NEMATODES

Classification of medically
significant nematodes
A. Based on the presence of absence of caudal
receptor.
a. Class Enoplea- with caudal receptor and
with caudal glands.
- trichuris trichura
- trichinella spiralis
- capillaria philipinensis

2. Class Rhabditea- with caudal receptor but without
caudal glands
- ascaris lumbricoides
- stronglyloides stercoralis
- enterobius vermicularis
- filarial worms
- hookworms
- dracunculus medinensis
- anglostrongylus cantonensis

Based of habitat
A.

Intestinal nematodes
1. Small intestine
- ascaris lumbricoides
- capillaria philipinensis
- hookworms
- strongyloides stercoralis
2. large intestine
- trichuris trichura
- enterobius vermicularis

b. Extra intestinal Nematodes
1.
Trichinella spiralis- muscle
2.
Filarial worms- lymphatic tissue
3.
Dracunculus medinensis- tissue
4.
Anglostrongylus cantonensis- brain

ASCARIS LUMBRICOIDES


Giant intestinal roundworm
Disease- human ascariasis
Adult
- largest and most common
- 15-30 cm by 3 mm male
- 20-40 cm by 5 mm female
- cylindrical, elongated, tapering in the end
- containing lateral lines seen as whitish streak along the
entire length of the body
- terminal mouth with trilobate lips with a small triangular
buccal cavity

Ova

Fertilized ova

Broadly ovoid, golden brown in color
45-75 by 35-45 micron with 3 thick transparent
layers
Vitelline membrane- inner non permeable
 Glycogen membrane- thick transparent middle layer
 Albuminous/ mammilary coat- outermost layer

Fertilized ova

Decorticated fertilized
ova

Unfertilized ova


Larger, longer, elongated or sometimes irregular in
shape
88-94 microns
Two layers
Glycogen membrane
 Albuminous layer
 * vitelline layer is absent

Unfertilzed Ova

Life cycle





Adult in small intestine
Eggs passes out in the feces
Embryonation in 1-2 weeks
Fully embryonayed egss ingested by man
In the small intestine, larva penetrate the mucosa and enters
the blood circulation
Heart and lung migration, molt twice
Larvae ascend respiratory tree and swallowed, descend to
the small intestine to mature

Pathology
Adult
 Feeds on intestinal contents
 abdominal pain, diarrhea, nausea, loss of appetite
 Due to eratic migration might lead to regurgitation
and escape through the nostril
 Vomited ascaris may pass the larynx and might lead
to suffocation or reach the lung producing gangrene
 might enter the eustachian tube and provole otitis
media





Extra intestinal pathology
May invade bile duct, gall bladder, appendix
May cause hemorrhagic pancreatitis
Migration to the peritoneal cavity leads to peritonitis
Even the worms cause little or no traumatic damage
the by product of living or dead worms may rarely
produced toxic manifestation such as edema and
urticaria accompanied by loss of appetite and weight

Diagnosis



Direct fecal smear
Kato-thick
Kato- katz
Concentration technique

Treatment



Piperazine citrate
Pyrantel pamoate
Mebendazole
Albendazole

*piperazine and pyrantel pamoate with
neuromuscular blocking effect that paralyses the
parasites.

Prevention and control





Treatment of infected individual
Sanitary waste disposal
Hand washing before meals
Proper personal hygiene
Thorough washing and cooking of food
Avoid using human excreta as fertilizer

TRICHURIS TRICHURA


Whipworm
Trichuriasis
Adults



Attached to the wall of the caecum
Whiplike and posterior end is more robust
Female- 3.5- 5 cm
Male- 3-4.5 cm and coiled posterior end

Ova



Unsegmented, barrel shaped, lemon, football
shaped ova
Bi-polar plugs
With 3 layers
Embryonation takes place in the soil where the
first stage larvae is formed within 3 weeks

Life cycle




Adult worms attached to the wall of the
caecum
Eggs passes out of the feces
Embryonate in 2-3 weeks
Embryonated eggs ingested by man
Larvae hatch in the intestine

Pathology





Small streaked diarrheic stool
Abdominal pain and tenderness
Nausea and vomiting
Hypochromic anemia
Weight loss
Rectal prolapse

Diagnosis


Direct fecal smear analysis
Kato-thick or kato Katz
Concentration technique

Treatment


Albendazole
Mebendazole
Pyrantel pamoate

Prevention and control





Treatment of infected individual
Sanitary waste disposal
Hand washing before meals
Proper personal hygiene
Thorough washing and cooking of food
Avoid using human excreta as fertilizer

Enterobius vermicularis


Pinworm or seatworm
Enterobiasis or oxyuriasis
Adults



Small whitish or brown in color
Male- 2-5 mm coiled tail end
Female- 8-13mm pointed tail end
Diagnostic in the presence of cephalic alae and
distinct or prominent esophageal bulb.

