors‬ ‭●‬ ‭Light Infection‬‭(<5,000 eggs per gram of stool)‬
‭‬
● ‭Soil-transmitted helminth (STH)‬ ‭○‬ ‭petechial hemorrhages: due to adult worms‬
‭●‬ ‭Secrete TT47 (released to help‬ ‭○‬ ‭predisposed to amebic dysentery (collab with E.‬
‭them attached to the intestinal mucosa)‬ ‭histolytica)‬
‭○‬ ‭mucosa is hyperemic (bloody) and edematous‬
‭OVA EXAMINATION‬ ‭(inflammation); enterorrhagia (intestinal‬
‭‬ B
● ‭ arrel, lemon-shaped w/ bipolar hyaline plugs‬ ‭bleeding) is common‬
‭●‬ ‭Yellowish outer and a‬ ‭●‬ ‭Heavy Infection‬‭(>5,000 eggs per gram of stool)‬
‭transparent inner shell‬ ‭○‬ ‭Trichuris Dysentery Syndrome‬
‭●‬ ‭Fertilized eggs are‬ ‭○‬ ‭chronic dysentery and rectal prolapse‬
‭unsegmented at‬ ‭○‬ ‭S/S: blood‬
‭oviposition (3,000-‬ ‭streaked‬
‭10,000 per day)‬ ‭diarrheal‬
‭●‬ ‭“Japanese lantern ova”‬ ‭stools,‬
‭abdominal‬
‭ADULT WORM EXAMINATION‬ ‭pain and‬
‭tenderness,‬
‭ ale‬
M ‭nausea &‬
‭●‬ ‭30 to 45 mm (shorter)‬ ‭vomiting, weight loss‬
‭●‬ ‭Coiled posterior with a single spicule and retractile‬ ‭○‬ ‭Anemia (blood loss of 0.8-8.6 mL per day)‬
‭sheath‬

‭ClinPara Lec M2‬ ‭8‬

 ‭LABORATORY DIAGNOSIS‬ ‭ADULT WORM EXAMINATION‬
‭‬ A
● ‭ nterior: thin filamentous‬
‭ pecimen‬
S ‭●‬ ‭Posterior: slightly thicker and‬
‭●‬ ‭Stool‬ ‭shorter‬
‭●‬ ‭Esophagus: has rows stichocytes‬
‭ ethods‬
M ‭(stichosome; unicellular cells that‬
‭1.‬ ‭Direct Fecal Smear‬ ‭produces granules for detecting‬
‭2.‬ ‭Kato Katz & Kato Thick‬ ‭chemical signals around their‬
‭3.‬ ‭Concentration techniques‬ ‭body)‬
‭●‬ ‭Formalin-ether/ethyl acetate concentration‬
‭technique‬ ‭ ale‬
M
‭●‬ ‭FLOTAC‬ ‭●‬ ‭1.5 to 3.9 mm in length‬
‭●‬ ‭male spicule is 230 to 300 μm‬
‭long and has an unspined sheath‬

‭ emale‬
F
‭●‬ ‭vulva in females is located at the junction of‬
‭anterior and middle thirds‬

‭LIFE CYCLE‬
‭TREATMENT & PREVENTION‬ ‭●‬ M ‭ OT: Ingestion of infective larvae through‬
‭undercooked fish‬
‭ ntihelminthic drugs‬
A ‭●‬ ‭Habitat: Small intestine‬
‭1.‬ ‭Mebendazole (100mg (2) for 3 days)‬ ‭(C-NASA)‬
‭2.‬ ‭Albendazole‬ ‭●‬ ‭Infective stage: Infective‬
‭larvae‬
‭ revention‬
P ‭●‬ ‭Diagnostic stage:‬
‭●‬ ‭WASHED Framework‬ ‭Unembryonated egg,‬
‭adults‬
‭EPIDEMIOLOGY‬ ‭●‬ ‭Birds are the definitive‬
‭●‬ T ‭ emperate and tropical countries but is more widely‬ ‭hosts‬
‭distributed in warm, moist‬ ‭●‬ ‭Humans are incidental‬
‭areas of the world‬ ‭hosts‬
‭●‬ ‭604 to 795 million people‬ ‭●‬ ‭Freshwater fishes are intermediate hosts (Ipon,‬
‭affected‬ ‭Birot, Bagsang, Bagtu)‬
‭●‬ ‭Age Group: children 5 to‬
‭15 years of age‬ ‭PATHOGENESIS AND CLINICAL MANIFESTATIONS‬
‭●‬ ‭Co-infection with Ascaris‬
‭(19.1%); found in the‬ I‭NTESTINAL CAPILLARIASIS‬
‭same stool sample‬ ‭●‬ ‭“Mystery Disease” = not well documented‬
‭●‬ ‭Abdominal pain, diarrhea & borborygmi (gurgling‬
‭sound of the stomach)‬
‭ APILLARIA PHILIPPINENSIS‬
C
‭●‬ ‭S/S: intermittent diarrhea, weight loss, malaise‬
‭●‬ ‭AKA “pudoc worm”; first discovered in Barangay‬ ‭(uneasy, irritable), anorexia, vomiting, and edema‬
‭Pudoc, Ilocos‬
‭●‬ ‭First reported by Chitwood et al. in 1963 in a 29‬ ‭ ab Findings‬
L
‭year old male from Northern Luzon‬ ‭1.‬ ‭Severe protein-losing enteropathy and‬
‭●‬ ‭Aphasmid: no caudal‬ ‭hypoalbuminemia‬
‭chemoreceptors‬ ‭2.‬ ‭Malabsorption of fats & sugars‬
‭●‬ ‭Acquired through eating‬ ‭3.‬ ‭Dec. excretion of xylose‬
‭undercooked fish‬ ‭4.‬ ‭LowK,Na,Ca‬
‭5.‬ ‭High IgE‬
‭OVA EXAMINATION‬
‭‬ s
● ‭ imilar to those of Trichuris trichiura but smaller‬ ‭LABORATORY DIAGNOSIS‬
‭●‬ ‭Guitar, peanut-shaped with striated shells and‬
‭flattened bipolar plugs‬ ‭ pecimen‬
S
‭●‬ ‭Stool, duodenal aspirate‬

