INTESTINAL NEMATODES

Morphology and Life Cycle

 Members of the class Nematoda assume three basic
morphologic forms:

• Vary in size • Located inside • Develop from the maturing

larvae
and shape the fertilized • Sexes separate (females
eggs; emerge larger than males)
and continue • Equipped with a digestive
and reproductive system
to mature
LARVA ADULT
EGGS E WORMS
Arrangement of Somatic muscles:
 Meromyarian – 2 to 5 cells per dorsal or ventral
half.
Enterobius vermicularis
 Common names:
Human Pinworm,
Threadworm

Seat worm

 Common associated disease and conditions:

Enterobiasis / Oxyuriasis

Pinworm infection
Human pinworm:
 Most common helminth parasite identified in
temperate regions where environmental sanitation
is in place.
 Less attention given to pinworm infection due to
presence of parasites
 Unlikely to cause significant morbidity or mortality
– migrating worms may go beyond the perianal
region – occasionally cause complications in
ectopic areas.
MORPHOLOGY
 EGGS outer albuminous covering
PARAMETER DESCRIPTION
SIZE 50-60um by 20-30um
SHAPE • Asymmetrical
• One side flattened;
other side convex
• Translucent covering
ering: outer triple
albuminous
• Inner embryonic
lipoidal membrane
(chemical protection)
inner lipoidal membrane
SHELL Smooth; yellow-brown
color because of host bile
contact
Egg:
Eggs:
 Range from 50 to 60 um by 20 to 30 um ( average:
55 by 36 um )
 Tadpole like embryo
- inside the egg and become
fully mature outside the
within 4 to 6 hours.
Eggs:
 are resistant to disinfectants but succumbs to
dehydration in dry air within a day.
 in moist conditions – eggs can remain viable for
up to 13 days ( remain viable longest under
conditions of fairly high humidity and moderate
temperature )
 may survive for some days in dry dust and
airborne eggs can infect persons at a distance via
inhalation.
MORPHOLOGY
 Rhabditiform larva:
– Measuring 140 to 150 um by 10 um.
- Has the characteristic esophageal bulb
- Has no cuticular expansion on the anterior end
MORPHOLOGY
 ADULTS
PARAMETE DESCRIPTION
R
SIZE Male – 2-5mm by 0.1-0.2mm
Female – 8-13mm by 0.4mm
Males are rarely seen because
they usually die after copulation.
The uteri of gravid females are
distended with eggs.
ANTERIOR Male – Note the esophageal
END bulb, characteristic of the
species, in the anterior end
Female – dorso-ventral
expansion of cuticle at anterior
end called alae or cephalic
inflation
Enterobius vermicularis ( Male )
 Formalin-ethyl acetate (FEA) concentrated
stool smear.

(Image contributed by the Centre for Tropical Medicine and Imported

Infectious Diseases, Bergen, Norway)
Enterobius vermicularis ( Male )
 Note the blunt end. The spicule is withdrawn into the
worm in this specimen.

( Close-up of the posterior end of the worm)

Enterobius vermicularis ( male )
 The esophagus, divided into muscular and bulbous
portions and separated by a short, narrow isthmus.

(Close-up of the anterior end of the worm)

 MORPHOLOGY
 ADULTS
PARAMETER DESCRIPTION
POSTERIOR END Male- curled posterior
tail with a spicule,
characteristic of the
male.
Female- long, pointed posterior part of
tail (arrow) leading to male E. vermicularis
the common name of
pinworm.

elongate whitish tubes

with pointed tails,
large esophageal bulb,
conspicuous
posterior anterior
cuticular inflation
part ofhead)
(swollen female
E. vermicularis
Adult worms:
 are found in the cecum and adjacent portions of
the small and large intestines.
 gravid female worms – migrate down to the
intestinal tract and exit through the anus to deposit
eggs in the perianal skin ( evening hours )
 female worm – lays from 4, 672 to 16,888 eggs
per day ( average 11, 105 eggs )
 eggs – fully embryonated within 6 hours
 female worms – die after eggs are deposited.
Ingestion of Eggs
 When fully embryonated with in 6 hours
- when the eggs are ingested – eggs contains
the 3rd stage larvae – hatch in the duodenum – pass
down to the small intestine – to the cecum – develop
into an adult.
Perianal region
LIFE CYCLE
PATHOGENESIS AND CLINICAL
MANIFESTATIONS

1. Pruritus ani → scratching, scarification,

haemorrhage, weeping eczema & pyogenic
infection. 

2. Parasite migrate into 

- Vagina & Uterus => Encysted. 
- Fallopian tubules => Salpingitis. 

3. Minute ulceration & secondary bacterial infection →

appendicitis.
DIAGNOSIS
 Graham’s scotch adhesive tape swab
TREATMENT
 Mebendazole 100mg PO single dose
 Pyrantel pamoate 11mg/kg base PO single dose
 Albendazole 400mg PO single dose
RISK FACTORS & EPIDEMIOLOGY

 children under 18, people who take care of infected

children and people who are institutionalized have 50%
chance of prevalence
 Humans are the only species that can transfer this parasite.
Household pets like dogs and cats cannot become infected
with human pinworms. Pinworm eggs can survive in the
indoor environment for 2 to 3 weeks.
 occurs in both temperate and tropical regions of the world
 high prevalence in both developed and developing
countries
E. vermicularis egg
 E. vermicularis
FEMALE

E. vermicularis
MALE
 NICE TO KNOW

Capillaria philippinensis Trichuris trichiura

 Medical Parasitology in the Philippines by Vicente
Belizario Jr, Winifreda U. de Le-on, 3rd edition
2015.
 CDC.
https://www.cdc.gov/dpdx/diagnosticprocedures/bl
ood/specimenproc.html.
https://www.cdc.gov/dpdx/diagnosticprocedures/in
dex.html
Proverbs 21:31
The horse is made ready
for the day of battle, but
victory rests with the
Lord.