Class Nematoda

CLASS NEMATODA
1
GENERAL CHARACTERISTICS
 Females are larger than males and have a
straight tail
 Males have curved tails with spicules or “hooks”
for copulation
 Unsegmented
 Round, elongated worms measuring from a few
mm to a meter in length
 Has complete digestive system (mouth to anus)
2
 Has no circulatory system
 Found in the intestine (A. lumbricoides), blood (W.
bancrofti), and tissue (O. vulvolus).
 Worldwide distribution
 Can be classified according to the location of its
sensory organs:
 Amphids – sensory organs located anteriorly
 Phasmids – sensory organs located posteriorly
 Aphasmids – without posterior sensory organs
3
 Can be classified according to habitat:
Small intestine – A. lumbricoides, C.
philippinensis, hookworms, S. stercoralis
Colon – T. trichiuria and E. vermicularis
Lymph nodes and vessels – W. bancrofti and B.
malayi
Eyes and meninges – A. cantonensis
Muscles – T. spiralis
4
APHASMIDS
5
Trichinella spiralis
6
PARASITE BIOLOGY
 Adult worm:
Commonly known as pork worm or trichina
worm
Minute and appears threadlike
More delicate anteriorly than posteriorly
7
PARASITE BIOLOGY
 Adult Male:
 measures 1.4-1.6 by 0.04-0.06 mm
 has a single testis located near the
ventrally curved posterior end of the
body and is joined in the midbody by
the genital tube which in turn extends
back to the cloaca.
 cloaca is found at the caudal end which
everts during coitus and guarded by 2
caudal appendage and 2 conical
papillae which clasp the female during
copulation. 8
PARASITE BIOLOGY
 Adult Female:
 measures 3-4 by 0.06-0.08 mm
 vulva opens at the anterior fifth
of the body
 has a single uterus which
contains the larvae
 a single ovary is found near the
bluntly rounded caudal end.
 viviparous (live young bearing)
and capable of producing > 1500
larvae in her 30 day life.
9
PARASITE BIOLOGY
 Larvae:
 measures 80-120 by 6 μm but
reaches the size of 900-1300 by
35-40 μm after in enters a
muscle fiber
 provided by a spear-like
burrowing tip at its tapering
anterior end
 digestive tract resembles of a
adult worm
 cysts calcify 6-12 months after
infection 10
LIFE CYCLE
 Infective stage: cystic larvae
 Diagnostic stage: cystic larvae in muscle biopsy
 Intermediate hosts: rats, pigs
 Definitive hosts: pigs, humans
 Habitat: adults in the stomach or small intestine;
larvae on the muscle
 Transmission: ingestion of infective larvae in raw
or insufficiently cooked meat
11
LIF
E
CY
CLE
12
PATHOLOGY
 Infection is called Trichinellosis or Trichinosis.
 Types of intensity of infection: light (up to 10
larvae), moderate (50 to 500 larvae), and severe
(more than 1000 larvae).
 Clinical manifestation is divided into three
phases:
Enteric phase (Incubation and intestinal
invasion) – resembles the attack of acute food
poisoning such as diarrhea/constipation, 13
PATHOLOGY
vomiting, abdominal cramps, malaise, and
nausea.
Invasion phase (larval migration and
encapsulation) – severe myalgia, periorbital
edema, eosinophilia. Sometimes remittent
fever, dyspnea, dysphagia, difficulty in
chewing, paralysis of extremities, and
splenomegaly. Myocardial and neurological
complication may occur.
14
PATHOLOGY
Convalescent phase (Encystment and
encapsulation) – fever, weakness, pain and
other symptoms start to abate.
 Full recovery is expected since trichinellosis/
trichinosis is a self-limiting disease.
15
DIAGNOSIS
 Demonstration of larva using muscle biopsy
which can only be done seven days after
infection, since encystment of invading larvae
starts this time.
 Biochemical test - elevated levels of creatine
phosphokinase, lactate dehydrogenase, and
myokinase indicate muscle damage from
invading larvae.
 CBC – eosinophilia indicates parasitic infection
16
DIAGNOSIS
 Beck’s xenodiagnosis – muscle from suspected
patient/animal is fed to albino rats. After 14
days, the rats will be examined for presence of
female worms in the duodenum and larvae in
the muscle.
17
TREATMENT
 Bed rest and supportive treatment
 Analgesics and antipyretics for symptoms
 Steroids – used for severe infections
 Thiabendzole – for expelling adult worms from
GI tract
 Mebendazole – to expel larvae in the muscles
 Albendazole
18
PREVENTION AND CONTROL
 Health education
 Proper meat cooking (at 1200C or 1770F)
 Meat freezing (-150C for 20 days or -300C for six
days)
 Meat inspection
 Keep pigs from rat-free pens
19
Trichuris trichiura
20
PARASITE BIOLOGY
 Adult worm:
 Commonly known as whipworm
 Anterior 3/5 is attenuated (thin and long) while
posterior 2/5 is thick and stout, hence the whiplike
appearance
 The esophagus, which traverses along the
attenuated anterior, is a delicate capillary tubule
than can dilate at its distal end. It is embedded with
glandular cells called stichocytes.
