REVISION

Types of Life Cycle in Trematoda and Cestoda

Life cycle in human trematodes

Type of life cycles in intestinal cestodes

Life cycles in human intestinal cestodes

Life cycles in human larval cestodiases

Nematoda
Dr. Mohiedden M Abdul-Fattah

General characters
Cylindrical, round in cross section (round worm). Body wall is formed of 3 layers Has body cavity containing fluid, sex organs and intestine.

 Separate sexes >. Single set of genitalia in and 2 sets in . Digestive system begins with; Mouth with lips, papillae or buccal capsules, followed by oesophagus, then Intestine and ends by Anus which opens ventrally joining the genital tract to form cloaca in . and separately in

Esophagus types in nematodes

Human Nematodes

Adult intestinal nematodes with pre adult larval migratory phase: Ascaris lumbricoides, strongyloides stercoralis, Hookworms Adult Intestinal nematodes without larval migratory phase: Enterobius vermicularis, Trichostrongylus colubriformis, Capillaria philippinensis and Trichuris trichiura. Intestinal nematodes with post-adult larval tissue invasion: Trichinella. Larval tissue nematodiases with developmental arrest: visceral and cutaneous larva migrans. Adult tissue nematodes: Adult tissue nematodiasis: Dracunculus medinensis and filariae.

Classification of nematodes according to habitat and development.

Adult intestinal nematodes with pre adult larval migratory phase: ,Ascaris, Hookworms, strongyloides.
Adult Intestinal nematodes without larval migratory phase: Enterobius, Trichostrongylus, Capillaria and Trichuris.

Intestinal nematodes with post-adult larval tissue invasion: Trichinella.

Larval tissue nematodes with developmental arrest: visceral and cutaneous larva migrans. Adult tissue nematodes: Adult tissue nematodiases: Dracunculus and filariae.

Nematodes according to mode of infection

1. 2.

3.
4.

Ingestion of eggs: Ascaris, Enterobius, Trichuris. Ingestion of larva: Trichostrongylus (on vegetable), Trichinella (in pork), Dracunculus (in cyclops), Capillaria (in fish). Active penetration of skin by larva: Ancylostoma, Necator, Strongyloides. Entrance of skin by larva transmitted by insect: Filarial worms : Wucheraria, Onchocerca, Loa, Acanthocheilonema, Mansonella.

Nematode infection by ingestion

Nematode infection via skin

Adult in intestine of man

Larva migrates in lung and arrives to pharynx to be swallowed down into intestine Immature Eggs exits with feces onto soil

Ascaris
Larva hatches in intestine & penetrates mucosa into circulation Man ingests infective 2nd stage larva within egg Infective 2nd stage larva develops within the eggs

Adult in intestine of man

Larva migrates in lung and arrives to pharynx to be swallowed down into intestine Immature Eggs exit with feces onto soil

Larva gets into circulation

Hookworms 1.Ankylostoma 2.Necator

larva develops within the eggs & hatches in soil

Infective 3rd stage Larva penetrates skin of man

Adult in intestine of man

Larva migrates in lung and arrives to pharynx to be swallowed down into intestine Eggs in intestinal mucosa

Strongyloides
Larva gets into circulation Larva hatches within the intestine & exits with feces into soil 3rd stage larva penetrates skin of man

Intestinal nematodes with larval lung migratory phase

Adult worm Man Reservoir Habitat Exit stage Ascaris Ankylostoma Necator Final host None Small intestines Immature egg with 8 cell stage none Strongyloides Free living & parasitic cycles

Immature egg with mammilated shell

Rhabditiform larva filariform larva Filariform larva in soil, in intestine, or on buttocks Larva penetrate skin in soil, or intestinal mucosa, perianal skin (Internal, external autoinfection)

IH Infective Egg with 2nd stage larva in stage soil Mode of Ingestion of egg with 2nd infection larva in food & drinks
Disease Loffler's pneomonitis Enteritis Intestinal obstruction Biliary stasis

Filariform larva in soil

Larva penetrate skin in soil
Ground itch, pneumonitis, Enteritis Microcytic anemia due to blood loss

Larva currens, Pneumonitis Enteritis, chronic diarrhea, hyperinfection in immune compromised

