CLASS NEMATODA

1

GENERAL CHARACTERISTICS 
Females are larger than males and have a straight tail  Males have curved tails with spicules or hooks for copulation  Unsegmented  Round, elongated worms measuring from a few mm to a meter in length  Has complete digestive system (mouth to anus)
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GENERAL CHARACTERISTICS 
Has no circulatory system  Found in the intestine (A. lumbricoides), blood (W. bancrofti), and tissue (O. vulvolus).  Worldwide distribution  Can be classified according to the location of its sensory organs:  Amphids sensory organs located anteriorly  Phasmids sensory organs located posteriorly  Aphasmids without posterior sensory organs
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lumbricoides. cantonensis Muscles T. hookworms.GENERAL CHARACTERISTICS  Can be classified according to habitat: Small intestine A. bancrofti and B. philippinensis. malayi Eyes and meninges A. S. vermicularis Lymph nodes and vessels W. C. trichiuria and E. stercoralis Colon T. spiralis 4 .

APHASMIDS 5 .

Trichinella spiralis 6 .

PARASITE BIOLOGY 
Adult worm: Commonly known as pork worm or trichina worm Minute and appears threadlike More delicate anteriorly than posteriorly

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PARASITE BIOLOGY 
Adult Male:  measures 1.4-1.6 by 0.04-0.06 mm  has a single testis located near the ventrally curved posterior end of the body and is joined in the midbody by the genital tube which in turn extends back to the cloaca.  cloaca is found at the caudal end which everts during coitus and guarded by 2 caudal appendage and 2 conical papillae which clasp the female during copulation.

8

PARASITE BIOLOGY 
Adult Female:  measures 3-4 by 0.06-0.08 mm  vulva opens at the anterior fifth of the body  has a single uterus which contains the larvae  a single ovary is found near the bluntly rounded caudal end.  viviparous (live young bearing) and capable of producing > 1500 larvae in her 30 day life.
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PARASITE BIOLOGY  Larvae:  measures 80-120 by 6 m but reaches the size of 900-1300 by 35-40 m after in enters a muscle fiber  provided by a spear-like burrowing tip at its tapering anterior end  digestive tract resembles of a adult worm  cysts calcify 6-12 months after infection 10 .

humans  Habitat: adults in the stomach or small intestine. larvae on the muscle  Transmission: ingestion of infective larvae in raw or insufficiently cooked meat 11 .LIFE CYCLE  Infective stage: cystic larvae  Diagnostic stage: cystic larvae in muscle biopsy  Intermediate hosts: rats. pigs  Definitive hosts: pigs.

L I F E C Y C L E 12 .

 Clinical manifestation is divided into three phases: Enteric phase (Incubation and intestinal invasion) resembles the attack of acute food poisoning such as diarrhea/constipation.PATHOLOGY  Infection is called Trichinellosis or Trichinosis. 13 . and severe (more than 1000 larvae).  Types of intensity of infection: light (up to 10 larvae). moderate (50 to 500 larvae).

eosinophilia. Sometimes remittent fever. and nausea.PATHOLOGY vomiting. dyspnea. paralysis of extremities. and splenomegaly. Myocardial and neurological complication may occur. abdominal cramps. Invasion phase (larval migration and encapsulation) severe myalgia. malaise. difficulty in chewing. periorbital edema. 14 . dysphagia.

weakness.  Full recovery is expected since trichinellosis/ trichinosis is a self-limiting disease. 15 . pain and other symptoms start to abate.PATHOLOGY Convalescent phase (Encystment and encapsulation) fever.

 Biochemical test .elevated levels of creatine phosphokinase.  CBC eosinophilia indicates parasitic infection 16 . and myokinase indicate muscle damage from invading larvae. lactate dehydrogenase.DIAGNOSIS  Demonstration of larva using muscle biopsy which can only be done seven days after infection. since encystment of invading larvae starts this time.

17 .DIAGNOSIS  Beck s xenodiagnosis muscle from suspected patient/animal is fed to albino rats. the rats will be examined for presence of female worms in the duodenum and larvae in the muscle. After 14 days.

TREATMENT  Bed rest and supportive treatment  Analgesics and antipyretics for symptoms  Steroids used for severe infections  Thiabendzole for expelling adult worms from GI tract  Mebendazole to expel larvae in the muscles  Albendazole 18 .

PREVENTION AND CONTROL  Health education  Proper meat cooking (at 1200C or 1770F)  Meat freezing (-150C for 20 days or -300C for six days)  Meat inspection  Keep pigs from rat-free pens 19 .

Trichuris trichiura 20 .

which traverses along the attenuated anterior. is a delicate capillary tubule than can dilate at its distal end.PARASITE BIOLOGY  Adult worm:  Commonly known as whipworm  Anterior 3/5 is attenuated (thin and long) while posterior 2/5 is thick and stout. It is embedded with glandular cells called stichocytes. 21 . hence the whiplike appearance  The esophagus.

PARASITE BIOLOGY  Adult Male:  Measures 3 3.5 cm  Has saccular testis  A single lanceolate spicule protrudes through a refractile penial sheath which has a bulbous termination covered with small recurved spines  Has a coiled caudal extremity 22 .