21
PARASITE BIOLOGY
 Adult Male:
 Measures 3 – 3.5 cm
 Has saccular testis
 A single lanceolate spicule
protrudes through a refractile
penial sheath which has a bulbous
termination covered with small
recurved spines
 Has a coiled caudal extremity
22
PARASITE BIOLOGY
 Adult Female:
 measure 3.5-5.5 cm
 vulva opens at the anterior
end, the fleshy portion of the
body
 has a single uterus and ovary
 Bluntly rounded at the
posterior end
 Lays approx 3000 to 10000
eggs per day 23
PARASITE BIOLOGY
 Ova/Eggs:
 Measures 50-54 by 22-23 μm
 Appears barrel-shaped
(football) with bipolar
unstained
 Intralaminar prominences
which have the appearance of
mucoid plugs
 It is passed in the unsegmented
stage 24
PARASITE BIOLOGY
 Ova/Egg:
 In addition to vitellaine
membrane, its triple shell is
made up of chorionic layer,
albuminous layer, and bile-
stained layer
 Embryonic development takes
place outside the host
 More susceptible to
dessiccation (dehydration)
25
LIFE CYCLE
 Infective stage: embryonated egg
 Diagnostic stage: Ovum/Egg in feces
 Intermediate hosts: none
 Definitive hosts: humans
 Habitat: large intestine
 Transmission: soil transmission then ingestion of
embryonated eggs
26
LIF
E
CY
CLE
27
PATHOLOGY
 Infection is called Trichuriasis.
 Light infections is usually asymptomatic and can
only be discovered in routine fecalysis. Moderate
infection (5000 eggs per gram feces) is
symptomatic. Heavy infection (20,000 eggs per
gram feces) develop bloody diarrhea or
dysentery.
28
PATHOLOGY
 Anterior portion of the worm is embedded in the
intestinal mucosa, causing petechial
hemorrhages, which may predispose amoebic
dysentery since the ulcers are suitable habitat
for Entamoeba coli.
 There is build up of blood (hyperemia) and fluid
(edema) in the mucosal lining. Intestinal
bleeding is common (enterorrhagia) and rectal
prolapse may occur.
29
PATHOLOGY
 Appendical lumen may be filled with worms,
irritating and inflaming the mucosaleading to
appendicitis and granulomas.
 Fortunately, trichuriasis only affect the large
intestine since it has no lung route like Ascaris
and hookworm infection.
30
DIAGNOSIS
 Clinical diagnosis is only possible in moderate
and heavy infection where host experiences
bloody diarrhea, abdominal pain and
tenderness, and prolapse.
 Direct fecal smear and Kato thick smear is used
in qualitative testing for trichuriasis; also
recommended in clinical patient diagnosis and
mass stool examination in communities.
31
DIAGNOSIS
 Kato-Katz technique is used in quantitative
testing of cure rate, egg reduction rate, and
intensity of infection.
 Acid-ether and formalin-ether methods can be
used, yet Kato thick smear and Kato-Katz
methods are simpler and low-cost.
32
TREATMENT
 Mebendazole
 Albendazole
 Piperazine citrate
 Egg reduction rates, cure rates, reinfection rates,
and pre- and post- egg counts should be
considered to evaluate the course of treatment.
33
 There is high reinfection rate so periodic mass
treatment is necessary.
 Sanitary disposal of human feces by building
toilets and their proper use
 Handwashing
 Thorough washing of vegetables where nightsoil
was used ad fertilizer
34
Capillaria philippinensis
35
PARASITE BIOLOGY
 Adult worm:
Characteristically filiform (thread like)
anteriorly and stout posteriorly but tapering is
gradual and more pronounced
First described in Northern Luzon, Philippined
in 1968
36
PARASITE BIOLOGY
 Adult Male:
 measures 1.45 to 3.9 mm in
length
 Charactrized by caudal alae
and long, non-spiny sheaths
 Esophagus has rows of
secretory cells called
stichocytes and the entire
esophagal structure is called
stichosome.
37
PARASITE BIOLOGY
 Adult Female:
 Measures 2.3 to 5.3 mm in length
 Body is divided into 2 parts: the
anterior containing the esophagus
and esophageal parts and the
posterior containing the intestine
and the reproductive system with
a slightly prominent vulva
 Anus is subterminal and the vulva
is found at the junction of anterior
and middle thirds 38
PARASITE BIOLOGY
 Ovum/Egg:
 Measures 36 to 45 μm
 Peanut-shaped with
striated shells and non
protruberant bipolar plugs
 Must reach brackish water
to be eaten by freshwater
fish, its intermediate host
39
LIFE CYCLE
 Infective stage: third stage larvae
 Diagnostic stage: Ova/eggs, larva, and adult
worms in feces
 Intermediate hosts: freshwater fish
 Definitive hosts: birds, humans
 Habitat: small intestine
 Transmission: water borne then ingestion of
infected freshwater fish
40
LIF
E
CY
CLE
41
PATHOLOGY
 Infection is called Capillariasis.
 Early symptoms include abdominal pains,
borborygmus (gurgling stomach), and diarrhea.
 Later symptoms include noticeable weight loss,
malaise, anorexia, vomiting, and edema.
 Lab findings show severe protein-losing
enteropathy, fat and sugar malabsorption,
decreased xylose excretion, low electrolyte
levels especially K+, high levels of IgE. 42
PATHOLOGY
 If the disease is not treated after symptom
manifestations and the lab findings continue,
patients become very weak (cachexia) and
usually die.
 Large number of worms are responsible for
micro-ulcers, compressive degeneration and
mechanical compression of intestinal epithelium
which account for the lab findings.