Diagnosis
Treatment Control 18

Detect & count eggs in stool

Detect & count eggs in stool

Oral Mebendazole

Oral Mebendazole

Detect larvae in stool (Baermanns) or in DA Oral Albendazole, Thiabendazole

Adequately wash vegetables 1. Do not walk bare footed Sanitary disposal of sewage 2. Dont play with soil, 3. Sanitary disposal of man excreta 1/7/2013 Fly control, Food sanitation

Adult in large intestine of man Adult females get out of anus & lay mature eggs with infective larva in perianal area

Larva hatches in intestine

Oxyuris
mature Eggs go with feces onto environment

Man ingests infective larva within egg

Adult in large intestine of man anchoring in mucosa Immature eggs exit with feces onto soil

Larva hatches in intestine

Trichuris
Infective larva develops within egg insoil

Man ingests infective larva within egg

Adult in small intestine of man Immature, mature eggs and infective larva exit with feces onto water

Larva liberated in intestine of man

Capillaria
mature Eggs eaten by fish & larvae hatch inside fish intestine

Man & birds ingests infective larva within fish

Intestinal nematodes without larval lung migratory phase

Adult Man Enterobius (oxyuris) Capillaria Final host Trichuris

Reservoir
Habitat Exit stage

None

Fish and birds

None
Large intestines Immature, Barrel shaped eggs with bipolar plugs

Small intestine D-shaped mature egg Immature egg with bipolar plugs, larvae, adults None IH D-shaped mature egg Infective Filariform larva in fish containing infective larva stage Mode of Ingestion of egg Ingestion of fish infection containing infective larva containing infective larva in food. Internal autoinfection By autoinfection Disease Appendicitis Enteritis Perianal itching Chronic diarrhea Insomnia Weight loss Nocturnal enuresis Detect eggs & larva in Diagnosis Detect eggs in perianal swab stool
Treatment

Mature egg containing 2nd stage larva Ingestion of infective egg with foods & drinks

Colitis & dysentery Rectal prolapse Anemia: microcytic and macrocytic

Detect eggs in stool.

Oral Mebendazole

Control
22

Personal hygiene

Oral mebendazole Oral Mebendazole Fish inspection Health education. 1/7/2013 Sanitary disposal system Sanitary sewage disposal

Adult in mucosa of small intestine of pigs, rats and man Adult females delivers larvae into circulation

Larvaliberated in intestine

Trichinella two hosts

Larva reaches muscles and other tissues, but larvae encyst only in skeletal muscles

1.Man ingests infective encysted larva within pork 2.Rats & pigs get infected by eating infected tissue of each other

Pigs

1. Encysted larva from pigs

1. Man ingests encysted larva in undercooked pork

2. Larvae released in intestine, mature to adults

Rodents Carnivorism

5. Larva encysts in striated muscles Circulation copulates 3. enter intestinal mucosa

4.Larva deposited in the mucosa

Life cycle of Trichinella

Visceral larva migrans

5. To circulation, lung alveoli, bronchi. Then through 4.Larva released swallowed sputum in the intestine to intestines

Toxocara LC
4.Larvae released in the intestine

3. Dogs < 5 week ingest the egg

1.Adult in dog Intestine passes eggs in feces

5. Larvae migrate in various organs

11. Larvae mature to adults 10. Swallowed into esophagus, to intestine

1. Adults in small intestine of dogs and cats Can not complete LC 2. Oviposit Immature eggs in intestine

9. Enter bronchi, reach trachea

Migrate in S.C. tissues

3. Eggs passed in feces

4. Rhabditiform larvae hatch

8. Larvae molt in alveoli

Larvae Penetrate skin of man 5. Filariform larvae in soil

6. Penetrate skin of dogs or cats

7. By circulation to lung

Larval tissue nematodes :

Adult worm Man Trichinella Final host & IH Toxocara of dogs and cats Ankylostoma of dogs and cats Paratenic blind end IH