5-5.PARASITE BIOLOGY  Adult Female:  measure 3. the fleshy portion of the body  has a single uterus and ovary  Bluntly rounded at the posterior end  Lays approx 3000 to 10000 eggs per day 23 .5 cm  vulva opens at the anterior end.

PARASITE BIOLOGY  Ova/Eggs:  Measures 50-54 by 22-23 m  Appears barrel-shaped (football) with bipolar unstained  Intralaminar prominences which have the appearance of mucoid plugs  It is passed in the unsegmented stage 24 .

albuminous layer.PARASITE BIOLOGY  Ova/Egg:  In addition to vitellaine membrane. and bilestained layer  Embryonic development takes place outside the host  More susceptible to dessiccation (dehydration) 25 . its triple shell is made up of chorionic layer.

LIFE CYCLE  Infective stage: embryonated egg  Diagnostic stage: Ovum/Egg in feces  Intermediate hosts: none  Definitive hosts: humans  Habitat: large intestine  Transmission: soil transmission then ingestion of embryonated eggs 26 .

L I F E C Y C L E 27 .

000 eggs per gram feces) develop bloody diarrhea or dysentery. 28 .  Light infections is usually asymptomatic and can only be discovered in routine fecalysis. Moderate infection (5000 eggs per gram feces) is symptomatic. Heavy infection (20.PATHOLOGY  Infection is called Trichuriasis.

 There is build up of blood (hyperemia) and fluid (edema) in the mucosal lining. 29 . causing petechial hemorrhages.PATHOLOGY  Anterior portion of the worm is embedded in the intestinal mucosa. Intestinal bleeding is common (enterorrhagia) and rectal prolapse may occur. which may predispose amoebic dysentery since the ulcers are suitable habitat for Entamoeba coli.

irritating and inflaming the mucosaleading to appendicitis and granulomas.PATHOLOGY  Appendical lumen may be filled with worms.  Fortunately. 30 . trichuriasis only affect the large intestine since it has no lung route like Ascaris and hookworm infection.

31 . and prolapse.DIAGNOSIS  Clinical diagnosis is only possible in moderate and heavy infection where host experiences bloody diarrhea. abdominal pain and tenderness.  Direct fecal smear and Kato thick smear is used in qualitative testing for trichuriasis. also recommended in clinical patient diagnosis and mass stool examination in communities.

32 .  Acid-ether and formalin-ether methods can be used. and intensity of infection. egg reduction rate.DIAGNOSIS  Kato-Katz technique is used in quantitative testing of cure rate. yet Kato thick smear and Kato-Katz methods are simpler and low-cost.

TREATMENT  Mebendazole  Albendazole  Piperazine citrate  Egg reduction rates. 33 . and pre.and post. reinfection rates.egg counts should be considered to evaluate the course of treatment. cure rates.

 Sanitary disposal of human feces by building toilets and their proper use  Handwashing  Health education  Thorough washing of vegetables where nightsoil was used ad fertilizer 34 .PREVENTION AND CONTROL  There is high reinfection rate so periodic mass treatment is necessary.

Capillaria philippinensis 35 .

Philippined in 1968 36 .PARASITE BIOLOGY  Adult worm: Characteristically filiform (thread like) anteriorly and stout posteriorly but tapering is gradual and more pronounced First described in Northern Luzon.

PARASITE BIOLOGY  Adult Male:  measures 1. non-spiny sheaths  Esophagus has rows of secretory cells called stichocytes and the entire esophagal structure is called stichosome.45 to 3.9 mm in length  Charactrized by caudal alae and long. 37 .

PARASITE BIOLOGY  Adult Female:  Measures 2.3 mm in length  Body is divided into 2 parts: the anterior containing the esophagus and esophageal parts and the posterior containing the intestine and the reproductive system with a slightly prominent vulva  Anus is subterminal and the vulva is found at the junction of anterior and middle thirds 38 .3 to 5.

its intermediate host 39 .PARASITE BIOLOGY  Ovum/Egg:  Measures 36 to 45 m  Peanut-shaped with striated shells and non protruberant bipolar plugs  Must reach brackish water to be eaten by freshwater fish.

humans  Habitat: small intestine  Transmission: water borne then ingestion of infected freshwater fish 40 .LIFE CYCLE  Infective stage: third stage larvae  Diagnostic stage: Ova/eggs. and adult worms in feces  Intermediate hosts: freshwater fish  Definitive hosts: birds. larva.

L I F E C Y C L E 41 .

and diarrhea. low electrolyte levels especially K+. fat and sugar malabsorption. decreased xylose excretion.  Later symptoms include noticeable weight loss.  Early symptoms include abdominal pains. vomiting. 42 .PATHOLOGY  Infection is called Capillariasis. borborygmus (gurgling stomach). high levels of IgE.  Lab findings show severe protein-losing enteropathy. anorexia. and edema. malaise.

43 . compressive degeneration and mechanical compression of intestinal epithelium which account for the lab findings.  Large number of worms are responsible for micro-ulcers. patients become very weak (cachexia) and usually die.PATHOLOGY  If the disease is not treated after symptom manifestations and the lab findings continue.

 Recovery of adult worms from small intestine by duodenal aspiration 44 . and/or adult worms in stool.DIAGNOSIS  Demonstration of embryonated or unembryonated egg. larvae.