43
DIAGNOSIS
 Demonstration of embryonated or
unembryonated egg, larvae, and/or adult worms
in stool.
 Recovery of adult worms from small intestine by
duodenal aspiration
44
TREATMENT
 Electrolyte replacement and high-protein diet
 Anti-diarrheal drugs
 Mebendazole
 Albendazole – destroys larvae more readily than
mebendazole
45
 Discouraging people to eat raw fish in endemic
areas
 Good sanitary practices and proper disposal of
human waste
 Infected persons should be treated quickly and
their feces disposed in a sanitary manner
 Health education, especially on the hazards of
eating uncooked fish
46
PHASMIDS
47
Ascaris lumbricoides
48
PARASITE BIOLOGY
 Adult worm:
 Also known as giant
intestinal round worm or
pink worm
 Has polymyarian type of
somatic muscles
arrangement in which cells
are numerous and project
well into the body cavity
 Has smooth striated cuticles
49
PARASITE BIOLOGY
 Adult worm:
 Has terminal mouth with
three lips and sensory
papillae
 Reside in but do not attach
to the mucosa of the small
intestine.
50
PARASITE BIOLOGY
 Adult Male:
 Measures 10-31 cm by
2-4 mm
 Has ventrally curved
posterior end with two
spicules
 Has a single long,
tortuous tubule found
in the posterior 2/3 of
the body 51
PARASITE BIOLOGY
 Adult Female:
 Measures 22 – 35 cm
 Has paired reproductive
organs in the posterior 2/3
 Posterior end is conical and
straight
 Capable of producing
200,000 eggs per day
52
PARASITE BIOLOGY
 Ovum/Egg:
 In the soil, it takes about two to three weeks for
eggs to be embryonated under favorable conditions
with suitable tempearture, moisture, and humidity.
 Larvae in the eggs reach the third stage when they
molt and become embryonated.
 The embryonated egg can survive is moist, shaded
soil for a few months to two years in tropical areas
but much longer in temperate regions.
53
PARASITE BIOLOGY
 Infertile Ovum/Egg:
 Measures 88 – 94 by 34 –
44 μm, longer and narrower
than fertile eggs
 Has thin shell and irregular
mammilated coating filled
with refractive granules
54
PARASITE BIOLOGY
 Infertile Ovum/Egg:
 The thin shell id composed
of inner chorionic and outer
irregular albuminous
coating
 Found only in the absence
of adult male , in about two
out of five infections
55
PARASITE BIOLOGY
 Fertile Ovum/Egg:
 Measures 45 – 70 by 35 – 50
μm, shorter and stouter than
infertile egg
 Has three layers:
• Mammilated albuminous
covering
• Thick, transparent hyaline
shell
• A delicate vitelline, lipoidal,
inner membrane 56
PARASITE BIOLOGY
 Fertile Ovum/Egg:
 At oviposition, the egg has
an ovoid mass of
protoplasm, which will
develop into larvae in 14
days
57
PARASITE BIOLOGY
 Decoticated Ovum/Egg:
 Could be fertilized or
unfertilized
 Lacks the mammillated
albuminous coating
58
LIFE CYCLE
 Diagnostic stage: infertile, fertile, or decorticated
eggs in feces
 Definitive hosts: humans
 Habitat: small intestines
 Transmission: soil-transmission then ingestion of
embryonated egg
59
LIF
E
CY
CLE
60
PATHOLOGY
 Infection is called Ascariasis
 Larvae in ingested embryonated
egg hatch in the small intestine
and penetrate the intestinal wall
 Larvae then go to the liver via
the portal vein, on to the heart
and pulmonary vessels where
they break out of pulmonary
capillaries to enter airsacs.
61
PATHOLOGY
 In the lungs, they
undergo molting before
migrating to the larynx
and oropharynx to be
swallowed into the
digestive tract.
62
PATHOLOGY
1. Tissue reaction to invading larvae
• During lung migration, invading larvae may result in
allergic manifestations such as lung infiltration,
asthma attacks, and edema of the lips.
• Hemoptysis (coughing up of blood) due to
pulmonary capillary penetration of larvae
• Eosinophilia
• Vague abdominal pain
• Lactose intolerance in young children (moderate
infection) 63
PATHOLOGY
2. Intestinal irritation by mechanical and
toxic action of adult worms
• Continuous biting of the intestinal
mucosa for food by adult worms
irritate the nerve endings and
results in spasm leading to intestinal
obstruction
• Intestinal volvulus results when
worms become entangled producing
a bolus that blocks the tract
• Intussusception or telescoping of
the intestine
64
PATHOLOGY
3. Complications arising from
the parasite’s extraintestinal
migrations
• High fever causes Ascaris
migration
• Adult worms may be
regurgitated and vomited,
may escape through the
nostrils, and may be
inhaled through the
trachea 65
PATHOLOGY
3. Complications arising from the parasite’s
extraintestinal migrations
• Biliary ascariasis – results when worms invade bile
ducts through the ampulla of Vater and enter
gallbladder or liver; this manifests in colic (sudden
abdominal pain)
• Worms may lodge in the appendix, resulting in
appendicitis
• Worms may block the pancreatic duct, resulting in
pancreatitis
66
PATHOLOGY
3. Complications arising from the parasite’s
extraintestinal migrations
• Worms may carry bacteria in appendix and/or
pancreas producing abscesses
• Worms may penetrate into the peritoneal cavity
and result peritonitis
67
DIAGNOSIS
 Demonstration of characteristic eggs in feces
using Direct Fecal Smear, Kato
technique/cellophane thick smear method
(qualitative), or Kato-Katz technique
(quantitative)
 Recovery of larvae in sputum or gastric
aspiration
 Recovery of adult worms in stools, mouth, or
nostrils
68
TREATMENT
 Albendazole
 Mebendazole
 Pyrantel pamoate
 Ivermectin
 Reinfection is observed four to seven months
after treatment so retreatment is necessary
69
 Sanitary disposal of human feces
 Personal, family, and community hygeine
education
 Mass chemotherapy twice or thrice a year with
children as target population
 Studies show that treatment of children alone in
a community has the same effects as treating
everybody, including adults.