Reservoir
Habitat Exit stage

Pigs

Old cats , dogs, birds

None

Large intestines Small intestine D-shaped mature egg Immature egg with Immature, Barrel shaped eggs bipolar plugs, larvae, with bipolar plugs adults Almost none, Paratenic IH (birds) may play role. IH pigs Encysted larva in pork Mature egg containing 2nd Filariform larva in soil Infective stage larva stage Ingestion of Ascaris like Ingestion of infective egg with Mode of Ingestion of encysted egg containing 2nd stage foods & drinks infection larva in pork. larva in foods, drinks Red itchy papules in the feet, Fever Disease Acute diarrhea arm and face for months Fever periorbital edema Hepatospleno-megaly. Myocarditis Ocular & CNS myositis manifestations Muscle biopsy Biopsy, Serology Biopsy, Serology Diagnosis Serology, eosinophilia Eosinophilia Bachman Intradermal test Eosinophilia Oral albendazole, Oral albendazole, Treatment Oral Mebendazole Oral thiabendazol Oral thiabendazol Dont play in soil Control Pork sanitation 1/7/2013 27 Dont play with dogs ,cats

8. L3 migrates to mosquito proboscis

1. Mosquito takes blood meal and L3 enters through bit wound 2. Adults in lymphatics

6. L1 5. microfilaria penetrate the midgut & migrate to thoracic muscles

4. Mosquito takes blood meal & ingests MF

3.Produce sheathed microfilaria (MF) in blood & lymph Wucheraria & Brugia LC

Chrysops stages 8. L3 migrate to the fly mouth parts

1. Fly takes blood meal & L3 enter the bite wound

Human stages

Adults in S.C. tissues

Loa loa LC

5. MF penetrate midgut to thoracic muscles

3. They produce sheathed microfilaria in blood, urine, CSF and sputum

4. Fly takes blood meal & ingest microfilaria (MF)

Loa loa LC

Onchocerca Life cycle

Simulium stages 9. L3 moves to black fly mouth parts 1. Fly takes blood and L3 enter through bite wound Human stages

2. Subcutaneous tissues (SC)

3. Adults in SC
6. MF migrate to thoracic muscles 4. Adults shed MF in skin

5. Fly takes microfilaria (MF) in blood meal

Adult tissue nematodes :

Adult worm Man Wucheraria Brugia Lymphatic filariasis Final host Loa loa Calabar swelling Final host Onchocerca River blindness Final host

none None Subcutaneous, subcutaneous Habitat Lymph vessels and nodes subconjunctival Exit stage Sheathed mf Sheathed mf Sheathed microfilaria in Non sheathed mf in skin with in blood with in blood with blood with tail full of tail free of nuclei anucleate tail 2 nuclei in tail nuclei Simulium (black fly) IH Mosquitoes: culex, Chrysops anopheles rd stage larva in labium of 3rd stage larva in labium of 3rd stage larva in labium of Infective 3 Culex, Anopheles, Aedes Chrysops Simulium stage 3rd larva enter Chrysops 3rd larva enter Simulium bite Mode of 3rd larva enter mosquito infection bite wound during blood bite wound during blood wound during blood meal meal meal Dermatitis Disease T.P E., Lymphangitis,fever Calabar swelling . Sowda Epidydmo-orchitis conjunctivitis Keratitis Hydrocele, eosinophilia Iridocyclitis, retinitis Elephantiasis Detect microfilaria in Detect microfilaria in skin Diagnosis Detect microfilaria in blood blood Treatment DEC, Ivermectin DEC, albendazole Ivermectin Control Aerial insecticides over Mosquitos control Chrysops control 31 waterfalls 1/7/2013 Mass treatment Reservoir

none

Cats, monkey

Intestinal Nematodes:
with pre-adult larval lung migratory phase:
1. Ascaris 2. Hookworms 3. Strongyloides stercoralis

Dr Mohieddin M Abdul-Fattah

1.Ascaris lumbricoides
I. Biology

Ascaris male and female

post end with spicule

Man related biology

1. 2.

3.

4.

Man (especially children) act as final host. Habitat: lumen of small intestine. Diagnostic morphology: Intestinal nematode; 25 cm long, creamy white. Exit stage: fertilized and unfertilized eggs in stool Ascaris lays 200,000 eggs per day.

II. Epidemiology

1. 2.

3.

4.