‭ClinPara Lec M2‬ ‭9‬

 ‭ACRONYMS‬
‭ ethods‬
M
‭1.‬ ‭Direct Fecal Smear‬ ‭ viparous: HAT (pabebe worms)‬
O
‭2.‬ ‭Concentration techniques (FECT)‬ ‭●‬ ‭Hookworm‬
‭3.‬ ‭Sandwich enzyme-linked immunosorbent assay‬ ‭●‬ ‭Ascaris lumbricoides‬
‭(ELISA): fastest‬ ‭●‬ ‭Trichuris trichiura‬

‭TREATMENT & PREVENTION‬ ‭ voviviparous: ES‬

O
‭●‬ ‭Enterobius vermicularis‬
‭ reatment‬
T ‭●‬ ‭Strongyloides stercolaris‬
‭●‬ ‭mebendazole (200 mg twice a day for 20 days)‬
‭●‬ ‭albendazole (400 mg may be given once daily for‬
‭10 days)‬ I‭n Small intestine: C-NASA‬
‭●‬ ‭For severe cases: give electrolyte replacement and‬ ‭●‬ ‭Capillaria philippinensis‬
‭a high protein diet‬ ‭●‬ ‭Necator americanus‬
‭●‬ ‭Ancylostomo duodenale‬
‭ revention‬
P ‭●‬ ‭Ascaris lumbricoides‬
‭●‬ ‭WASHED framework‬
I‭n Large intestine: ET‬
‭ PIDEMIOLOGY‬
E ‭●‬ ‭Enterobius vermicularis‬
‭‬
● ‭Location: Pudoc West, Tagudin, Ilocos Sur (19666)‬ ‭●‬ ‭Trichuris trichiura‬
‭●‬ ‭1967 to 1990: 2,000 cases‬
‭●‬ ‭“Mystery Disease”: Monkayo, Compostela Valley‬ ‭ y Egg Ingestion: ATE‬
B
‭Province outbreak (1998)‬ ‭●‬ ‭Ascaris lumbricoides‬
‭●‬ ‭Thailand, Iran, Japan, Indonesia, United Arab‬ ‭●‬ ‭Trichuris trichiura‬
‭Emirates, South Korea, India, Taiwan, Egypt, and‬ ‭●‬ ‭Enterobius vermicularis‬
‭Lao People’s Democratic Republic‬
‭ auses Autoinfection: Cool CHEST‬
C
‭●‬ ‭Capillariasis‬
‭LIFE CYCLE SUMMARIES‬ ‭●‬ ‭Cryptosporidium‬
‭●‬ ‭Hymenolepis nana‬
‭ scaris lumbricoides‬
A ‭●‬ ‭Enterobius vermicularis‬
‭●‬ ‭Small intestine → bloodstream → liver → heart →‬ ‭●‬ ‭Strongyloides stercolaris‬
‭trachea‬ ‭●‬ ‭Tenia‬

‭ nterobius vermicularis‬
E
‭●‬ ‭Large intestine → perianal region‬

‭ ookworms‬
H
‭●‬ ‭Skin → small intestine → bloodstream → lungs →‬
‭trachea → small intestine to develop‬

‭ trongyloides stercolaris‬
S
‭●‬ ‭Skin → bloodstream → small intestine → lungs →‬
‭trachea → small intestine to develop‬

‭ richuris trichiura‬
T
‭●‬ ‭Small intestine → intestinal wall → large intestine‬
‭→ feces‬

‭ apillaria philippinensis‬
C
‭●‬ ‭Eggs → fish (larvae) → small intestine (adult)‬

‭ClinPara Lec M2‬ ‭10‬