70
Strongyloides stercoralis
71
PARASITE BIOLOGY
 Adult worm:
Commonly called threadworm
Characterized by free-living rhabditiform and
parasitic filariform
The only species naturally pathogenic to
humans
Autoinfection also characterizes this specie
72
PARASITE BIOLOGY
 Parasitic Filariform Female:
 measure 2.2 by 0.04 mm
 Colorless, semi-transparent, with finely striated
cuticle
 Short buccal cavity has 4 distinct lips
 Slender tapering anterior end and a short pointed
tail
 Lays approx 3000 to 10000 eggs per day
73
PARASITE BIOLOGY
 Parasitic Filariform Female:
 Has a long, slender esophagus that
extends to the anterior fourth of
the body, and the intestine is
continuous to the subterminal anus
 Vulva is located at the one-third
length of the body form the
posterior end
 The uteri contain a single file of
eight tot twelve thin-shelled,
transparent, segmented ova 74
PARASITE BIOLOGY
 Free-Living Female:
 measure 1 by 0.06 mm;
smaller than the parasitic
female
 Has a muscular double-
bulbed esophagus and the
intestine is a straight
cylindrical tubule
75
PARASITE BIOLOGY
 Free-Living Male:
 Measures 0.7 by 0.04 mm,
smaller than female
 Has ventrally curved tail,
two copulatory spicules, a
gubernaculum but no
caudal alae
76
PARASITE BIOLOGY
 Rhabditiform (Feeding stage) larva:
 Measures 225 by 16 μm
 Has elongated esophagus with a
posterior bulb
 Has shorter buccal capsule and a
larger genital primordium
 Differs from hookworm in being
slightly smaller and less
attenuated posteriorly
77
PARASITE BIOLOGY
 Filariform (Non- Feeding stage)
larva:
 Slender measuring 550 μm in
length
 Similar to hookworm yet
smaller and with distinct
notch at tip of the tail
78
PARASITE BIOLOGY
 Egg:
Oviposited in the intestine and other tissues
Rarely seen in stool specimen
Have a clear, thin shell and are similar to those
of hookworms
Measures 50-58 by 30-34 μm
79
LIFE CYCLE
 Infective stage: filariform larvae
 Diagnostic stage: rhabditiform larva in stool
• N.B. Eggs hatch in the mucosa of intestines and are rarely seen in
feces.
 Definitive host: humans, monkeys
 Habitat: large intestine
 Transmission: soil transmission then skin
penetration; can be transferred through organ
transplant; transmammary
80
LIF
E
CY
CLE
81
PATHOLOGY
 Infection is called Strongyloidiasis
1. Invasion of the skin by filariform larvae
• Produces erythema (redness in the skin) and
pruritic (itchy) elevated hemorrhagic papules.
• Filariform larvae then enter cutaneous veins
and find their way to pulmonary capillaries
82
PATHOLOGY
2. Larval migration to the lungs
• Results in lobar pneumonia with hemorrhage
as larvae breakout from pulmonary capillaries
in the alveoli
• Larvae is then carried to pharynx where it will
be swallowed and then reach the small
intestine
83
PATHOLOGY
3. Penetration of intestinal mucosa by adult females
• Swallowed larvae molt twice then become adult
female and thread themselves in the epithelium
of the small intestine
• By parthenogenesis (reproduction without
fertilization), females produce eggs which yield
rhabditiform larvae, which in turn will autoinfect
the host by penetrating the intestinal mucosa
then into veins and start the first phase.
84
PATHOLOGY
 Light infection is asymptomatic. Moderate
infection causes alternating diarrhea and
constipation. Heavy infection results in Cochin-
China diarrhea (intractable, painless, irregular
diarrhea), characterized by bloody stools.
