HELMINTH

Sitti Wahyuni, MD, PhD

Department of Parasitology
Medical Faculty, Hasanuddin University

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 Cestoda
Nematoda

Trematoda
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 Introduction

• Helminth is a general term meaning worm.

• invertebrates characterized by elongated, flat or
round bodies.
• The clinically relevant groups are separated
according to their general external shape and the
host organ they inhabit.
• Hermaphroditic and bisexual species.
• Classification is based on the external and
internal morphology of egg, larval, and adult
stages

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Classification based on morphology
• Flukes (Trematodes):
• Adult: leaf-shaped flatworms.
• Prominent oral and ventral suckers help maintain position in situ.
• Hermaphroditic except for blood flukes
• life-cycle includes a snail intermediate host.
• Tapeworms (Cestodes):
• Adult: elongated, segmented, hermaphroditic, inhabit the intestinal
lumen
• Larval : cystic or solid, inhabit extraintestinal tissues.
• Roundworms (Nematodes):
• Bisexual
• Cylindrical worms
• They inhabit intestinal and extraintestinal sites.
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 Nematods Trematods Cestods
Ascaris lumbrocoides Paragonimus westermani Diphyllobothrium latum
Toxocara spp. (Diphyllobothrium mansoni)
Necator americanus Fasciola hepatica
Ancylostoma spp. Fasciola gigantica Taenia saginata
Enterobius vermicularis Ophistorcis felineus Taenia solium
Trichuris trichuria Ophistorcis viverini Echinococcus granulosus
Strongiloides stercoralis Clonorchis sinensis Echinococcus alveolaris
Trichostrongilus spp. Dicrocoelium dendriticum Multiceps multiceps
Gnathostoma spinigerum
Trichinella spiralis Faciolopsis buski Bertiella studeri
Wuchereria bancrofti Echinostoma ilocanum
Brugia malayi Heteropyes heteropyes Diphyllidium caninum
Loa loa Metagonimus yokogawai
Onchocerca volvulus Gastrodiscoides hominis Hymenolepis nana
Manzonella ozardi Hymenolepis diminuta
A. perstans Schistozoma hematobium
Dracunculus medinensis Schistozoma mansoni
Capilaria hepatica Schistozoma japonicum
A. cantonensis
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 Life cycle stage
• Knowledge of the different stages in relation to their
growth and development is the basis for
understanding the epidemiology and pathogenesis of
helminth diseases
• Stages of helminthes commonly responsible for
pathologic changes in humans
Helminths Egg Larva Adult
Flukes + +a +
Tapeworm - + +
Nematodes - + +
aMigrating and developing larva forms may cause transient pathologic
responses in host
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 Flukes Tapeworms Roundworms
(Trematodes) (Cestodes) (Nematodes)
Miracidiuma Cysticercosus b,c,d Rabditiform d
Sporocystaa Cysticercoid b Filariform b
Redia a Coenurus b,d Microfilaria a,d
Cercaria a,b,c Coracidium a
Metacercaria b Procercoid a,b
Pleurocercoid a,b,c,d (sparganum)
Hydatid a,c,d

a. Infective to or develops within intermediate host or vectors

b. infective stages for human
c. Cause of pathogenic changes in humans
d. Can be isolated from human host and, therefore, is important in definitive diagnosis
Table1. Common larval form found in human

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 Flukes morphology

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 Flukes life cycle

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 Cestoda (morphology)

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 Cestoda (life cycle)

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 Nematoda (morphology)

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 Life cycle of nematoda

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 Life cycle
Free: Eggs/Larva
-Ascaris lumbricoides
-Necator americanus
-Ancylostoma duodenale
-Trichuris trichuria
-Enterobius vermicularis
-Strongiloides stercoralis
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Insect:/ Arthropoda:
-Wuchereria bancrofti (mosq)
-Brugia malayi/ timori (mosq)
-Loa-loa (Lalat Chrysop)
-Dracunculus medinensis
(Cyclops)
-Onchocerca volvulus (Lalat
hitam/Simulium)
-Manzonella spp (Lalat
kuda/Tabanus)
Babi:
- Trichinella spiralis
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 Transmission of helminth Infection

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 Host factors influencing susceptibility

• Human behavior is a major factor influencing

susceptibility to infection: hygiene and food
• Level of infection is directly related to the
number of infective stages encountered.
• Dynamic balance between the rate of
infection and the efficiency of human defense.
• Children are more susceptible
• Individuals differ genetically in their ability to
resist infection

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 Pathogenesis
• Direct damage from helminth activity

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• Indirect Damage from Host Response

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 Defenses Against Infection
• Nonspecific resistance
– Following oral ingestion, parasites must survive passage
through the acid stomach to reach the small bowel.
– Penetration into the intestinal wall may trigger
inflammatory responses that immobilize and kill the worm.
– Worms entering through the skin must survive the skin
secretions, penetrate the epidermal layers, and avoid
inflammatory trapping in the dermis.
– Invasion of humans by the larvae of dog and cat
hookworms (Ancylostoma spp.) results in dermatitis and
“creeping eruption”
– Once in the tissues, worms need the correct sequence of
environmental signals to mature. Absent or incomplete
signals constitute a form of nonspecific resistance that may
partially or completely prevent further development.
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• Specific Acquired Immunity
– responsible for the most effective forms of host
defense

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 Avoidance of host defenses

• Many helminths survive for extended periods in the bodies

of their hosts (size, motility, employ many sophisticated
devices to render host defenses ineffectiv)
• Some worms (schistosomes) disguise their outer surface by
acquiring host molecules which reduce their antigenicity;
• Intrinsic membrane changes also make these worms
resistant to immune attack.
• Filarial nematodes acquire serum albumin on their cuticle,
which may act as a disguise.
• Many worms release substances that depress lymphocyte
function, inactivate macrophages, or digest antibodies.
• Larval cestodes appear to prolong their survival by
producing anticomplement factors which protect their
outer layers from lytic attack.

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