10TH GRADE

CHAPTER
15
NEMATODE
S
ROLINA M. CABALLERO R. N
 Learning Objectives
Describe the general
characteristics of the
01. medically important 02.
nematodes
Characterize and differentiate
nematodes as to:
a. General features
b. Source of infection
c. Mode of transmission
d. Clinical manifestation
e. Treatment
f. Prevention and control
of infection
 General Properties of Nematodes
● Roundworms are unsegmented, bilaterally symmetrical worms with
elongated cylindrical bodies.
● Life cycle: Three stages- embryonated egg or ova, larva and adult
worm.
● Cuticle-body covering
● Separate sexes female larger than the male.
● Adult worm- complete digestive system, simple nervous system,
excretory system, and a reproductive system.
● Digestive system:
- Stomodeum (mouth, esophagus, and buccal cavity.)
- Intestines
- Anus (proctodeum)
● Nervous system:
- 2 nerves that run along the length of the body of the worm on
both the dorsal and ventral sides and connected to the nerve
center at the head of the worm.
● Amphid- sensory organ located in the anterior end of the head.
- (e. g.,. aphasmids Trichuris and Trichinella) posterior head.

● Phasmids- caudal chemoreceptors (Ascaris, Necator, and filarial

worm Wuchereria.
● Equipped with excretory canals on each side for elimination.
● Most patients with infection are asymptomatic.
● The severity of the disease depends on the worm burden and the
host’s immunity.
● Three groups of nematodes: intestinal, intestinal-tissue and the blood-tissue
nematodes
● Philippines: Enterobius, Ascaris, Trichuris, Necator, Ancylostoma,
Strongyloides and Capillaria.
- Soil contaminated with feces (All except Capillaria)
- Ingestion of the embryonated ova (Ascaris, Enterobius, and Trichuris).
- Skin penetration (Necator, Ancylostoma, and Strongyloides.
- Ingestion of undercooked or raw infected fish (Capillaria philippinensis
endemic in the Philippines).

● Wuchereria and Brugia- Blood tissue nematodes of significant medical

importance particularly in the Philippines.
- Bite from arthropod vectors (mosquitoes).

● Trichinella- intestinal-tissue, improperly cooked or raw pork meat with worm’s

encysted larva.
Parasite/ disease Site of Mode of Diagnosis Treatment
infection transmission

Enterobius vermicularis Lumen of Ingestion of Scotch Tape Pyrantel

(pinworm) cecum, colon eggs, self- test; pamoate,
contamination microscopy for mebendazole
or eggs
autoinfection

Trichuris trichiura Cecum, colon Ingestion of Stool exam for Mebendazole,

(Whipworm) eggs from eggs albendazole
fecally con
taminated soil
or food

Ascaris Lumbricoides Small Ingestion of Stool exam for Albendazole,

(common roundworm) intestines; eggs from eggs; sputum mebendazole
larvae through fecally exam for
lungs contaminated larvae
soil or food
 Parasite/ disease Site of Mode of Diagnosis Treatment
infection transmission

Ancylostoma Small Larvae in soil Stool exam Albendazole,

duodenale, necator intestines; penetrate for eggs; mebendazole
americanus (human larvae skin sputum
hookworms) through skin, exam for
lungs larvae
Strongyloides Small Larvae in soil Stool exam, Ivermectin,
stercoralis intestines; penetrate sputum albendazole
larvae skin; exam or
through skin, autoinfection bronchial
lungs (rare) lavage for
larvae