 Hyperinfection syndrome – may lead to death
due to massive tissue invasion and damage by
adult worm and larvae; occurs in
immunosuppressed patients
85
DIAGNOSIS
 Demonstration of rhabditiform larvae and/or
filariform larvae the feces using:
 Direct fecal smear,
 concentration technique,
 Baermann funnel technique
 Harada-Mori culture
 Duodenal aspiration and small bowel biopsy
 Demonstration of larvae in sputum or urine in
disseminated strongyloidiasis 86
TREATMENT
 Albendazole
 Ivermectin
 Thiabendazole
87
 Proper human waste disposal
 Avoid walking barefooted
 Personal, family, and community hygiene
education
 Immunosuppressed individuals and transplant
pateitns should be cleared to avoid
dissemination of infection
88
Necator americanus
Ancylostoma duodenale
Ancylostoma braziliense
Ancylostoma caninum
Ancylostoma ceylanicum
89
PARASITE BIOLOGY – N. americanus
 Adult worm:
Commonly called New
World Hookworm
Small, cylindrical,
fusiform, grayish-white
nematodes
The buccal capsule has a
ventral pair of semi-lunar
cutting plates 90
 Adult Worm:
The head is curved
opposite to the
curvature of the body
which is like a hook at
the anterior end
Rarely seen in stool
since firmly imbedded
in mucosa of small
intestine. 91
 Adult Male:
Measures 5 – 9 mm by 0.30
mm and are shorter than
females
The posterior end has a
broad, membranous caudal
bursa (bursa copulatrix) with
rib-like rays, which are used
for copulation
92
 Adult Female:
 Measures 9 – 11 mm by
0.35 mm and are larger
than the male worm
 Has a blunt, pointed
posterior end
 May live from two to 14
years
93
PARASITE BIOLOGY – A. duodenale
 Adult worm:
Commonly called Old
World Hookworm
Slightly larger than N.
Americanus
Have single paired
reproductive organs
94
 Adult worm:
The head continues in
the same direction as
the curvature of the
body
The buccal capsule has
two pairs of curved
ventral teeth
95
 Adult Male:
Measures 10 mm by 0.5 mm
They have a prominent fan-
like copulatory bursa (bursa
copulatrix) found in the
posterior portion of the
worm
96
 Adult Female:
 Measures 12-15 mm by
0.7 mm, longer than male
worms
 Have blunt posterior end
97
PARASITE BIOLOGY
 Rhabditiform larva:
 Non-infective, feeding
stage
 Resembles S. stercoralis
but larger
 More attenuated
posteriorly
 Has longer buccal capsule
 Genital primordium is
conspicuous 98
PARASITE BIOLOGY
 Filariform larva:
 Infective, non-feeding stage
 In N. americanus, buccal
spears are conspicuous and
parallel throughout their
lengths while in A. duodenale,
buccal spears are
inconspicuous
 Transverse striations are
present in the tail region
99
PARASITE BIOLOGY
 Filariform larva:
 Measures 700 um
 Straight esophagus (1/4
of the body)
 Pointed tail covered with
sheath
100
PARASITE BIOLOGY
 Ova/Eggs:
 Measures about 64 – 76
μm by 36-40 μm
 Eggs are regularly oval
 Has single thin,
transparent hyaline shell
 Unsegmented at
oviposition
 Colorless and usually
seen in 2-8 cell stages 101
PARASITE BIOLOGY – A. braziliense
 Adult Worm:
 Buccal capsule is provided
with a pair of big teeth
 Definitive host is dogs
102
PARASITE BIOLOGY – A. caninum
 Adult Worm:
 Buccal capsule is provided
with three pairs of ventral
teeth, the innermost are
the smallest
 Definitive host is dogs
103
PARASITE BIOLOGY – A. ceylanicum
 Adult Worm:
 Buccal capsule is provided with two pars of teeth
but the outer pair is bigger than the other pair
104
LIFE CYCLE
 Infective stage: Filariform larvae
 Diagnostic stage: eggs in stool
 Definitive host: humans, dogs and cats (for A.
braziliense, caninum, ceylanimcum)
 Habitat: small intestine
 Transmission: soil – skin penetration
105
LIF
E
CY
CLE
106
LIF Cutaneous larva
migrans
E
CY
CLE
107
PATHOLOGY
 Infection is called Ancylostomiasis, Uncinariasis,
Necatoriasis, Hookworm Disease
1. The skin at the penetration site
• Produces macropopular lesions and localized
erythema
• Sever itching, called ground itch or dew itch
• Papulovesicular eruption lasting for 2 weeks
108
PATHOLOGY
2. The lung during larval migration
• Produces bronchitis or pneumonitis
• Minute hemmorhages with eosinophilic and
leukocytic infiltrates
3. Small intestine as habitat
• Abdominal pain, steatorrhea (fat in stool), bloody
diarrhea
• Blood eosinophilia of 30%-60%
• Hypoalbuminuria due to continues loss of blood,
lymph, and protein. 109
PATHOLOGY
 Produces microcytic anemia (each adult worm
consumes 0.2 ml of blood/day)
 Cutaneous larva migrans – creeping larvae
underneath the skin, route for filariform larvae of A.
braziliense, A. caninum, and A. ceylanicum.
