Class Nematoda -

The Roundworms
Blood and Tissue-Dwelling Nematodes
Trichinella spiralis – trichinosis
• Due to meat inspection programs, not very
prevalent in U.S.A. When seen, it is usually
due to home butchering and meat preparation.
Outbreaks most commonly associated with
pork.
• Trichinella spiralis is a parasite of carnivorous
mammals. It is common in rats and in swine
fed uncooked garbage and slaughterhouse
scraps.
• Human infections occur most often as a result
of consumption of raw or undercooked pork.
Class Nematoda -
The Roundworms
Trichinella spiralis – trichinosis
Life cycle:
• Infective stage larvae are ingested in
meat products.
• Tissue is digested, larvae are freed in the
intestine. They mature into adult males
and females.
• Female in mucosa releases larvae.
These disseminate throughout the body
via the bloodstream.
• Larvae encyst in striated muscle.
Class Nematoda -
The Roundworms
Trichinella spiralis - trichinosis
Morphology - females are 3.5 mm long;
males measure 1.5 mm long; larvae measure
100 microns long.
Diagnosis - Identification of encysted larvae
in muscle biopsy. Serology becomes
positive 3 to 4 weeks after infection. A
history of eating undercooked pork, deer,
walrus or bear is indicative whenever
appropriate symptoms appear.
Class Nematoda -
The Roundworms
Trichinella spiralis – trichinosis
Major pathology and symptoms:
• Fever, muscle pain, bilateral periorbital edema,
and increased eosinophil count
• Intestinal phase – small intestine edema and
inflammation, nausea, vomiting, abdominal
pain, diarrhea, headache, and fever.
• Migrational phase - high fever (104 degrees),
blurred vision, edema, cough and pleural
pains.
• Muscle phase – acute, local inflammation with
edema and pain.
Class Nematoda -
The Roundworms
Trichinella spiralis – trichinosis
Distribution:
• Cosmopolitan among meat-eating
populations, highest incidence is
reported from China, common in Spain,
France, Italy, and Yugoslavia.
• Prevalence in U.S.A. is about 4%
based on autopsy studies.
• Only about 100 cases are recognized
and reported per year in the U.S.A.
 Trichina worms
• Trichinella, just as a virus does, manipulates the host
cell’s DNA. It causes the cell to recruit a blood supply
to supply food to the cell and also produce collagen
to form a cyst around the cell.

• The Trichinella juvenile awaits ingestion by another

host. When ingested it emerges from its cysts enters
the mucosal lining of gut, develops into an adult and
continues the life cycle.
Trichinella life cycle in humans
 Trichina worms
• Adults usually do not persist long in the gut before
being expelled by the host’s immune system.

• Trichinella occurs commonly in wild animals such as

foxes, wolves and bears. Smaller mammals such as
skunks, raccoons and rats, which commonly
associate with people, are the main sources of
domestic pig infections.
 Trichina worms

• Pigs may become infected by eating fecal matter or

the bodies of animals infected with the parasite.
Humans are an inadvertent host of Trichinella.

• In humans, infection with a few Trichinella parasites

may cause no symptoms, but heavy infections can
cause intense muscle pain and in some cases death.
 Tissue Nematodes
• The tissue nematodes are present in the
tissues and lympho-hematogenous system of
the human body.
• The 4 major nematodes, Wuchereria
bancrofti, Brugia malayi, Onchocerca volvulus,
and Loa loa, and all use humans as their
natural definitive host.
• The thin, thread-like adults live for years in the
subcutaneous tissues and lymphatic vessels,
where they discharge their live-born offspring or
microfilariae.

• These progeny circulate in the blood or migrate

in the subcutaneous tissues until they are
ingested by a specific bloodsucking insect.

• Within this vector, they transform into filariform

larvae capable of infecting another human when
the invertebrate host again takes a blood meal.
 Class Nematoda -
The Roundworms
Dracunculus medinensis – The Guinea Worm
Overview:
• An important parasite in the Middle East,
central India and Pakistan. Also found in
Africa in the Sudan and scattered through
central equatorial regions, and on its west
Blister containing Dracunculus medinensis coast.
• It is believed to no longer occur in the
Western Hemisphere.
• Sometimes classified with the filarial
worms, but Dracunculus is not a true
filaria.
Adult Dracunculus emerging from broken blister
Dracunculus
medinensis
• Site of infection: Ingested infective larvae
penetrate the gut and invade subcutaneous
connective tissues, migrating mainly to the
axillary and inguinal regions.
• Maturing female worms migrate from deep
connective tissues to peripheral subsurface
locations, particularly in the extremities of
limbs (legs and arms.
 Pathogenesis
• Usually do not produce any clinical signs until
the mature female worms migrate to the skin
and provoke the formation of a papule then a
blister.

• Migration may sometimes produce vague

allergic reactions, including nausea, dizziness,
diarrhoea, rash and local oedema.
• Infections generally produce two types of lesions:
subcutaneous or deep abscesses around dead worms
(involving many inflammatory cell types) that tend to
calcify; or cutaneous papules which rapidly become
blisters through which females release live larvae.