Summary of intestinal nematodes

 Summary of blood and tissue nematodes

Parasite/ Site of infection Mode of Diagnosis Treatment

disease transmission

Trichinella Adults in small Eating Serology and Albendazole

spiralis intestines for 1-4 undercooked muscle + steroids
(muscle months; larvae , infected biopsy (severe
worm) encysted in muscle pork or other symptoms)
tissue animal
Wuchereria Adult worms in lymph Bite of Blood smear Diethylcarba
bancrofti, nodes, lymphatic mosquitoes for mazine
brugia malayi ducts transmit microfilariae
(filarial larvae
worms)
 Intestinal Nematodes
Ascaris Lumbricoides (Large Intestinal Roundworm)
● Largest intestinal roundworm infecting humans.
● Adults- creamy white covered with cuticle.
● Ingestion of contaminated food with human feces containing embryonated
ova.
● Small intestines- larvae is released from the eggs-penetrate the intestinal
wall-blood-liver-localizes to the lungs.
● Lungs-air sacs and migrate into the bronchioles
● Larvae are then coughed and swallowed returning the worm to the
intestines.
● Larvae mature into adult worms in the small intestines, lay their eggs and
eliminated with the feces.
● Eggs are capable of surviving in soil, sewage, or water for several years.
 Epidemiology and Pathogenesis
● Most common worldwide, warm climate and poor
sanitation.
● Areas that use human feces as fertilizer or where
children directly defecate on the ground.
● Young children when they play in the soil.
● Adult worms produce little damage in the intestines.
● Development of malnutrition.
● The major damage occurs during larval migration to
the lungs where inflammation occurs.
 Disease: Ascariasis
● Asymptomatic-low worm burden
● Symptomatic infection occurs due to migration of the parasite through
the host.
● Larval migration, larvae may induce allergic reactions, manifesting
asthmatic attacks accompanied by eosinophilia (loeffler’s syndrome).
● Pneumonia-penetration of the lung capillaries by the larvae
● Intestines- multiple adult worms in the intestines can lead to abdominal
pain (most common complaint), vomiting, fever, and abdominal
distention, intestinal obstruction (entangled worm).
● Appendicitis, peritonitis, and obstruction of the liver and bile ducts.
Laboratory Diagnosis:
● Stool specimen (eggs).
● Heavy worm burden- present in stool or be regurgitated.
● Sputum-pulmonary phase

Treatment
● Mebendazole, Albendazole, and pyrantel pamoate

Prevention and Control

● Proper disposal of human feces, health education, improved personal
hygiene
● Avoid human feces as fertilizer.
● Mass chemotherapy especially for children and in areas with high
incidence of parasitism.
 Enterobius vermicularis (Pinworm, seatworm)
Important Properties and Life Cycle
● Eggs- Oval and flat on one side.
● Adult worm- small and yellowish-white in color.
● Based on the appearance of a clear, pointed tail of the adult
female that resembles the pinhead.
● Small intestines larvae from the eggs and matured into adult
worms. In the large intestines.
● Female became impregnated it migrates to the perianal region
and lay eggs.
● Autoinfection occurs as a result of hand-mouth transmission.
 Epidemiology and Pathogenesis
● At risk: children, their caretakers, institutionalized persons, and
those in unsanitary and crowded living conditions.
● Itchiness- deposition of eggs in the anal region.
● Appendicitis-obstruction

Disease: Enterobiasis
● Asymptomatic
● Intense itching in the anal area (pruritus ani) or vaginal region at
night.
● Intestinal irritation and mild nausea.
Laboratory Diagnosis
● Scotch tape method or cellophane tape method
● Several samples may be necessary to confirm diagnosis.

Treatment
● Albendazole, mebendazole, pyrantel pamoate
● Household member must undergo treatment (group infection)

Prevention and Control

● Good personal hygiene, clipping of fingernails, thorough washing of
beddings, and prompt treatment of infected persons contribute to the
control and prevention of the parasite spreading to other individuals.
● Avoid ingestion and inhalation of eggs, thoroughly clean the house using
damp mop in areas including the floor under the beds, the windowsills,
and overdoors.
 Trichuris trichiura (Whipworm)
Important Properties and Life Cycle
● The larvae and adult worms live in the intestine of humans and can
cause intestinal disease. The name comes from the worm’s whip-
like shape.
● Whipworms live in the intestine and whipworm eggs are passed in
the feces (poop) of infected persons. If the infected person
defecates (poops) outside—for example, near bushes, in a garden,
or field—or if the feces of an infected person is used as fertilizer,
then eggs are deposited on the soil.
● Roundworm infection is caused by ingesting eggs. Hands or
fingers that have contaminated dirt on them are put in the mouth,
or by eating vegetables or fruits that have not been carefully
washed, peeled, or cooked.
● People with light infections usually have no
signs or symptoms.
● People with heavy infections can experience
frequent, painful bowel movements that contain
a mixture of mucus, water, and blood.
● The diarrhea typically smells worse than usual.
Severe cases can slow growth in children.
● Rectal prolapse (when the rectum sags and
comes out of the anus) can also occur. In
children, heavy infection may also be
associated with impaired cognitive
development.
 Disease
● People infected with whipworm can suffer light or
heavy infections. People with light infections usually
have no symptoms.
● People with heavy symptoms can experience
frequent, painful passage of stool that contains a
mixture of mucus, water, and blood.
● Rectal prolapse can also occur.
● Heavy infection in children can lead to severe
anemia, growth retardation, and impaired cognitive
development.
Laboratory Diagnosis
● Eggs in stool specimen