TREATMENT  Electrolyte replacement and high-protein diet  Anti-diarrheal drugs  Mebendazole  Albendazole destroys larvae more readily than mebendazole 45 .

PREVENTION AND CONTROL  Discouraging people to eat raw fish in endemic areas  Good sanitary practices and proper disposal of human waste  Infected persons should be treated quickly and their feces disposed in a sanitary manner  Health education. especially on the hazards of eating uncooked fish 46 .

PHASMIDS 47 .

Ascaris lumbricoides 48 .

PARASITE BIOLOGY  Adult worm: Also known as giant intestinal round worm or pink worm Has polymyarian type of somatic muscles arrangement in which cells are numerous and project well into the body cavity Has smooth striated cuticles 49 .

PARASITE BIOLOGY  Adult worm: Has terminal mouth with three lips and sensory papillae Reside in but do not attach to the mucosa of the small intestine. 50 .

PARASITE BIOLOGY  Adult Male: Measures 10-31 cm by 2-4 mm Has ventrally curved posterior end with two spicules Has a single long. tortuous tubule found in the posterior 2/3 of the body 51 .

PARASITE BIOLOGY  Adult Female: Measures 22 35 cm Has paired reproductive organs in the posterior 2/3 Posterior end is conical and straight Capable of producing 200.000 eggs per day 52 .

53 . moisture.  Larvae in the eggs reach the third stage when they molt and become embryonated.PARASITE BIOLOGY  Ovum/Egg:  In the soil. and humidity. shaded soil for a few months to two years in tropical areas but much longer in temperate regions. it takes about two to three weeks for eggs to be embryonated under favorable conditions with suitable tempearture.  The embryonated egg can survive is moist.

PARASITE BIOLOGY  Infertile Ovum/Egg:  Measures 88 94 by 34 44 m. longer and narrower than fertile eggs  Has thin shell and irregular mammilated coating filled with refractive granules 54 .

PARASITE BIOLOGY  Infertile Ovum/Egg:  The thin shell id composed of inner chorionic and outer irregular albuminous coating  Found only in the absence of adult male . in about two out of five infections 55 .

inner membrane 56 . shorter and stouter than infertile egg  Has three layers: ‡ Mammilated albuminous covering ‡ Thick. transparent hyaline shell ‡ A delicate vitelline.PARASITE BIOLOGY  Fertile Ovum/Egg:  Measures 45 70 by 35 50 m. lipoidal.

the egg has an ovoid mass of protoplasm. which will develop into larvae in 14 days 57 .PARASITE BIOLOGY  Fertile Ovum/Egg:  At oviposition.

PARASITE BIOLOGY  Decoticated Ovum/Egg: Could be fertilized or unfertilized Lacks the mammillated albuminous coating 58 .

LIFE CYCLE  Infective stage: embryonated egg  Diagnostic stage: infertile. or decorticated eggs in feces  Definitive hosts: humans  Habitat: small intestines  Transmission: soil-transmission then ingestion of embryonated egg 59 . fertile.

L I F E C Y C L E 60 .

on to the heart and pulmonary vessels where they break out of pulmonary capillaries to enter airsacs.PATHOLOGY  Infection is called Ascariasis  Larvae in ingested embryonated egg hatch in the small intestine and penetrate the intestinal wall  Larvae then go to the liver via the portal vein. 61 .

they undergo molting before migrating to the larynx and oropharynx to be swallowed into the digestive tract. 62 .PATHOLOGY  In the lungs.

invading larvae may result in allergic manifestations such as lung infiltration. Tissue reaction to invading larvae ‡ During lung migration. ‡ Hemoptysis (coughing up of blood) due to pulmonary capillary penetration of larvae ‡ Eosinophilia ‡ Vague abdominal pain ‡ Lactose intolerance in young children (moderate infection) 63 . asthma attacks. and edema of the lips.PATHOLOGY 1.

Intestinal irritation by mechanical and toxic action of adult worms ‡ Continuous biting of the intestinal mucosa for food by adult worms irritate the nerve endings and results in spasm leading to intestinal obstruction ‡ Intestinal volvulus results when worms become entangled producing a bolus that blocks the tract ‡ Intussusception or telescoping of the intestine 64 .PATHOLOGY 2.

PATHOLOGY 3. Complications arising from the parasite s extraintestinal migrations ‡ High fever causes Ascaris migration ‡ Adult worms may be regurgitated and vomited. may escape through the nostrils. and may be inhaled through the trachea 65 .

Complications arising from the parasite s extraintestinal migrations ‡ Biliary ascariasis results when worms invade bile ducts through the ampulla of Vater and enter gallbladder or liver.PATHOLOGY 3. resulting in pancreatitis 66 . this manifests in colic (sudden abdominal pain) ‡ Worms may lodge in the appendix. resulting in appendicitis ‡ Worms may block the pancreatic duct.

Complications arising from the parasite s extraintestinal migrations ‡ Worms may carry bacteria in appendix and/or pancreas producing abscesses ‡ Worms may penetrate into the peritoneal cavity and result peritonitis 67 .PATHOLOGY 3.

DIAGNOSIS  Demonstration of characteristic eggs in feces using Direct Fecal Smear. or nostrils 68 . mouth. or Kato-Katz technique (quantitative)  Recovery of larvae in sputum or gastric aspiration  Recovery of adult worms in stools. Kato technique/cellophane thick smear method (qualitative).