Geographical distribution: moist warm climates and temperate zones. Transmission:. Intermediate host: none Reservoir hosts: None, Human is the only host. Infective stage: egg containing Filariform larvae. Fertile eggs embryonate optimally in moist, warm, shaded soil and develop infective filariform larva in 2 5 weeks. Mode of infection: Ingestion of foods mainly vegetables and carrots contaminated by eggs with (2nd stage) larvae.

III. Host parasite relationship

1. 2.

3.

4.

Immune responses Adult in the lumen elicits no immune response. Migrating larva stimulates humoral response with an increase of IgE. Migrating larvae in the lung initiate inflammatory cellular response (eosinophilic) The immune responses are not protective as reinfection occurs.

III. Host parasite relationship

1.

2.

3.

4.

Pathogenesis Larvae in the lung cause pneumonitis (Loffler's syndrome) Heavy worm burden (> 200 eggs/ G feces) causes intestinal obstruction. Parasite secretes trypsin inhibitor, prevents host from digesting proteins protein-calorie malnutrition. Migrating adult into bile ducts causes obstructive jaundice and pancreatitis

Volvulus

Inflammatory eosinophilic granuloma around larva in lung

Ascaris extracted from liver

III. Host parasite relationship

1.

Clincal picture:
Migratory phase: Lofflers syndrome: fever, cough, eosinophilia lung infiltration; (during prepatent period). Intestinal stage: Asymptomatic in light infection. Heavy infection; nausea, vomiting, diarrhea and abdominal pain. Intestinal obstruction due to intussusception and volvulus may occur.

2.

III. Host parasite relationship

1. 2. 3. 4. 5. 6.

Erratic movement of the adult: occurs due to its irritation by fever, anesthesia and drugs: Adult migrate from normal habitat through any opening, and can even perforate the intestinal wall to: Ampulla of Vater: (pancreatitis). CBD: (obstructive jaundice). Appendix: (appendicitis). Peritoneum: (peritonitis due to intestinal bacteria) Liver: granulomas around eggs and adult . Biliary ducts: biliary ascariasis with recurrent cholangitis.

IV. Diagnosis

ovoid. 60 x 45 um

Direct methods: Detection of eggs in feces. Egg count by Stoll technique is needed to estimate worm burden. Detection of larvae in sputum Indirect methods: Eosinphilia. Chest x-ray (lung infiltration). X-ray with Barium meal: filling defects

Alternating streaking filling defects in barium meal

V.

Treatment
Albendazole: 200 mg for 3 days. Mebendazole: 100 mg bid for 3 days. Treatment; to be followed by purge to avoid allergic manifestation.

VI. Control

Personal hygiene Hand washing Vegetable washing Avoid playing in soil. Sanitary disposal of human excreta. Avoid use of human excreta as fertilizer for vegetables Treatment of patients

Use of night soil as fertilizer

2. Hookworms: Ancylostoma and Necator

BIOLOGY:
Final host: human. Habitat: The adult are usually found in jejunum. Exit stage: Adult females put eggs [20,000/24h; Ancylostoma, 4000; Necator] in the 4 cell stage. When passed in stool they develop to the morula stage and hatches in 1-2 days.

D. morphology: 9 12 mm x 0.4 mm, the head bends back dorsally and has a buccal capsule with teeth [Ancylostoma] or plates [Necator].

3. Filariform larva in soil

4. Penetrates skin

5. Adults live in small intestine

2. Rhabditiform larva Hatches in soil

1. Egg in feces

Life cycle of Hookworms

The 1st stage larva develops to the 2nd stage rhabditiform larvae with distal oesophageal bulb Within 5-8 days it develop to infective 3rd stage nonfeeding filariform larvae [800 m with simple muscular esophagus and protective sheath].

The larvae penetrate skin, enter blood & migrate to lungs. They enter alveoli, pass up trachea, then swallowed to become mature worms in jejunum that lay eggs within 5 week period from exposure.

II.
1. 2.

Epidemiology

3.

1. 2.

Geographical distribution: Endemic in tropics; favoured by promiscous daefecation. moist, shady, warm, sandy soil with decaying vegetation. the presence of dung and stool burying beetles. Prolonged dry and cold climates are unsatisfactory. Transmission: Intermediate host: No. Resevoir hosts: No, Human are the only hosts. Infective stage: Filariform larvae in soil. These larvae survive 3-4 weeks in the soil or moisture films on the ground. They move towards warmth, moisture, oxygen, and CO2 but away from gravity [larval tropism]. Mode of infection: Filariform larvae in soil penetrate skin of feet.