• Skin lesions may involve local erythema, urticaria,

inflammation, ulceration and intense burning pain
(fiery serpent of biblical times).
• Patients seek to relieve symptoms by immersing the affected region
in cool water.

• Lesions are initiated by the deposition of larvae in the tissues and

the induction of hypersensitivity reactions which ultimately produce
blisters through which larvae, and parts of the adult worm, emerge.

• In uncomplicated cases, lesions may only last for several weeks until
the worm is completely expelled.

• However, many cases involve secondary bacterial infection of the

worm track with persistence of the lesion, chronic ulceration and
possible sequelae, involving disseminated infections, phlegma of
limbs, contractures of tendons, fibrous ankylosis or arthritis in the
joints, or even tetanus.
Class Nematoda -
The Roundworms
Dracunculus medinensis – The Guinea Worm
Life cycle:
• Infective stage exists in a water flea (copepod –
the intermediate host).
• Humans become infected by drinking water
containing the infected copepod.
• Larvae penetrate the digestive tract to enter the
deep connective tissues where they mature in
about 1 year.
• Females migrate to the subcutaneous tissue
(usually the skin of the extremities).
• Females release larvae which leave the human
through ruptured blisters on the skin.
• The larvae enter the water and are ingested by
copepods.
Class Nematoda -
The Roundworms
Dracunculus medinensis – The Guinea Worm

Morphology –
• Males measure 40mm in length.
• Females measure 800mm in length.

Diagnosis -
• Visual observation of skin blister. The worm’s
serpentine presence beneath skin can be
seen.
• Induce release of larvae from the skin ulcer by
applying cold water.
Class Nematoda -
The Roundworms
Dracunculus medinensis – The Guinea Worm
Major pathology and symptoms –
• Mild allergic symptoms such as urticaria
during the migration phase.
• A papule develops into a blister with
localized erythrema and tenderness.
• Generalized symptoms include nausea,
vomiting, diarrhea, and possibly asthma
attacks.
• Additional complications include
secondary bacterial infections, permanent
damage to joints.
Distribution - Middle East and Africa.
 Loa Loa
• Loiasis is a filarial disease of West Africa produced by the eye
worm, Loa loa.
• The long-lived adults migrate continuously through the
subcutaneous tissues of humans at a maximum rate of about 1
cm/hr.
• During migration, they produce localized areas of allergic
inflammation termed Calabar swellings.
• These egg-sized lesions persist for 2 to 3 days and may be
accompanied by fever, itching, urticaria, and pain.
• At times, the adult worms may cross the eye subconjunctivally,
producing intense tearing, pain, and alarm.
Deer fly or mango fly (Chrysops spp)
Class Nematoda -
The Roundworms
The Filarial Worms
Loa loa:
The “eyeworm.” Infections involve the dermis
and subcutaneous tissues (Calabar
swellings).
• Diagnosis - Usually made from clinical
symptoms, but if laboratory confirmation is
required, blood should be drawn between 11
am & 1 pm.
• Diagnosis - Microfilariae are sheathed, nuclear
column extends to tip of tail.
• Loa loa does not normally affect one's vision
but can be painful when moving about the
eyeball or across the bridge of the nose
• Adult Loa worms -males are 30–34 mm long and
0.35–0.42 mm wide compared to females with
40–70 mm long and 0.5 mm wide.

• Adults live in the subcutaneous tissues of

humans, where they mate and produce wormlike
eggs called microfilariae.

• These microfilariae are 250–300 μm long, 6–8

μm wide are sheathed and contain body nuclei
that extend to the tip of the tail.
Class Nematoda -
The Roundworms
The Filarial Worms
Loa loa:
Major pathology and symptoms -
Infections cause a localized
subcutaneous edema, particularly
around the eye, because of larval
migration and death in capillaries.

Living adults cause no inflammation; dying

adults induce granulomatous reactions.
 Signs and symptoms
• Asymptomatic micro-filaremia.
• In some lymphatic dysfunction - lymphedema.
• Episodic angioedema (Calabar swellings) in the arms and legs,
caused by immune reactions, are common.
• When chronic, they can form cyst-like enlargements of the
connective tissue around the sheaths of muscle tendons,
becoming very painful when moved.

• The swellings may last for one to three days and may be
accompanied by localized urticaria (skin eruptions) and pruritus
(itching).
• “African eye worm."
• Eosinophilia

• Dead worms may cause chronic abscesses, which may lead to

the formation of granulomatous reactions and fibrosis.

• Adult worms migrate in the subcutaneous tissues at a speed

less than 1 cm/min, mating and producing more microfilariae.

• The adult worms can live up to 17 years in the human host.

 Diagnosis
• To find Loa loa.
• blood collection for microfilariae (10:00 a.m. and
2:00 p.m.).
• Giemsa or haematoxylin and eosin.
• Sedimentation and filtration method.
 Treatment
• Chemotherapy or surgical removal of adult
worms followed by systemic treatment.
• Diethylcarbamazine (DEC), 8–10 mg/kg/d
taken three times daily for 12 days per CDC.