TREATMENT  Albendazole  Mebendazole  Pyrantel pamoate  Ivermectin  Reinfection is observed four to seven months after treatment so retreatment is necessary 69 .

including adults.PREVENTION AND CONTROL  Sanitary disposal of human feces  Personal. family. and community hygeine education  Mass chemotherapy twice or thrice a year with children as target population  Studies show that treatment of children alone in a community has the same effects as treating everybody. 70 .

Strongyloides stercoralis 71 .

PARASITE BIOLOGY  Adult worm: Commonly called threadworm Characterized by free-living rhabditiform and parasitic filariform The only species naturally pathogenic to humans Autoinfection also characterizes this specie 72 .

04 mm  Colorless. semi-transparent. with finely striated cuticle  Short buccal cavity has 4 distinct lips  Slender tapering anterior end and a short pointed tail  Lays approx 3000 to 10000 eggs per day 73 .2 by 0.PARASITE BIOLOGY  Parasitic Filariform Female:  measure 2.

PARASITE BIOLOGY 
Parasitic Filariform Female:  Has a long, slender esophagus that extends to the anterior fourth of the body, and the intestine is continuous to the subterminal anus  Vulva is located at the one-third length of the body form the posterior end  The uteri contain a single file of eight tot twelve thin-shelled, transparent, segmented ova

74

PARASITE BIOLOGY 
Free-Living Female:  measure 1 by 0.06 mm; smaller than the parasitic female  Has a muscular doublebulbed esophagus and the intestine is a straight cylindrical tubule
75

PARASITE BIOLOGY 
Free-Living Male:  Measures 0.7 by 0.04 mm, smaller than female  Has ventrally curved tail, two copulatory spicules, a gubernaculum but no caudal alae

76

PARASITE BIOLOGY  Rhabditiform (Feeding stage) larva:  Measures 225 by 16 m  Has elongated esophagus with a posterior bulb  Has shorter buccal capsule and a larger genital primordium  Differs from hookworm in being slightly smaller and less attenuated posteriorly 77 .

PARASITE BIOLOGY  Filariform (Non.Feeding stage) larva:  Slender measuring 550 m in length  Similar to hookworm yet smaller and with distinct notch at tip of the tail 78 .

PARASITE BIOLOGY  Egg: Oviposited in the intestine and other tissues Rarely seen in stool specimen Have a clear. thin shell and are similar to those of hookworms Measures 50-58 by 30-34 m 79 .

transmammary 80 .LIFE CYCLE  Infective stage: filariform larvae  Diagnostic stage: rhabditiform larva in stool ‡ N.  Definitive host: humans. can be transferred through organ transplant.B. monkeys  Habitat: large intestine  Transmission: soil transmission then skin penetration. Eggs hatch in the mucosa of intestines and are rarely seen in feces.

L I F E C Y C L E 81 .

‡ Filariform larvae then enter cutaneous veins and find their way to pulmonary capillaries 82 . Invasion of the skin by filariform larvae ‡ Produces erythema (redness in the skin) and pruritic (itchy) elevated hemorrhagic papules.PATHOLOGY  Infection is called Strongyloidiasis 1.

PATHOLOGY 2. Larval migration to the lungs ‡ Results in lobar pneumonia with hemorrhage as larvae breakout from pulmonary capillaries in the alveoli ‡ Larvae is then carried to pharynx where it will be swallowed and then reach the small intestine 83 .

which in turn will autoinfect the host by penetrating the intestinal mucosa then into veins and start the first phase. Penetration of intestinal mucosa by adult females ‡ Swallowed larvae molt twice then become adult female and thread themselves in the epithelium of the small intestine ‡ By parthenogenesis (reproduction without fertilization).PATHOLOGY 3. 84 . females produce eggs which yield rhabditiform larvae.

irregular diarrhea). occurs in immunosuppressed patients 85 . painless. Heavy infection results in CochinChina diarrhea (intractable.  Hyperinfection syndrome may lead to death due to massive tissue invasion and damage by adult worm and larvae. characterized by bloody stools.PATHOLOGY  Light infection is asymptomatic. Moderate infection causes alternating diarrhea and constipation.

 Baermann funnel technique  Harada-Mori culture  Duodenal aspiration and small bowel biopsy  Demonstration of larvae in sputum or urine in disseminated strongyloidiasis 86 .DIAGNOSIS  Demonstration of rhabditiform larvae and/or filariform larvae the feces using:  Direct fecal smear.  concentration technique.

TREATMENT  Albendazole  Ivermectin  Thiabendazole 87 .

family.PREVENTION AND CONTROL  Proper human waste disposal  Avoid walking barefooted  Personal. and community hygiene education  Immunosuppressed individuals and transplant pateitns should be cleared to avoid dissemination of infection 88 .

Necator americanus Ancylostoma duodenale Ancylostoma braziliense Ancylostoma caninum Ancylostoma ceylanicum 89 .