Ova



Elongated
50-80 by 20-30 microns
Flattened lateral side, lopsided D
Two egg-shell layer




Albuminous layer- outer
Embryonic or lipoidal membrane- inner
Embryonated when laid
Resistant to disinfectant
Under favorable condition, it remains viable for 13 days

Life cycle




Adults in the caecum
Gravid females migrate to the perianal area to
deposit embryonated egg
Ova are infective to man 6hrs after deposition
Ova are ingest of inhaled by man
Larvae hatch in the duodenum
Migrate to its final habitat in the large intestine

Pathology







Poor appetite
Insomia
Weight loss
Irritability
Grinding of teeth
Nausea
Vomiting
Pruritus ani

Diagnosis

Scotch tape swab

Treatment


Albendazole
Mebendazole
Pyrantel pamoate

Transmission


Hand to mouth
Inhalation
autoinfection

Trichinella spiralis


Trichina worm
Trichinosis
Adult
Minute
 Male-1.5 by 0.04 mm with single testis near the
posterior end
 Female- 3.6 by 0.06 mm with single ovary
 The female is viviparous or larviparous capable of
producing 1,500 larvae

Larvae


80-120 micron by 5.6 microns at birth
900-1300 micron by 35-40 microns
Spear like burrowing anterior

Life cycle




Encysted larvae in pig
muscle
Ingestion of improperly
cooked pork
Infected flesh is digested by
gastric juice
Adults in the duodenum
Larviparous female burrows
into mucosa and deposit
larvae
Larvae enters the circulation
Encyst in striated muscle
Dead end cycle

Pathology

Incubation and intestinal invasion

Larval migration muscle invasion

Includes diarrhrea, constipation, vomiting
abdominal cramps, nausea
Fever, facial edema, urticaria, pain and swelling
weakness
Splenomegaly, gastric and intestinal hemorrhages

Encysment and encapsulation

Fever, weak, pain

Diagnosis

Muscle biopsy
Serological- ELISA

Treatment

Thiabendazole during the first week
Mebedazole larvicidal

Prevention and control

Cook meat 77 C 177 F
Freezing- - 15C for 20 days or -30 C for 6
days
Smoking, salting, or drying is not effective

Hookworms



Necator americanus- New World Hookworm
Ancylostoma duodenale- old world hookworm
Ancylostoma braziliense- cat hookworm
Ancylostoma caninum- dog hookworm

Necator americanus

S-shaped
Buccal capsule id provided with semilunar
cutting plate
With amphidial gland that secretes
anticoagulant
Copulatory bursa is longer than broad with
bipartite dorsal ray and a long slender
copulatory spicules that is fused at the tip
forming a delicate barb.

Necator americanus

Adult necator

Tail- end

Necator Ova

Ancylostoma duodenale


Stout, body contour into letter c
2 pairs of ventral teeth
With copulatory bursa characterized as bristle
like with tridigitate dorsal ray

Ancylostoma duodenale

Ova

Ancylostoma brazilienze

With a pair of teeth and a pair o f
inconspicuous median teeth in the buccal
capsule
Broad and long copulatory bursa with short
lateral rays

Filariform, rhabditiform

Ova

Ancylostoma caninum

With 3 pair of ventral teeth
Secretes anticoagulant that delays the
coagulation of blood.

Ancylostoma caninum

Ova

Larval stage

Rhabditiform




Long narrow buccal cavity
Flask shaped esophagus
With inconspicuous genital primordium
Open mouth
Feeding stage

Filariform



Longer and slender with pointed posterior end
Closed mouth with protective covering
Non feeding stage
Infective stage

Life cycle









Adults in the small intestine
Ova in feces
Rhabditiform larvae 1-2 days
Filariform 5-8 days
Filariform penetrate the skin
Enters the circulation
Lungs
Trachea
Swallowed
Esophagus

Pathology



Ground itch- pruritus, secondary bacterial
infection
Pulmonary lesion- Wakana disease
Creeping eruption- dermatitis characterized by
intracutaneous lesion
Hookwrom anemia- microcytic hypochromic
Albuminea- low level of albumin due to
combined loss of blood, lymph and protein

Diagnosis

Direct fecal smear
Harada-mori

Treatment


Mebendazole
Albendazole
Thiabendazole

Strongyloides stercoralis




Threadworm
Cochin-china diarrhea
Capable of both free living and parasitic
2-7 mm and 30-40um in width
Colorless, semitransparent nematode

Larvae

Rhabditiform- short buccal cavity, elongated
esophagus with pyriform posterior bulb and
conspicuous genital primodium
Filariform- long delicate larvae with long
esophagus and forked or notched tail