 A. barziliense and A. caninum filariform larvae
penetrate subcutaneous tissue causing itching
(ground itch) and the formation of serpigenous
(hardened)tunnel
110
DIAGNOSIS
 Demonstration of characteristic egg in the feces
(2-8 cell stages) using DFS, Kato or Kato-Katz
technique, concentration methods (ZnSO4 or
foramlin-ether)
 Larva is not seen in feces, unless the specimen is
left for 24 hours using Harada-Mori culture
 If a stool specimen is left at room temp, the larva
may continue to develop and must be
differentiated with strongyloides 111
DIAGNOSIS
 Should you recover the adult Hookworm, easier
differentiation is done by observing the buccal capsule
 N. americanus – semilunar cutting plates
 A. duodenale – 2 pairs of ventral teeth
 A. caninum – 3 pairs of ventral teeth
 A. ceylanicum – 2 pairs of ventral teeth with with
outer bigger than the inner pair
 A. braziliense – a pair of big teeth
112
TREATMENT
 Albendazole
 Mebendazole
113
 Proper disposal of feces
 Avoid walking barefooted
 Health education on personal, family, and
community hygiene
 Treatment of infected individuals
 Mass chemotherapy when prevalence is greater
than 5%
 Protection of susceptible individuals
114
Enterobius vermicularis
115
PARASITE BIOLOGY
 Adult worm:
Commonly called oxyuris,
sitworm, pinworm
Has a cuticular alar
expansions at the anterior
end and a prominent
posterior esophangeal bulb
116
PARASITE BIOLOGY
 Adult Male:
 measure 2-5 by 0.1-0.2
mm, relatively smaller
than female worm
 Spindle-shaped and has
ventrally curved tail with a
single spicule
 Oral end is provided with 3
lips and a pair of laterally
placed capehalae or wings
117
PARASITE BIOLOGY
 Adult Male:
 Bursa is greatly reduced
and designated as caudal
alae which is supported by
6 pairs of caudal alae
 Rarely seen since it dies
after copulation
118
PARASITE BIOLOGY
 Adult Female:
Measures 8-13 by 0-4 mm
It has a long pointed tail
Vulva opens in front of the
middle third of the body
Vagina is long, extending
posteriorly from the vulva
before joining the paired
genital organs
119
PARASITE BIOLOGY
 Adult Female:
 The uteri of the gravid female are
distended with eggs
 They are capable of laying of 4,
672 to 16,888 eggs/day
 Female dies after laying eggs,
since it bursts.
120
PARASITE BIOLOGY
 Egg:
 Measures 50-60 μm by 20-30 μm
 Assymetrical, with one side
flattened and the other side
convex (letter D)
 Translucent shell consists of an
outer, triple albuminous covering
for mechanical protection and
inner lipoidal membrane for
chemical protection
121
PARASITE BIOLOGY
 Egg:
 Outside the host, eggs become
infective in four to six hours
 Resistant to disinfectants but
can’t survive in dry air for a day.
If moisture is present, may
remain viable for 13 days.
122
LIFE CYCLE
 Diagnostic stage: rhabditiform larva in stool
 Definitive host: humans
 Habitat: larvae in small intestine, adults in lumen
of caecum
 Transmission: ingestion of eggs, air-borne
123
LIF
E
CY
CLE
124
PATHOLOGY
 Perianal itching or pruritus ani – caused by
migration of female to perineal region
 Autoinfection – caused by scratching perineal
region and eventually ingesting the egg
 May produce appendicitis, vaginitis,
endometritis, salpingitis, peritonitis
 Familial disease
125
DIAGNOSIS
 Scotch tape technique (cellulose tape) – eggs
and larvae stick to the tape; since migration of
female occurs at night, the method is performed
before the patient’s bowel movement or before
the patient has taken a bath; adults may become
stuck to the outside the perianal folds where the
female migrates to lay eggs
126
TREATMENT
 Albendazole
 Mebendazole
127
 Proper personal hygiene
 Public education
 Familial treatment
 Handwashing after toilet use
 Underwear, night clothes, blankets and
bedsheets handled with care, boiled and
laundered
128
BLOOD AND TISSUE NEMATODES
129
MICROFILARIA GROUP
 General characteristics:
• Require an arthropod as an intermediate host
• Diagnosis is made by examining Giemsa
stained thick and thin blood smear (except O.
volvulus – skin scraping from nodules)
• They exhibit periodicity
130
MICROFILARIA GROUP
 General Life Cycle:
1. Ingestion of microfilaria from the
blood/tissue by a blood-sucking/tissue-eating
insect
2. The metamorphosis of the microfilaria in the
arthropod vector first into rhabditiform larva
then an infectious filariform larva.
131
MICROFILARIA GROUP
 General Life Cycle:
3. The transfer of the infectious larva to the skin
of the new host via the proboscis of the
biting insect.
4. The development of the larva at the entry
site into a mature worm at its secretion site
(may be lymphatics or remain at the dermis)
132
MICROFILARIA DISEASE ARTHROPOD DIAGNOSTIC MICROFILARIA
VECTOR STAGE FOUND NUCLEI
IN
Wuchereria Elephantiasis Culex and Blood Does not reach

bancrofti Anopheles the tip of the
mosquito tail
Brugia malayi Elephantiasis Mansonia Blood One at the

mosquito extreme tip of
the tail
Loa loa Calabar Chrysops fly Blood Up to the tip of

swelling the tail
Blindess
Onchocerca River Simulian fly Tissue/Skin None

volvulus Blindness scraping
133
Wuchereria bancrofti
Brugia malayi
134
PARASITE BIOLOGY – W. bancrofti
 Adult worm:
 Long, hair-like and transparent
with smooth cuticle
 Filiform in shape with both ends