PARASITE BIOLOGY N. fusiform. americanus  Adult worm: Commonly called New World Hookworm Small. grayish-white nematodes The buccal capsule has a ventral pair of semi-lunar cutting plates 90 . cylindrical.

americanus  Adult Worm: The head is curved opposite to the curvature of the body which is like a hook at the anterior end Rarely seen in stool since firmly imbedded in mucosa of small intestine. 91 .PARASITE BIOLOGY N.

americanus  Adult Male: Measures 5 9 mm by 0.30 mm and are shorter than females The posterior end has a broad. membranous caudal bursa (bursa copulatrix) with rib-like rays. which are used for copulation 92 .PARASITE BIOLOGY N.

PARASITE BIOLOGY N.35 mm and are larger than the male worm  Has a blunt. pointed posterior end  May live from two to 14 years 93 . americanus  Adult Female:  Measures 9 11 mm by 0.

Americanus Have single paired reproductive organs 94 . duodenale  Adult worm: Commonly called Old World Hookworm Slightly larger than N.PARASITE BIOLOGY A.

PARASITE BIOLOGY A. duodenale  Adult worm: The head continues in the same direction as the curvature of the body The buccal capsule has two pairs of curved ventral teeth 95 .

duodenale  Adult Male: Measures 10 mm by 0.PARASITE BIOLOGY A.5 mm They have a prominent fanlike copulatory bursa (bursa copulatrix) found in the posterior portion of the worm 96 .

longer than male worms  Have blunt posterior end 97 .PARASITE BIOLOGY A.7 mm. duodenale  Adult Female:  Measures 12-15 mm by 0.

feeding stage  Resembles S. stercoralis but larger  More attenuated posteriorly  Has longer buccal capsule  Genital primordium is conspicuous 98 .PARASITE BIOLOGY  Rhabditiform larva:  Non-infective.

buccal spears are conspicuous and parallel throughout their lengths while in A. americanus. buccal spears are inconspicuous  Transverse striations are present in the tail region 99 . non-feeding stage  In N.PARASITE BIOLOGY  Filariform larva:  Infective. duodenale.

PARASITE BIOLOGY  Filariform larva:  Measures 700 um  Straight esophagus (1/4 of the body)  Pointed tail covered with sheath 100 .

PARASITE BIOLOGY  Ova/Eggs:  Measures about 64 76 m by 36-40 m  Eggs are regularly oval  Has single thin. transparent hyaline shell  Unsegmented at oviposition  Colorless and usually seen in 2-8 cell stages 101 .

PARASITE BIOLOGY A. braziliense  Adult Worm:  Buccal capsule is provided with a pair of big teeth  Definitive host is dogs 102 .

caninum  Adult Worm:  Buccal capsule is provided with three pairs of ventral teeth.PARASITE BIOLOGY A. the innermost are the smallest  Definitive host is dogs 103 .

ceylanicum  Adult Worm:  Buccal capsule is provided with two pars of teeth but the outer pair is bigger than the other pair 104 .PARASITE BIOLOGY A.

dogs and cats (for A. braziliense.LIFE CYCLE  Infective stage: Filariform larvae  Diagnostic stage: eggs in stool  Definitive host: humans. caninum. ceylanimcum)  Habitat: small intestine  Transmission: soil skin penetration 105 .

L I F E C Y C L E 106 .

L I F E C Y C L E Cutaneous larva migrans 107 .

Hookworm Disease 1.PATHOLOGY  Infection is called Ancylostomiasis. called ground itch or dew itch ‡ Papulovesicular eruption lasting for 2 weeks 108 . The skin at the penetration site ‡ Produces macropopular lesions and localized erythema ‡ Sever itching. Uncinariasis. Necatoriasis.

steatorrhea (fat in stool). The lung during larval migration ‡ Produces bronchitis or pneumonitis ‡ Minute hemmorhages with eosinophilic and leukocytic infiltrates 3.PATHOLOGY 2. bloody diarrhea ‡ Blood eosinophilia of 30%-60% ‡ Hypoalbuminuria due to continues loss of blood. and protein. Small intestine as habitat ‡ Abdominal pain. lymph. 109 .

PATHOLOGY  Produces microcytic anemia (each adult worm consumes 0. caninum filariform larvae penetrate subcutaneous tissue causing itching (ground itch) and the formation of serpigenous (hardened)tunnel 110 . ceylanicum.2 ml of blood/day)  Cutaneous larva migrans creeping larvae underneath the skin. braziliense.  A. route for filariform larvae of A. barziliense and A. and A. A. caninum.

concentration methods (ZnSO4 or foramlin-ether)  Larva is not seen in feces. Kato or Kato-Katz technique. the larva may continue to develop and must be differentiated with strongyloides 111 . unless the specimen is left for 24 hours using Harada-Mori culture  If a stool specimen is left at room temp.DIAGNOSIS  Demonstration of characteristic egg in the feces (2-8 cell stages) using DFS.

DIAGNOSIS  Should you recover the adult Hookworm. caninum 3 pairs of ventral teeth  A. duodenale 2 pairs of ventral teeth  A. ceylanicum 2 pairs of ventral teeth with with outer bigger than the inner pair  A. americanus semilunar cutting plates  A. easier differentiation is done by observing the buccal capsule  N. braziliense a pair of big teeth 112 .

TREATMENT  Albendazole  Mebendazole  Pyrantel pamoate 113 .

PREVENTION AND CONTROL  Proper disposal of feces  Avoid walking barefooted  Health education on personal. and community hygiene  Treatment of infected individuals  Mass chemotherapy when prevalence is greater than 5%  Protection of susceptible individuals 114 . family.