Host-Parasite Relationship
1. Ground itch: cutaneous penetration; associated with stinging
sensation, followed by local oedema, erythema and papule formation.

These are more common in repeated infections and

reflect enhanced host immune reaction (type I) to larval forms. They are more pronounced among the expatriates.

2. Transient creeping eruption caused by larvae of

Necator americanus.

Host Parasite Relationship

3. Pulmonary lesions; pneumonitis and
eosinophilia occurs during massive migration of larvae in the lung. If Ancylostoma duodenale infection has occurred orally, pneumonitis is preceded by nausea, salivation, itching of the pharynx and hoarsness [Wakana disease]. 4. Intestinal infection & hookworm disease; abdominal pain, diarrhea, less commonly malabsorption, 5. iron deficiency anaemia and chronic protein calorie malnutrition if the infection was heavy (>100 worms). Less than 25 worm load is insignificant.

Diagnosis

Detection of eggs or larvae in faeces. Egg count by Stoll technique is needed to estimate worm burden. Eosinphilia usually occurs. Egg characters: thin shelled, colourless, ovoid with blunt ends, 60 x 40 m and contain an ovum in 4 or 8 cell stage. Rhabditoid larva: 250 m with rhabditiform oesophagus, and buccal cavity longer than the width of the head tip.

Treatment
1.

2.

3.

Albendazole (Alzental, tablets 100, 200) 200 mg for 3 days. Mebendazole (Antiver, tablet 100mg) 100 mg twice daily for 3 days. Pyrantel pamoate (Combantrin,tablets; 250, 125), a single dose of 12.5 mg/kg, i.e. 3 tablets

Control:
1.Use footwear.
2.Proper disposal of human waste

3. Strongyloides stercoralis
Biology: Final host: Human. Habitat:. Adult lives and lays egg in mucosa of small intestine . Exit stage: egg in the mucosa hatches Rhabditiform larva that escapes into the lumen and is passed in faeces. Diagnostic morphology: Parasitic female is larger (2.2 mm x 45 m) than the free-living worm (1 mm x 60 m) .The eggs, when laid are 55 m by 30 m.

Life cycle of Strongyloides

2.Epidemiology: Geographical distribution: endemic in tropics and subtropics with poor sanitation. It has 2 features: The worm has potential for autoinfection and multiplication within the host. It has two types of cycles; free living and parasitic. Intermediate host: No. Reservoir host: No The infective stage: Filariform larvae. Mode of infection: Filariform larvae can penetrate either by: The intestinal mucosa (internal autoinfection), The skin of the perianal area (external autoinfection),or Contact of the skin of hands and feet with contaminated soils.

3. Host parasite relationship: Patients with a low worm burden are asymptomatic, otherwise; Larva currens: A. rash caused by chronic cutaneous larval migration localized around the waist and buttocks. B. It is a serpiginous red line that progresses 1 to 2cm/h for up to 48 h. Larvae in the lung produce pneumonitis. Adults within the mucosa cause enteritis leading to diarrhea. Sepsis due to enteric bacteria may occur due to damage caused by autoinfection. Massive super infection occurs in the immune compromised (hyper-infection)..

4.Lab diagnosis: Detection of larvae in stool sample by direct exam. Or by Baermann concentration. Eosinophilia in blood count Characters of the rhabditiform larva: Very short buccal cavity. The esophagus has two bulbs with narrow isthmus between them.

5.Treatment: Albendazole 5mg/kg/12h peroral (PO) for3d or Thiabendazole 25mg/kg/12h PO for 3d or Ivermctin (Mectizan) 200 g/kg/d for two days.

6.Control: Foot wear and proper disposal of human waste.