Treatment
● Drug of choice Mebendazole or albendazole

Prevention and Control

● Health education, proper sanitation, good personal
hygiene, and avoidance of use of human feces as
fertilizer
 Ancylostoma duodenale (Old World Hookworm) and Necator
americanus (New World Hookworm)

Important Properties and Life Cycle

● 2 Common hookworms: Ancylostoma duodenale and Necator americanus- both has four
stages of life cycle: eggs, rhabditiform larvae, filariform larvae and adults.
● Rhabditiform larvae- immature newly hatched.
- Buccal cavity or buccal capsule (use for feeding, long oral cavity).

● Filariform- non-feeding, infective larvae, with distinct pointed tail.

● Adult form- different in the two hookworms (buccal capsule)
- N.americanus- a pair of cutting plates
- A. duodenale-teeth

● Filariform larva- infective stage, transmission: skin penetration

● Site of penetration: feet or legs
● Carried by the blood to the lungs, coughed up and swallowed with sputum.
● Small intestine- larvae transforms into adult worm. Site for mating, thousand of eggs each day,
passed out with the feces.
Epidemiology and Pathogenesis
● Worldwide; tropical countries
● Walking barefoot on soil
● Irritation at the site of penetration, inflammatory reactions in the lungs
during larval phase.
● Major damage: Chronic blood loss at the site of attachment.

Disease: Hookworm infection

● Pruritic papule or vesicle (ground itch) at the site.
● Intestine- nausea, vomiting, and diarrhea.
● Microcytic, hypochromic anemia, iron deficiency anemia.
Laboratory Diagnosis
● Stool exam will show the thin-shelled eggs.
● Occult blood in the stool and blood eosinophilia
● Peripheral blood smear - anemia
● Sputum-larva

Treatment
● Mebendazole and pyrantel pamoate
● Iron replacement therapy for anemia
● Severe cases: blood transfusion

Prevention and Control

● Wearing shoes or any protective footwear is also important in
endemic areas.
 STRONGYLOIDES STERCORALIS ( Threadworm)

Important Properties and Life Cycle

● Ova are smaller and well-developed larvae.
● Rhabditiform larvae- differ in form: longer buccal cavity and smaller genital
primordium.
● Filariform larvae-infective stage. Longer esophagus and a notched tail.
● 2 distinct life cycle: within a host and a free-living cycle in soil.
● Rhabditiform larvae passed out with feces instead of eggs, and transform into
filariform larvae in warm, moist soil.
● Transmission:
- a. Skin penetration (beginning of human cycle).
- b. Indirect mode- rhabditiform passed out with feces, transform into
filariform larvae in the soil. (start of free living).
- C. autoinfection- Rhabditiform transform into filariform in the intestines,
enter the lymphatic or bloodstream, thus starting a new cycle.
 Epidemiology and Pathogenesis
● Tropical, subtropical, warm temperate areas.
● Agricultural areas
● Ground itch similar to hookworm.
● Inflammatory reaction in the intestinal wall-diarrhea

Disease: Strongyloidiasis (Cochin China Diarrhea)