Enterobius vermicularis 115 .

pinworm Has a cuticular alar expansions at the anterior end and a prominent posterior esophangeal bulb 116 . sitworm.PARASITE BIOLOGY  Adult worm: Commonly called oxyuris.

1-0. relatively smaller than female worm  Spindle-shaped and has ventrally curved tail with a single spicule  Oral end is provided with 3 lips and a pair of laterally placed capehalae or wings 117 .PARASITE BIOLOGY  Adult Male:  measure 2-5 by 0.2 mm.

PARASITE BIOLOGY  Adult Male:  Bursa is greatly reduced and designated as caudal alae which is supported by 6 pairs of caudal alae  Rarely seen since it dies after copulation 118 .

PARASITE BIOLOGY  Adult Female: Measures 8-13 by 0-4 mm It has a long pointed tail Vulva opens in front of the middle third of the body Vagina is long. extending posteriorly from the vulva before joining the paired genital organs 119 .

since it bursts. 120 .888 eggs/day  Female dies after laying eggs.PARASITE BIOLOGY  Adult Female:  The uteri of the gravid female are distended with eggs  They are capable of laying of 4. 672 to 16.

with one side flattened and the other side convex (letter D)  Translucent shell consists of an outer.PARASITE BIOLOGY  Egg:  Measures 50-60 m by 20-30 m  Assymetrical. triple albuminous covering for mechanical protection and inner lipoidal membrane for chemical protection 121 .

eggs become infective in four to six hours  Resistant to disinfectants but can t survive in dry air for a day. If moisture is present. 122 . may remain viable for 13 days.PARASITE BIOLOGY  Egg:  Outside the host.

LIFE CYCLE  Infective stage: embryonated egg  Diagnostic stage: rhabditiform larva in stool  Definitive host: humans  Habitat: larvae in small intestine. adults in lumen of caecum  Transmission: ingestion of eggs. air-borne 123 .

L I F E C Y C L E 124 .

PATHOLOGY  Perianal itching or pruritus ani caused by migration of female to perineal region  Autoinfection caused by scratching perineal region and eventually ingesting the egg  May produce appendicitis. endometritis. peritonitis  Familial disease 125 . vaginitis. salpingitis.

since migration of female occurs at night. adults may become stuck to the outside the perianal folds where the female migrates to lay eggs 126 .DIAGNOSIS  Scotch tape technique (cellulose tape) eggs and larvae stick to the tape. the method is performed before the patient s bowel movement or before the patient has taken a bath.

TREATMENT  Pyrantel pamoate  Albendazole  Mebendazole 127 .

PREVENTION AND CONTROL 
Proper personal hygiene  Public education  Familial treatment  Handwashing after toilet use  Underwear, night clothes, blankets and bedsheets handled with care, boiled and laundered
128

BLOOD AND TISSUE NEMATODES

129

MICROFILARIA GROUP 
General characteristics: ‡ Require an arthropod as an intermediate host ‡ Diagnosis is made by examining Giemsa stained thick and thin blood smear (except O. volvulus skin scraping from nodules) ‡ They exhibit periodicity

130

MICROFILARIA GROUP  General Life Cycle: 1. The metamorphosis of the microfilaria in the arthropod vector first into rhabditiform larva then an infectious filariform larva. Ingestion of microfilaria from the blood/tissue by a blood-sucking/tissueeating insect 2. 131 .

4.MICROFILARIA GROUP  General Life Cycle: 3. The transfer of the infectious larva to the skin of the new host via the proboscis of the biting insect. The development of the larva at the entry site into a mature worm at its secretion site (may be lymphatics or remain at the dermis) 132 .

MICROFILARIA DISEASE ARTHROPOD VECTOR Culex and Anopheles mosquito Mansonia mosquito Chrysops fly DIAGNOSTIC STAGE FOUND IN Blood MICROFILARIA NUCLEI Does not reach the tip of the tail One at the extreme tip of the tail Up to the tip of the tail None 133 Wuchereria bancrofti Brugia malayi Elephantiasis Elephantiasis Blood Loa loa Calabar swelling Blindess River Blindness Blood Onchocerca volvulus Simulian fly Tissue/Skin scraping .

Wuchereria bancrofti Brugia malayi 134 .

PARASITE BIOLOGY W. bancrofti  Adult worm:  Long. hair-like and transparent with smooth cuticle  Filiform in shape with both ends tapering but terminations are bluntly rounded  Head is slightly swollen with 2 rings of small sessile papillae  Mouth is unarmed 135 .

bancrofti  Adult worm: Living and degenerating worms are both pathogenic Found tightly coiled in nodular dilations in lymph dilations in lymph vessels and in sinuses of lymph glands 136 .PARASITE BIOLOGY W.

bancrofti  Adult Male: Measures 20 40 mm by 0.1 mm Copulatory spicules are distinctly unequal and dissimilar Gubernaculums are crescent shaped Caudal end is curved sharply ventrad 137 .PARASITE BIOLOGY W.

bancrofti  Adult Female: Measures 80 100 mm by 0.3 mm Vulva is cervical in position Posterior end is narrow and abruptly pointed Generally found in the Far East 138 .24 0.PARASITE BIOLOGY W.

bancrofti  Microfilariae:  Measures 270 290 m  Nocturnal periodicity greatest concentration in the blood at 9PM 2AM  Minute snake like organisms that constantly move among red blood cells  Enclosed in a hyaline sheath which is longer than the microfilaria itself  When stained. the central axis shows dark staining which serve as identifying feature 139 .PARASITE BIOLOGY W.

bancrofti  Microfilariae:  Central column of nuclei are discrete and do not extend down to the tip of the tail  The column of nuclei is arranged in two or three rows and is conspicuous  Single stylet is seen at the anterior end  Cephalic space is as long as it is broad  Has several curvatures giving it a graceful appearance 140 .PARASITE BIOLOGY W.

