HELMINTH

Sitti Wahyuni, MD, PhD

Department of Parasitology
Medical Faculty, Hasanuddin University

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 Cestoda
Nematoda

Trematoda
 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.
The definitive 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 flukes are leaf-shaped
flatworms. Prominent oral and ventral suckers help
maintain position in situ. Flukes are hermaphroditic except
for blood flukes, which are bisexual. The life-cycle includes
a snail intermediate host.
Tapeworms (Cestodes):Adult tapeworms are elongated,
segmented, hermaphroditic flatworms that inhabit the
intestinal lumen. Larval forms, which are cystic or solid,
inhabit extraintestinal tissues.
Roundworms (Nematodes): Adult and larval roundworms
are 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
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 S.Wahyuni/BMD 5
 Life cycle stage
Helminths develop through egg, larval (juvenile), and
adult stages.
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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 Stages of helminthes commonly responsible for
pathologic changes in humans

Knowledge of the different stages in relation to their

growth and development is the basis for
understanding the epidemiology and pathogenesis of
helminth diseases

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 morphology

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Clonorchis sinensis
Fasciola hepatica

Paragonimus westermani

Ophistorchis velineus Heterophyes heterphyes

Schistozoma spp.

Metagonimus yokogawai
Fasciolopsis buski
General life cycle of flukes

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 Other Trematodes

Schiztosoma spp: Water

S. Japonicum) Snail
Water S. haematobium
Snail S. mansoni
Man

Water
animal/plant
LIFE CYCLE
Cestoda (morphology)

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 Hymenolepis spp
Hymenolepis nana
Hymenolepis diminuta
 Taenia spp
Taenia saginata Taenia solium
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Cestoda (life cycle)

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 Life cycles Diphyllobothrium latum

H. diminuta (pinjal) Cyclops

D. caninum (crustacea)
T. saginata (Sapi)
HP T. Solium (babi)
Man
Incidental

H. nana
HD-A
Free

E. granulosus Fish / frog

Diphyllobothrium latum, sparganum
Nematoda (morphology)

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Cacing Gilig

Enterobius vermicularis

Trichuris trichuria

Strongiloides stercoralis

Ancylostoma duodenale
Ascaris lumbricoides Necator americanus
Cacing Filaria
Live cycle of nematoda

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Life cycle

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

Babi:
- Trichinella spiralis
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.
Not every exposure results in the development of a mature
infection.
The number of worms present at any one time represents a
dynamic balance between the rate of infection and the efficiency of
defense. This balance (which reflects the host's overall
susceptibility) is altered by changes in the host's behavior and
ability to express forms of defense.
Children are more susceptible to many helminths than are adults
The waning of immune competence with age may also result in
increased levels of infection
Individuals differ genetically in their ability to resist infection

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 Pathogenesis
Direct Damage from Worm 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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