tapering but terminations are
bluntly rounded
 Head is slightly swollen with 2
rings of small sessile papillae
 Mouth is unarmed
135
 Adult worm:
Living and degenerating worms are both
pathogenic
Found tightly coiled in nodular dilations in
lymph dilations in lymph vessels and in sinuses
of lymph glands
136
 Adult Male:
Measures 20 – 40 mm by 0.1 mm
Copulatory spicules are distinctly unequal and
dissimilar
Gubernaculums are crescent shaped
Caudal end is curved sharply ventrad
137
 Adult Female:
Measures 80 – 100 mm by 0.24 – 0.3 mm
Vulva is cervical in position
Posterior end is narrow and abruptly pointed
Generally found in the Far East
138
 Microfilariae:
 Measures 270 – 290 μm
 Nocturnal periodicity – greatest
concentration in the blood at 9PM –
2AM
 Minute snake like organisms that
constantly move among red blood
cells
 Enclosed in a hyaline sheath which is
longer than the microfilaria itself
 When stained, the central axis shows
dark staining which serve as
identifying feature
139
 Microfilariae:
 Central column of nuclei are
discrete and do not extend down to
the tip of the tail
 The column of nuclei is arranged in
two or three rows and is
conspicuous
 Single stylet is seen at the anterior
end
 Cephalic space is as long as it is
broad
 Has several curvatures giving it a
graceful appearance
140
LIFE CYCLE – W. bancrofti
 Infective stage: 3rd stage microfilaria
 Diagnostic stage: demonstration of sheathed
microfilaria in thin and thick blood smears
 Habitat: adults in lymphatics, microfilaria in
blood
 Transmission: Culex and Anopheles mosquito (as
biological vector)
141
PARASITE BIOLOGY – B. malayi
 Adult worm:
Creamy white, long, and filiform in shape
Bears great resemblance to W. bancrofti
Male worm measures 13-23 mm in length
Female worm measures 43-45 mm in length
142
 Microfilariae:
 Measures 177 - 230 μm
 Sheathed, double stylets are
found at the anterior end
 Cephalic space is longer than
broad
 There is one discrete nuclei
at the extreme tip of the tail
143
 Microfilariae:
 There is another discrete
nuclei midway between the
tip and the posterior column
of nuclei
 In stained blood smears, they
can be seen enclosed in
sheath and having angular
curvatures with secondary
kinks instead of smooth
curves 144
LIFE CYCLE – B. malayi
 Diagnostic stage: demonstration of sheathed
microfilaria in thin and thick blood smears
 Habitat: adults in lymphatics, microfilaria in
blood
 Transmission: Mansonia mosquito (as biological
vector)
145
LIF
E
CY
CLE
146
PATHOLOGY
 Disease is called Bancroftian filariasis,
Wuchereriasis, or Elephantiasis (hydrocoele if
the scrotum is affected) and Malayan filariasis
 Asymptomatic stage:
 There is induced CD4+ lymphocyte apoptosis
 May have hidden lymphatic pathology and
kidney damage
147
PATHOLOGY
 Acute stage:
 Clinical manifestations are mainly caused by
living, dead, or degenerating adult worms in
lymphatics
 Fever with lymphadenitis of male genital
organs, arms, and legs
 Dermatolymphangioadenitis (DLA) –
immunologic sensitization to the worms
148
PATHOLOGY
 Acute stage:
 Individuals who are infected but not living in
the endemic areas experience “Expatriate
Symdrome” – DLA and allergic reactions such
as hives, rashes, and blood eosinophilia
 Acute manifestations gradually merge into
proliferative fibrous tissue growth around
dead worms leading to elephantiasis or
hydrocoele
149
PATHOLOGY
 Chronic stage:
 Fibrous hyperplasia –
proliferative fibrous tissue growth
around and replacing the dead
worms
 Elephantiasis – there is
continuous dermal and
connective tissue growth and the
enlarged parts gradually harden
with the loss of skin elasticity and
150
fibrosis
PATHOLOGY
 Chronic stage:
 Hydrocoele or Chylocoele – results
from the obstruciton of
lymphatics of the tunica vaginalis
 Tropical Pulmonary Eosinophilia
(TPE) – microfilariae are absent in
blood but present in tissue; if
untreated progresses to chronic
pulmonary fibrosis and respiratory
failure
151
DIAGNOSIS
 Demonstration of sheathed microfilariae in
blood in thick and thin smears
 Demonstration of Circulating Filarial Antigens
(CFA) using ELISA, immunochromatography
 Molecular diagnostic techniques using PCR
 Ultrasonography – lymphagiography and
lymphscintigraphy
152
TREATMENT
 Diethylcarbamazine citrate (DEC)
 Ivermectin
 Surgery for enlarged parts
 Relieving symptoms with analgesics and
antipyretics
153
 Destruction of mosquito habitat
 Use of mosquito nets
 Breeding insect-eating animals like lizards and
frogs
 Use of mosquito repellents
 Use of mosquito sprays like Bacillus sphaericus
or chemicals like Baygon
154
Loa loa
155
PARASITE BIOLOGY
 Adult worm:
Also known as eye worm
Creamy white, long, and filiform in shape
Vary in size
156
PARASITE BIOLOGY
 Microfilaria:
Sheathed
Has nuclei up to the tip of the tail
Exhibits diurnal periodicity –
found in peripheral blood
anytime of the day
157
LIFE CYCLE
 Diagnostic stage: demonstration of micorfilaria
or adult worms in thick and thin blood smears
 Habitat: dermis of the skin
 Transmission: Chrysops fly (as biological vector)
158
LIF
E
CY
CLE
159
PATHOLOGY
 Disease is called Loiasis
 Episodic angioedema (Calabar swellings) and
subconjunctival migration of an adult worm can
occur.