LIFE CYCLE W. microfilaria in blood  Transmission: Culex and Anopheles mosquito (as biological vector) 141 . bancrofti  Infective stage: 3rd stage microfilaria  Diagnostic stage: demonstration of sheathed microfilaria in thin and thick blood smears  Definitive host: humans  Habitat: adults in lymphatics.

long. malayi  Adult worm: Creamy white. and filiform in shape Bears great resemblance to W. bancrofti Male worm measures 13-23 mm in length Female worm measures 43-45 mm in length 142 .PARASITE BIOLOGY B.

malayi  Microfilariae:  Measures 177 .PARASITE BIOLOGY B. double stylets are found at the anterior end  Cephalic space is longer than broad  There is one discrete nuclei at the extreme tip of the tail 143 .230 m  Sheathed.

PARASITE BIOLOGY B. they can be seen enclosed in sheath and having angular curvatures with secondary kinks instead of smooth curves 144 . malayi  Microfilariae:  There is another discrete nuclei midway between the tip and the posterior column of nuclei  In stained blood smears.

microfilaria in blood  Transmission: Mansonia mosquito (as biological vector) 145 . malayi  Infective stage: 3rd stage microfilaria  Diagnostic stage: demonstration of sheathed microfilaria in thin and thick blood smears  Definitive host: humans  Habitat: adults in lymphatics.LIFE CYCLE B.

L I F E C Y C L E 146 .

Wuchereriasis. or Elephantiasis (hydrocoele if the scrotum is affected) and Malayan filariasis  Asymptomatic stage:  There is induced CD4+ lymphocyte apoptosis  May have hidden lymphatic pathology and kidney damage 147 .PATHOLOGY  Disease is called Bancroftian filariasis.

PATHOLOGY  Acute stage:  Clinical manifestations are mainly caused by living. or degenerating adult worms in lymphatics  Fever with lymphadenitis of male genital organs. and legs  Dermatolymphangioadenitis (DLA) immunologic sensitization to the worms 148 . arms. dead.

and blood eosinophilia  Acute manifestations gradually merge into proliferative fibrous tissue growth around dead worms leading to elephantiasis or hydrocoele 149 .PATHOLOGY  Acute stage:  Individuals who are infected but not living in the endemic areas experience Expatriate Symdrome DLA and allergic reactions such as hives. rashes.

PATHOLOGY  Chronic stage:  Fibrous hyperplasia proliferative fibrous tissue growth around and replacing the dead worms  Elephantiasis there is continuous dermal and connective tissue growth and the enlarged parts gradually harden with the loss of skin elasticity and fibrosis 150 .

if untreated progresses to chronic pulmonary fibrosis and respiratory failure 151 .PATHOLOGY  Chronic stage:  Hydrocoele or Chylocoele results from the obstruciton of lymphatics of the tunica vaginalis  Tropical Pulmonary Eosinophilia (TPE) microfilariae are absent in blood but present in tissue.

immunochromatography  Molecular diagnostic techniques using PCR  Ultrasonography lymphagiography and lymphscintigraphy 152 .DIAGNOSIS  Demonstration of sheathed microfilariae in blood in thick and thin smears  Demonstration of Circulating Filarial Antigens (CFA) using ELISA.

TREATMENT  Diethylcarbamazine citrate (DEC)  Ivermectin  Surgery for enlarged parts  Relieving symptoms with analgesics and antipyretics 153 .

PREVENTION AND CONTROL  Destruction of mosquito habitat  Use of mosquito nets  Breeding insect-eating animals like lizards and frogs  Use of mosquito repellents  Use of mosquito sprays like Bacillus sphaericus or chemicals like Baygon  Health education 154 .

Loa loa 155 .

and filiform in shape Vary in size 156 . long.PARASITE BIOLOGY  Adult worm: Also known as eye worm Creamy white.

PARASITE BIOLOGY  Microfilaria: Sheathed Has nuclei up to the tip of the tail Exhibits diurnal periodicity found in peripheral blood anytime of the day 157 .

LIFE CYCLE  Infective stage: 3rd stage microfilaria  Diagnostic stage: demonstration of micorfilaria or adult worms in thick and thin blood smears  Definitive host: humans  Habitat: dermis of the skin  Transmission: Chrysops fly (as biological vector) 158 .

L I F E C Y C L E 159 .

 Allergic reaction due to migration into tissue and death in capillaria 160 .PATHOLOGY  Disease is called Loiasis  Episodic angioedema (Calabar swellings) and subconjunctival migration of an adult worm can occur.