Life cycle









Small intestine
Ova in feces
Rhabditiform larvae-------------filariform—adult free living--Filariform
--ova---rhabditiform---filariform-----host
Skin
----adult
Circulation
Heart
Lungs
Trachea
esophagus

Prevention


Proper waste disposal
Personal hygiene
Avoid being barefooted on suspected infected
area
medication

Treatment


Mebendazole
Albendazole
thiabendazole

Precaution

Administration of ORS to prevent dehydration
and loss of electrolytes

Filarial worms




Arthropod transmitted
Invades circulatory system, muscle, serous cavities,
lymphatic system
2-50cm with inconspicuous buccal cavity
Males with two copulatory spicule
Viviparous females gives birth to prelarval
microfilaria
Microfilaria is motile , snakelike with dark staining
nuclei occupying most of the entire body
Sheathed ( with embryonic sheath )
Unsheated ( with no embryonic sheath )

Periodicity




Noctunal
Diurnal
Subperiodic
Subpeiodic diurnal
Subperiodic nocturnal

Wuchereria Bancrofti





Bancroft’s filarial worm
elephantiasis
Males- 2-4 cm
Females- 8-10 cm
Microfilaria is nocturnal with curvatures and graceful
appearance, tapering tail with no terminal nuclei
Lower lmphatics
Elephantiasis

Microfilaria ( wuchereria bancrofti )

Pathology


Tropical pumonary eosinophilia
Granuloma of the spleen
In the lymph nodes they promote pseudotubercular
granulomatous reactions, leads to edema, vascular
and lymphatic hyperplasia, fibrosis and caesation
Elephantiasis- scrotum, vulva, enlargement of the
genitals and lower lymphatics

Diagnosis and treatment

Blood smear ( check periodicity )
Treatment

DEC- Diethyl carbamazine

Aedes

Anopheles

Brugia malayi




Malayan filarial worm
Malayan filariasis
Male- 13-23 mm
Female- 43-55 mm
With two distinct or discrete nuclei at the tip
of the tail

Vector Mansonia uniformis

Treatment

DEC

Loa Loa




African Eye worm
Calabar swelling
Sheathed microfilaria
Subcutaneous tissue ( Habitat )
Vector- chrysops

Disease



Calabar swelling
Conjunctiva granuloma
Bug eye- painless edema of the eyelids
Protopsis- bug eye

Calabar swelling

Treatment and control


Protection from the bite of the vectors
Control of the vector
Chemotherapy with diethylcarbamazine

Onchocerca volvulus





Convoluted filaria
River blindness
Nodules in the subcutaneous tissue
Males- 19-42 mm
Females- 33.5-50mm
Vector simulium

Pathology






Fever
Eosinophilia
Urticaria
Blindness
Pruritus
Hyperkeratosis
Hanging groin

Diagnosis and treatment



Skin snip of the subcutaneous nodules
Not found on the blood but can be found on
the urine
Surgical removal of the nodule
DEC followed by suramin
Mebendazole as an alternate drug of choice

Toxocara canis and Cati



Dog and cat ascaris
Normal habitat- cats and dogs, human accidental host
Visceral larval migrans
Life cycle- same as humans

Pathology






Visceral larval migration
Hemorrhage
Necrosis and granuloma
Eosinophilia
Liver damage
Pulmonary inflammation
Ocular problems

Diagnosis and Treatment




Marked eosinophilia
Hepatomegaly
Hyperglobulinemia
Direct fecal smear
Tx

Thiabendazole

Prevention and control

Avoid contact with infected animals
Animal under 6 mos. Should be dewormed
with piperazine
Proper waste disposal of animal droppings

Toxocara canis ova

Toxocara cati

Toxocara canis ova

Capillaria philipinensis



Pudoc worm
Borborygamy
Diarrheal disease
dehydration

Capillaria ova

Other nematodes

Angiostrongylus cantonensis


Rat lungworm
Pila, planaria, fresh water prawns are intermediate
host
Infection to rats involves lungs for development
In humans stays in the brain

Pila Africana

Planaria

Dracunculus medinensis


Guinea worm, dragon worm, fiery serpent
worm of the israelites
Inhabits the tissue
Female 70-120cm

Life cycle







Adults in the cutaneous tissue
Larva escapes from skin blister 1st stage
Free swimming ( rhabditiform )
Ingested by cyclops, copepods
Body cavity of cyclops or copepods
Infective stage ( filariform )
Ingested by man
Adults in the tissue

Diagnosis includes flooding of the ulceration
on the skin
Treatment- niridazole, metronidazole and
thiabendazole

Copepods

Cyclops

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