 Allergic reaction due to migration into tissue and
death in capillaria
160
DIAGNOSIS
 Demonstration of sheathed microfilariae in
blood in thick and thin smears
TREATMENT
 Diethylcarbamazine citrate (DEC)
 Ivermectin
 Surgical removal of worms from infected
area
161
 Keeping environment clean to prevent
creating fly habitat
162
Onchocerca vovulus
163
PARASITE BIOLOGY
 Adult worm:
 Also known as blinding worm
 Cuticula possess distinct transverse striations
 Adult Male:
 Measures 19 – 42 mm by 130-210 mm
 Posterior end is tightly curved ventrad
 Adult Female:
 Measures 33.5 – 50 cm by 270 – 400 um
 Vulva opens slightly behinad the posterior end of
esophagus 164
PARASITE BIOLOGY
 Microfilariae:
 Measures 285 – 386 by 6 – 9
um or 150 – 287 by 5-7 um
 Anterior end is bluntly rounded
and enlarged and the posterior
end is abruptly narrowed
 Unsheathed and no stylets are
seen at the anterior end
 Has no nuclei in both anterior
and posterior ends
 Has sweeping curves
165
LIFE CYCLE
 Diagnostic stage: recovery of micorfilaria or
adult worms from skin snips
 Habitat: dermis of the skin
 Transmission: Simulium fly (as biological vector)
166
LIF
E
CY
CLE
167
PATHOLOGY
 Disease is called Onchocerciasis or River
blindness
 Longterm corneal inflammation, or keratitis,
leads to thickening of the corneal stroma and
ocular lesions which ultimately leads to
blindness
 Pruritus, dermatitis, onchocercomata
(subcutaneous nodules), and
lymphadenopathies.
168
DIAGNOSIS
 Demonstration of unsheathed microfilariae in
skin scraps tissue
TREATMENT
 Ivermectin
169
 Keeping environment clean to prevent
creating fly habitat
170
Drancunculus medinensis
171
PARASITE BIOLOGY
 Adult worm:
Also known as Guinea worm,
Fiery Serpent, or Medina
Worm
Longest human infecting
nematode
 Adult Male:
Measures 1.2 – 2.9 cm in
length
172
PARASITE BIOLOGY
 Adult Female:
Measures 60 cm in length
Migrates along subcutaneous tissues to reach
the skin below the knee, forming a painful
ulcerating blister
 Larva:
Measures between 520 – 700 um
Can live for 6 days in clear water and 2 – 3
weeks in muddy water 173
LIFE CYCLE
 Infective stage: 3rd stage larva
 Diagnostic stage: recovery of adult worms from
the ulcer
 Definitive host: humans, dogs, horses
 Habitat: skin
 Transmission: Copepods, especially cyclops
(small crustaceans)
174
LIF
E
CY
CLE
175
PATHOLOGY
 Disease is called
Drancunculiasis
 Migrating females are usually
found in subcutaneous tissue
and muscles of humans,
dogs, cattle, and horses
 Causes subcutaneous
nodules and subsequent
ulcers
176
DIAGNOSIS
 Recovery of adult worm in the ulcerating blister
TREATMENT
 Local cleansing of the lesion and local application
of antibiotics
 Mechanical removal of worms (clip, pull, & roll!)
177
 Filtering and boiling of drinking water
 Avoiding contact with contaminated
water
178
Angiostrongylus cantonensis
179
PARASITE BIOLOGY
 Commonly called Rat-
Lung Worm
 Was described by chen
in 1935 from domestic
rats in Canton, China
180
PARASITE BIOLOGY
Adult Male:
 Pale and filiform, 16-19
mm by 0.26 mm
 They have well
developed caudal bursa
(kidney shaped and
single lobed
181
PARASITE BIOLOGY
Adult Female:
 Pale and filiform, 21-25 mm by 0.30-0.36 mm
 Has uterine tubules which are round spirally
around the intestine (barber’s pole pattern)
 Lays 15,000 egg/day
182
PARASITE BIOLOGY
Eggs/Ovum
 Have delicate hyaline shell, measure 46-48 by 68
um
 Unembryonated when oviposited, together with
the feces
183
LIFE CYCLE
 Infective stage: 3rd stage larva
 Diagnostic stage: recovery of adult worms from
the ulcer
 Intermediate host: snails (Achantina fulica)
 Definitive host: humans, rats
 Habitat: CSF in the brain
 Transmission: shrimp, crab, frog, snails
184
LIF
E
CY
CLE
185
PATHOLOGY
 Disease is called Angiostrongyliasis
 Causes eosinophilic meningoencephalitis
186
DIAGNOSIS
 Relatively difficult
 Presumptive diagnosis is made by travel history
and exposure
 CSF (10% eosinophilia in proportion to the WBC)
 CT scan
 ELISA (Enzyme Linked ImmunoSorbent Assay) –
antigen antibody detection
187
TREATMENT
 No antihelminthic treatment
recommended
 Thiabendazole, Mebendazole,
Albendazole, Ivermectin (effective in
experimental animals)
188
 Proper eating habits
 Safe food preparation
 Elimination of eliminating intermediate
host
 Washing of leafy vegetables
 Eating sufficiently cooked prawns and
crabs
189
Gnathostoma spinigerum
190
Disease
 Gnathostomiasis in humans, also known
as creeping eruption
 Larva migrans
 Yangtze edema
 Choko-FuschuTuachid
 Wandering swelling
191

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CLASS NEMATODA

Wuchereria Elephantiasis Culex and Blood Does not reach

Brugia malayi Elephantiasis Mansonia Blood One at the

Loa loa Calabar Chrysops fly Blood Up to the tip of

Onchocerca River Simulian fly Tissue/Skin None

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