DIAGNOSIS  Demonstration of sheathed microfilariae in blood in thick and thin smears TREATMENT  Diethylcarbamazine citrate (DEC)  Ivermectin  Surgical removal of worms from infected area 161 .

PREVENTION AND CONTROL  Health education  Keeping environment clean to prevent creating fly habitat 162 .

Onchocerca vovulus 163 .

5 50 cm by 270 400 um Vulva opens slightly behinad the posterior end of esophagus 164 .PARASITE BIOLOGY  Adult worm:  Also known as blinding worm  Cuticula possess distinct transverse striations  Adult Male: Measures 19 42 mm by 130-210 mm Posterior end is tightly curved ventrad  Adult Female: Measures 33.

PARASITE BIOLOGY  Microfilariae:  Measures 285 386 by 6 9 um or 150 287 by 5-7 um  Anterior end is bluntly rounded and enlarged and the posterior end is abruptly narrowed  Unsheathed and no stylets are seen at the anterior end  Has no nuclei in both anterior and posterior ends  Has sweeping curves 165 .

LIFE CYCLE  Infective stage: 3rd stage microfilaria  Diagnostic stage: recovery of micorfilaria or adult worms from skin snips  Definitive host: humans  Habitat: dermis of the skin  Transmission: Simulium fly (as biological vector) 166 .

L I F E C Y C L E 167 .

PATHOLOGY  Disease is called Onchocerciasis or River blindness  Longterm corneal inflammation. dermatitis. and lymphadenopathies. leads to thickening of the corneal stroma and ocular lesions which ultimately leads to blindness  Pruritus. 168 . onchocercomata (subcutaneous nodules). or keratitis.

DIAGNOSIS  Demonstration of unsheathed microfilariae in skin scraps tissue TREATMENT  Ivermectin 169 .

PREVENTION AND CONTROL  Health education  Keeping environment clean to prevent creating fly habitat 170 .

Drancunculus medinensis 171 .

Fiery Serpent.9 cm in length 172 .2 2.PARASITE BIOLOGY  Adult worm: Also known as Guinea worm. or Medina Worm Longest human infecting nematode  Adult Male: Measures 1.

forming a painful ulcerating blister  Larva: Measures between 520 700 um Can live for 6 days in clear water and 2 3 weeks in muddy water 173 .PARASITE BIOLOGY  Adult Female: Measures 60 cm in length Migrates along subcutaneous tissues to reach the skin below the knee.

LIFE CYCLE  Infective stage: 3rd stage larva  Diagnostic stage: recovery of adult worms from the ulcer  Definitive host: humans. horses  Habitat: skin  Transmission: Copepods. especially cyclops (small crustaceans) 174 . dogs.

L I F E C Y C L E 175 .

PATHOLOGY  Disease is called Drancunculiasis  Migrating females are usually found in subcutaneous tissue and muscles of humans. dogs. and horses  Causes subcutaneous nodules and subsequent ulcers 176 . cattle.

DIAGNOSIS  Recovery of adult worm in the ulcerating blister TREATMENT  Local cleansing of the lesion and local application of antibiotics  Mechanical removal of worms (clip. pull. & roll!) 177 .

PREVENTION AND CONTROL  Health education  Filtering and boiling of drinking water  Avoiding contact with contaminated water 178 .

Angiostrongylus cantonensis 179 .

PARASITE BIOLOGY  Commonly called RatLung Worm  Was described by chen in 1935 from domestic rats in Canton. China 180 .

PARASITE BIOLOGY
Adult Male:  Pale and filiform, 16-19 mm by 0.26 mm  They have well developed caudal bursa (kidney shaped and single lobed
181

PARASITE BIOLOGY
Adult Female:  Pale and filiform, 21-25 mm by 0.30-0.36 mm  Has uterine tubules which are round spirally around the intestine (barber s pole pattern)  Lays 15,000 egg/day

182

PARASITE BIOLOGY
Eggs/Ovum  Have delicate hyaline shell, measure 46-48 by 68 um  Unembryonated when oviposited, together with the feces

183

crab. rats  Habitat: CSF in the brain  Transmission: shrimp.LIFE CYCLE  Infective stage: 3rd stage larva  Diagnostic stage: recovery of adult worms from the ulcer  Intermediate host: snails (Achantina fulica)  Definitive host: humans. snails 184 . frog.

L I F E C Y C L E 185 .

PATHOLOGY  Disease is called Angiostrongyliasis  Causes eosinophilic meningoencephalitis 186 .

DIAGNOSIS  Relatively difficult  Presumptive diagnosis is made by travel history and exposure  CSF (10% eosinophilia in proportion to the WBC)  CT scan  ELISA (Enzyme Linked ImmunoSorbent Assay) antigen antibody detection 187 .

Mebendazole. Ivermectin (effective in experimental animals) 188 . Albendazole.TREATMENT  No antihelminthic treatment recommended  Thiabendazole.

PREVENTION AND CONTROL  Proper eating habits  Safe food preparation  Elimination of eliminating intermediate host  Washing of leafy vegetables  Eating sufficiently cooked prawns and crabs 189 .

Gnathostoma spinigerum 190 .

also known as creeping eruption  Larva migrans  Yangtze edema  Choko-FuschuTuachid  Wandering swelling 191 .Disease  Gnathostomiasis in humans.

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