Intestinal nematodes with postadult larval tissue invasion Trichinella spiralis

Trichinella spiralis
A.Biology:
Final host: Pigs, wild boars, rats, bears, walruses, and many other carnivores including man. Habitat: i. Adult in Small intestines while females inhabit rows of epithelial cells of the mucosa of duodenum and jejunum. ii. Larvae live in Striated muscle fibers (cells). Exit stage: i. Males in the faecal streams. ii. Larvae have no exit as they encyst in muscle fibers. Morphology: 2.5 mm long with tapering post. end and 1.2 mm long with 2 caudal appendages. puts 5000 larvae each 100 m long.

Pigs

1. Encysted larva from pigs

1. Man ingests encysted larva in undercooked pork

2. Larvae released in intestine, mature to adults

Rodents Carnivorism

5. Larva encysts in striated muscles Circulation copulates 3. enter intestinal mucosa

4.Larva deposited in the mucosa

Life cycle of Trichinella

Trichinella Life Cycle

Pigs

1. Encysted larva from pigs

1. Man ingests encysted larva in undercooked pork

2. Larvae released in intestine, mature to adults

Rodents Carnivorism

5. Larva encysts in striated muscles Circulation copulates 3. enter intestinal mucosa

4.Larva deposited in the mucosa

Life cycle of Trichinella

B. Epidemiology: Distribution: Worldwide; prevalent in pork eating countries (USA and Europe). Transmission:
Intermediate host (IH): Pigs. One host may serve as both final and IH. Humans are dead end IH. Reservoir host: Pigs, wild boars, rats, bears, walruses, and many other carnivores. Infective stage: Encysted larvae in muscles. Mode of infection: Ingestion of pork infected by encysted larvae.

C.Host-parasite relationship: 1. Intestinal stage (20-24 hours): eneteritis nausea, vomiting, abdominal pain and diarrhea. 2. Migratory stage: A. Invading skeletal muscles (1-2 weeks): fever, facial edema, conjunctivitis, pain, swelling and weakness of the involved muscles. B. Invading cardiac muscles and CNS (3rd week): Myocarditis and CNS involvement are the most frequent two causes of death in trichinosis. 3. Encapsulation (3w 4 w): symptoms subside or decrease. Myocarditis persists and may precipitate congestive heart failure. 4. If the infective dose 100 larvae morbidity occurs. If it is 300,000 death occurs

D. Diagnosis: 1. Symptoms. 2. detection of free or encapsulated larvae. From the 7th day onward a) In compressed (trichinoscopy) or b) Stained biopsy. c) Or digested samples from deltoid, biceps, gastrocnemius or Pectoralis muscles. d) Or by xenodiagnosis in rats. 3. Immune-diagnosis by a. Bachman intra-dermal skin test (IDT). Or by b. Serology: from 2 weeks in heavy infection and 3-4 w in lighter ones: BFT (2w), IFAT (2-3w) and Sandwich Elisa.

E.Treatment:

Prednisolone 40 mg/day for 5d, with Mebendazole 50 mg/kg/12h PO for 10 days.

F. Control:

Properly cooking pork. Feeding pigs on cooked garbage.

Intestinal nematodes without lung larval migratory phase

1. 2. 1. 2.

Habitat in large intestine: Enterobius vermicularis (Oxyuris) Ttichuris trichiura Habitat in small intestine Trichostrongylus colubriformis Capillaria philipinensis.

Enterobius vermicularis (Oxyuris)

I. BIOLOGY

Final host: Human. Habitat: Cecum and colon. Exit stage: mature egg. Diagnostic morphology: cylindrical 1 cm with pointed ends. cm with curved posterior end.

II.

Epidemiology
Distribution: worldwide. Mostly in children. Transmission: Intermediate host: No. Reservoir host: No. Infective stage: Embryonated egg. Mode of infection: Ingestion of mature eggs fro environment, with foods, or by hand to mouth. Re-infection (auto infection).

III. Host-Parasite relationship

Peri-anal pruritis and insomnia, Nausea, and loss of appetite Urinary tract infection especially in females. Worm may migrate into genital tract inducing bacterial infection, salpingitis.
Eggs are detected in peri-anal skin by Scotch tape technique. Adult in the stool or diapers. Eggs are detected in stool accidentally, in 3% of patients

IV. Diagnosis

V.

Treatment

Mebendazol 200 mg/12 hours for one day, repeated after one week. If aged < 2 years, piperazine; 0.3ml/kg/day for 7 days. Treat the whole family

VI.