● Asymptomatic
● Skin irritation at the site of entry
● Pneumonitis-migration to the lungs
● Adult worms in the intestines- diarrhea and abdominal pain
● Stimulate recurrent allergic reactions-urticaria and eosinophilia
● Autoinfection-malabsorption syndrome: biliary ducts, pancreas, intestines and
colon
● Steatorrhea- (fat in the stool)- nutrients deficiency, diarrhea, epigastric pain
● Hyperinfection syndrome- fatal electrolytes abnormalities, bacterial sepsis,
peritonitis and endocarditis.
Laboratory Diagnosis
● Eggs not commonly present in stool, may be present in the stool of patients with
heavy worm burden who have severe diarrhea.
● Recovery of rhabditiform larvae in fresh stool sample.
● 3 samples : one per day for three days, as the larvae may occur in showers
● Examination of duodenal aspirates (larvae).
● Sputum exam
● Eosinophilia in massive infection
● ELISA (enzyme-linked immunoassay)

Treatment:
● IVERMECTIN with mebendazole and thiabendazole

Prevention and Control

● Health education, proper sanitation, sewage disposal, wearing of footwear, and
prompt treatment.
 Capillaria Philippinensis (Pudoc worm)

Important Properties and Life Cycle

● First describe in the Philippines in 1963, when the first human case
died from infection.
● 1967-68- outbreaks
● Migratory fish-eating birds are the natural hosts.
● Un-embryonated eggs are passed from the birds feces or infected
human usually in fresh-water.
● Eggs become embryonated and are ingested by fresh water fish
(bagsit of Ilocos region)
● Larva encyst in the tissues of the fish.
● Infection: improperly cooked or raw fresh water fish.
● Small intestines-larvae mature into adult worms that burrow into
the wall of the intestines and lay eggs.
● Autoinfection
Epidemiology and Pathogenesis
● Endemic in the Philippines particularly in the Ilocos Region, and
have also been seen in Thailand.
● The large number of worms-responsible for pathology (disease)
● Adult worms can cause micro ulcers that if severe, can lead to
malabsorption syndrome.

Disease: Intestinal Capillaries

● Abdominal pain, with a gurgling stomach (borborygmus) and
chronic diarrhea.
● Weight loss (diarrhea), loss of appetite (anorexia), nausea and
vomiting.
● Malabsorption of fat, carbohydrates, proteins and electrolytes
abnormalities can be fatal.
Laboratory Diagnosis
● Eggs in the stool specimens.
● In high worm burden-larvae and adult worms are present.

Treatment
● Albendazole, with mebendazole as alternative in adult patients.
● Chemotherapy - 20 days
● Severe case- Electrolytes and high-protein diet

Prevention and Control

● Adequate cooking and thorough cooking of seafood
● Proper waste disposal, health education, and prompt treatment
 BLOOD AND TISSUE NEMATODES
Wuchereria Bancrofti (Bancroft’s filarial worm) and Brugia malayi
(Malayan Filarial worm)
Important Properties and Life Cycle
● Both mosquito borne parasites
● 2 morphologic forms: adult worm (male and female) and larvae
(microfilariae).
● Sheath-delicate outer covering of the microfilariae.
● Infective larvae-migrate to the tissues , mature, and localize in the
lymphatics, subcutaneous, or internal body cavities.
● Migration exhibit periodicity, parasite is present in the bloodstream
during specific times of the day, corresponds to the feeding time of the
mosquito.
● Night (nocturnal), during the day (diurnal), or with no clear-cut timing
(sub-periodic).
Epidemiology and Pathogenesis
● Wuchereria bancrofti- worldwide, Asia- Brugia malayi, Philippines-
Bancrofti.
● Mosquito vectors for W. bancrofti:
- Culex spp, Anopheles spp., Aedes spp, and mansonia spp.

● Philippines rural area: Anopheles minimus falvirostris

- Urban - culex spp.
- 44 provinces in the Ph according to DOH as endemic.
- Filaria-free- Southern leyte, Sorsogon, Biliran, Bukidnon, Romblon,
Agusan del Sur, and Dinagat Islands.

● Manifestation- due to the obstruction of the lymphatic vessels by the adult

worms, causing edema of the limbs.
● Adult worms cause inflammatory and fibrotic reactions.
● Microfilariae cause less severe pathology
Disease; Filariasis
- Depends on the species .

