Intestinal nematodes

Ascaris lumbricoides

Giant Worm
 Ascaris lumbricoides Ascariasis
Ascaris: worm
lumbricoides:
earthworm-like
Geographical Distribution:
cosmopolitan Green salad
25 ♀ 20 contaminated with
cm cm embryonated Ascaris
♂ eggs
migration

Adult Ascaris worm

Definitive host:
Man
Habitat: Ascaris eggs in stool
lumen of small Diagnostic stage
intestine
Diagnostic Stage Infective Stage
Ascaris egg in stool Embryonated egg

X
Fertilized Decorticated Egg contains 2nd
Unfertilized egg egg
egg stage rhabditiform
As fertilized egg
larva
S 90X40 µ 60X45 µ but lacking
long, narrow, oval, thick mamillations
S ill-defined smooth layer Rhabditiform Larva develops in
Covered by the egg on the ground
mamillations mamillations
1st moult
C brownish
‫األرض‬
C immature Geohelminthic infection
Development of Ascaris inside body of infected human
Larva is swallowed Embryonated egg
Migration stage is swallowed

2nd
moult

Rhabditiform
larva Venous circulation
Adult Ascaris in
small intestine
Intestinal stage
3rd & 4th moults
Pathogenesis and Clinical Picture
During larval migration:
Intense‫ ش==ديد‬local inflammatory reaction around the
larvae leading to pneumonitis.
Eosinophilia

Inflammatory cells
Fever, cough, dyspnea (‫ ) ض==يقا==لنفس‬and asthmatic
attacks ( ‫ ) أزماتربو‬and oedema of lips
 Pathogenesis and Clinical Picture
Adult worms in the intestine:
1- Digestive disturbances:
Abdominal pain, colic, nausea,
vomiting.
Distension (‫ )ا=نتفاخ‬or

Dyspepsia
Due (=‫)عسر هضم‬
to production of anti-enzymes
that interfere with protein digestion.
Malnutrition and underdevelopment
Adult in the
of children. intestine
2- Changes of the bowel movements:
Diarrhoea or Constipation.
 Complications ‫مضاعفات‬
Traumatic effects: due to worm irritation by fever, drugs
or anaesthesia
Liver abscess

Perforation,
peritonitis
Obstructive
jaundice

Appendicitis Intestinal obstruction

 Intussusception
Volvulus a portion of the
a portion of the intestine intestine enters into
twists around itself another portion
 Complications
II-Toxic effects:
caused by toxins of living or dead worms.
Oedema of face, urticaria ‫ى‬( ‫ ) طفح جلد‬, asthma (‫) ربو‬,
insomnia (‫) أرق‬, nervous irritability and convulsions

Asthma Urticaria
 Complications
III- Larvae in ectopic sites: Larvae go to
patient’s viscera

Venous
blood
Larvae penetrated intestinal
Visceral larva migrans wall to blood stream
 Diagnosis
Clinically:
Transient cough, dyspnea (1-2 weeks).
Vague ‫غير وا=ضحة‬abdominal manifestations.
Laboratory:
Sputum examination: streaks of blood, eosinophilia
and larvae.
Eosinophilia (20% - 7%)
Eggs in stool.
Adult in vomits, faeces.
Radiologically:
Plain X-ray of the lungs and Barium meal.
 Plain X-ray of the lungs

Normal lung Lung shows

scattered mottling
‫ب===قع= مبعثرة‬
Loeffler’s syndrome
Barium meal
 Treatment
Albendazole OR Mebendazole

In mixed infections: treat Ascaris infection first to

prevent stimulating the worms to unwanted activity
‫ت===ذهبا==لىأ=ماكنغير مرغوبف===يه=ا‬

Surgical treatment of complications.

 Epidemiology and Control
Ascariasis is prevalent (‫ ) منتشر‬at all
ages, most common in preschool
children.
(Play and defaecate in soil)

Sanitary disposal of human faeces.

Nightsoil (human faeces & urine) should
not be used as fertilizer for food crops.
Proper washing of vegetables eaten raw.
Washing of hands before meals.
Mass treatment.
 Case
A young youth suddenly complained of abdominal pain
accompanied by constipation. He was admitted to the
Emergency Department of El-NOUR Hospital. He was
diagnosed as a case of intestinal obstuction.
a- Enumerate helminths that may cause such condition.
T.solium T.saginata D.Latum ??? A.lumbricoides
b- If the patient gave a history of eating Grilled
Grilled
Greenbeef,
pork
salad
what is the possible parasite causing this condition?
A.lumbricoides
T.saginata
T.solium
c- Name the infective stage in this condition.
S: 60X40µ
Embryonated
Cysticercus S: thick-shelled C:Scolex
brownish
Scolex with
Cysticercus bovis Bladder-like with
egg
cellulosae & mamillated
10X5 mm C:
noLarva
hooks
hooks