Control

Personal cleanliness. Hygiene is more important than drugs as adults die after 6 weeks. Continued symptoms means re-infection

Trichuris Trichiura
I. BIOLOGY

Final host: Man Habitat: Large intestine with ant end embedded in the intestinal wall. Exit stage: one cell immature egg. Morphology: Whip like with narrow ant part is half the length of thick posterior part in and double the length in .

II.

Epidemiology

Distribution:
worldwide, esp. in the tropics.

Transmission:
Intermediate host: None. Reservoir host: None. Infective stage: embryonated egg with 2nd stage larva. Mode of infection: Ingestion of soil, food or drinks contaminated with embryonated egg.

III. Host Parasite Relationship

1. Mild infection is asymptomatic, 2. In heavy infection: Penetration of mucosa may predispose to 2ry bacterial infection, appendicitis and peritonitis. Bleeding from friable mucosa hypochromic iron deficiency anemia and growth retardation in children. Megaloblastic (hyperchromic) anaemia may occur 3. Severe infection: dysentery frequently lead to rectal prolapse

IV. Diagnosis

1. 2.

3. 4.

Detection of typical eggs in stool sample. Counting eggs with Stoll technique Characters of egg: 50 x 25 m, Barrel shaped with mucoid plug at both ends, brownish, unsegmented with one cell

V.

Treatment

Mebendazole 200 mg/ 12h perooral (PO) for 6 days

VI. Control

Personal hygiene Proper disposal of human faeces

Capillaria Philippinensis

5. Some lay larvae Internal autoinfection

6.These reinvade mucosa & develop to adults

Capillaria Philippinensis Life Cycle

1. Man or birds ingest larvae in fish & larvae develop to adults in intestinal mucosa 2. lay Immature eggs

4. Infective larva develops in fish

3. Mature egg

C. philippinensis
I. BIOLOGY

Final host: Humans, fish. Habitat: mucosa of the small intestine (the jejunum). Exit stage: Eggs, larvae, and adults passed in feces. Basic morphology and life cycle: adult 2-4 mm long.

II.

Epidemiology
Distribution:
worldwide but more in the Orientals ; Philippines and Thailand.

Transmission

I. Reservoir hosts: Fish and Birds. II. Intermediate hosts: fish III. Infective stage: infective larva in the mucosa of fish. IV. Mode of infection: ingestion of undercooked fish infected with the larvae or by internal autoinfection.

III. Host Parasite Relationship

1. Watery diarrhea with excessive fluid loss.
2. Malabsorption with weight loss, abdominal
distension, oedema and muscle wasting.

3. Death due to heart failure, pneumonia or

hyperkalaemia in severe infection.

IV.

Diagnosis

Clinical picture in endemic areas gives a clue to diagnosis. Detection of eggs in the stool: 1. Thick shelled with polar plugs 2. 40x20 in size. Detection of larvae or adults in stool.

V.

Treatment Control

Mebendazole: 400mg daily for 20 days

VI.

Health education, proper cooking of fish.

Trichostrongylus I. Biology

Final host: - herbivorous animals (sheep, goats). Occasionally, found in man. Habitat:- small intestine; with anterior end embedded in the mucosa. Exit stage: Egg with 16 -32 cell morula stage. Morphology: 4mm long , 8mm long , slender hair like worm with narrow anterior extremity. Male adult is with post. copulatory bursa.

I.

Biology: Life cycle

II.

Epidemiology

Distribution: Middle East and Far East. Transmission: 1. Intermediate host: No. 2. Reservoir host:- Sheep, camels and goats. 3. Infective stage:- Filariform larvae on vegetables. 4. Mode of infection:- Ingestion of vegetables contaminated with filariform larvae.

III. Host-Parasite relationship

Slight enteritis and diarrhea

IV. Diagnosis
Detection of typical eggs in stool sample. Characters of egg: 90 x 45 m, thin shelled, pointed at one end, brownish, and segmented embryo with 16 -32 cells.

V. Treatment: Mebendazole 200 mg/ 12h peroral

(PO) for three days.

VI.Control:- Personal hygiene, washing

vegetables and water sanitation