3 stages:

1. Asymptomatic- presence of thousands of microfilariae in the peripheral

blood. Adult worms may be found in the lymphatic system without
manifestations.
2. Acute- Marked by fever. Inflammation of the lymph nodes
(lymphadenitis), particularly those of the male genitalia (bancroft’s) and
of extremities (Brugia).
- Female- breast
- Recurrent attacks : epididymitis, orchitis (testes), retrograde
lymphagitis, and localized inflammation of the arms and legs.
- Adenolymphangitis
- Calabar swellings-transient swellings of subcutaneous tissues
3. Chronic filariasis- slowly for several years.
- Chronic edema, repeated acute inflammatory episodes.
- Edema and fibrosis- lymphatic obstruction of the legs and
genitalia (scrotum).
- Elephantiasis- hardened enlarged extremities (loss of
elasticity).
- Deformities resulting from malayan filariasis are not as
severe and include enlargement of the epitochear, inguinal,
and axillary lymph nodes.
- In malayan, elephantiasis of one or more limbs, scrotum
not involved.
Laboratory Diagnosis
● Giemsa stained peripheral blood smear. (diagnostic method
of choice for microfilariae).
● Light infections- blood specimen (approx. 1ml ) immersed
in 10 ml of a 2% formalin solution to lyse RBC.
● Optimal sampling collection at night, for species that
demonstrate nocturnal periodicity (usually wuchereria).
● Ideal time for collection are between 9:00 pm to 4:00 am
(the peak period for the appearance of mosquito vector)
● Antigen detection and serological test.
Treatment:
● Diethylcarbamazine (DEC) and Ivermectin in
combination with albendazole.
● Higher dose is necessary to kill adult worms.
● Microsurgery to remove parasites from the lymphatics.
● Anti inflammatory drugs, elastic bandages and elevation
of the involved limbs may help to reduce the size.

Prevention and Control

● The WHO Division of Control of Tropical Diseases
recommend mass treatment in the endemic areas.
● Filariasis control program was implemented in 2001.
● Mosquito nets and repellents, vector control.
 Intestinal-Tissue Nematode

Trichinella spiralis (muscle worm. Trichina worm)

Important Properties and Life Cycle
● 2 important morphologic form: Larva and adult worm.
● Larvae has a coiled appearance and encysts in muscle tissues, surrounded by
muscle cells call nurse cells.
● Pig- usual host
● Ingestion of improperly cooked or raw pork meat with encysted larva.
● Larvae are released from the cysts with exposure to gastric acid and pepsin,
invade intestinal mucosa and matured into adult worms.
● After mating, the gravid female gives birth in the intestinal submucosa.
● Has NO egg stage.
● Larvae migrate through the bloodstream and localize to striated muscles
where they undergo encystation.
 Epidemiology and Pathogenesis
● Worldwide, especially in Europe and United States, where meat can be eaten raw.
● Other animals include bear, walrus, and rodents can be infected other than the pig.
● Harboring hundreds or more worms are usually symptomatic.
● Encystation of the larvae may lead to inflammation, then granuloma formation which
can be later calcified.

Disease: Trichinosis, Trichinellosis

● Divided into three phases:
1. Enteric phase- intestinal phase, manifest diarrhea, abdominal pain, and vomiting.
2. Invasion- (larval migration and muscle) any organ with striated muscle will be the target.
- Symptoms include: periorbital and facial edema, conjunctivitis, fever, muscle pain,
splinter hemorrhages, rashes, and peripheral eosinophilia.
- Involvement of the heart can lead to life threatening myocarditis

3. Convalescent- (encystation and encapsulation stage of larva)- Manifestations start to decline.

- Self-limiting, hence full recovery is expected.
- Rare cause of death are congestive heart failure and respiratory paralysis.
Laboratory Diagnosis
● Muscle Biopsy specimen- encysted larva
● Blood exam results in eosinophilia, leukocytosis, and elevated serum muscle enzyme
level (lactate dehydrogenase, aldolase, creatinine phosphokinase)
● False negative in early infection.

Treatment
● Self-limiting and therefore does not require medication.
● Bed rest, analgesics, antipyretics to relieve muscle pain and fever.
● Corticosteroids may be given for severe infection
● Thiabendazole during early stages of the disease, specially during first week, to
kill adult worms, no effect on larvae.

Prevention and control

● Health education.
● Cook meat adequately
● Freezing meat may kill encysted larvae
● Strict meat inspection and keeping pigs and other farm animals in rat-free pens.