Larva migrans

Cutaneous larva migrans (abbreviated CLM) is a skin disease

in humans, caused by the larvae of various
nematode parasites of
the hookworm family (Ancylostomatidae). The most
common species causing this disease in the Americas
is Ancylostoma braziliense. These parasites live in the
intestines of dogs, cats, and wild animals and should not be
confused with other members of the hookworm family for
which humans are definitive hosts, namely Ancylostoma
duodenale and Necator americanus.
Symptoms :
The infection causes a red, intensely pruritic (itchy) eruption.
The itching can become very painful and if scratched may
allow a secondary bacterial infection to develop. Cutaneous
larva migrans usually heals spontaneously over weeks to
months and has been known to last as long as one year.
However, the severity of the symptoms usually causes those
infected to seek medical treatment before spontaneous
resolution occurs. Following proper treatment, migration of
the larvae within the skin is halted and relief of the
associated itching can occur in less than 48 hours (reported
for thiabendazole).
This is separate from the similar cutaneous larva
currens which is caused by Strongyloides. Larva currens is
also a cause of migratory pruritic eruptions but is marked by
1) migratory speed on the order of inches per hour 2)
 perianal involvement due to autoinfection from stool and 3)
a wide band of urticaria.

Causes :
Hookworm eggs are shed in the infected dog (or other
animal) feces to the ground and beach sand, where they then
develop over a period of 1–2 weeks into the infectious larval
form (filariform larvae).  The filariform larvae can burrow
through intact skin that comes into contact with soil or sand
that is contaminated with feces. Although they are able to
infect the deeper tissues of animals (through to the lungs and
then the intestinal tract), humans are incidental hosts and
the larvae are only able to penetrate the epidermis of
the skin  and thus create the typical wormlike burrows visible
underneath the skin. These parasites apparently lack the
collagenase enzymes required to penetrate through
the basement membrane deeper into the dermal layers of
the skin.
Treatment :
CLM can be treated in a number of different ways:
 Systemic (oral) agents include albendazole  (trade
name Albenza)  and ivermectin  (trade name Stromectol)).
 Another agent which can be applied either
topically or taken by mouth is thiabendazole  (trade
name Mintezol)), an anti-helminthic.
 Topical freezing agents, such as ethylene
chloride or liquid nitrogen,  applied locally can freeze and kill
the larvae, but this method has a high failure rate because
the larvae are usually located away from the site of the
visible skin trails. Additionally, this is a painful method which
can cause blistering and/or ulceration of the skin and it is
therefore not recommended.

Trichinella spiralis

Trichinella spiralis is an ovoviviparous nematode parasite,

occurring in rodents, pigs, bears, hyenas and humans, and is
responsible for the disease trichinosis. It is sometimes
referred to as the "pork worm" due to it being typically
encountered in undercooked pork products. It should not be
confused with the distantly related pork tapeworm.

Life cycle :
Trichinella spiralis can live the majority of its adult life in the
intestines of humans. To begin its life cycle, Trichinella
spiralis adults will invade the intestinal wall of a pig, and
produce larvae that invade the pig's muscles. The larval
forms are encapsulated as a small cystic structure within a
muscle cell of the infected host. When another animal
(perhaps a human) eats the infected meat, the larvae are
released from the nurse cells in the meat (due to stomach
pH), and migrate to the intestine, where they burrow into the
intestinal mucosa, mature, and reproduce.  Juveniles within
nurse cells have an anaerobic or facultative anaerobic
metabolism, but when they become activated, they adopt
the aerobic metabolism characteristics of the adult.

Trichinella spiralis lifecycle
Female Trichinella worms live for about six weeks, and in that
time can produce up to 1,500 larvae; when a spent female
dies, she passes out of the host. The larvae gain access to the
circulation and migrate around the body of the host, in
search of a muscle cell in which to encyst.  The migration and
encystment of larvae can cause fever and pain, brought on by
the host inflammatory response. In some cases, accidental
migration to specific organ tissues can
cause myocarditis and encephalitis that can result in death.

Symptoms :
The first symptoms may appear between 12 hours and two
days after ingestion of infected meat. The migration of adult
worms in the intestinal epithelium can cause traumatic
damage to the host tissue, and the waste products they
excrete can provoke an immunological reaction.  The
resulting inflammation can cause symptoms such as nausea,
vomiting, sweating, and diarrhea. Five to seven days after the
appearance of these symptoms, facial edema and fever may
occur. Ten days following ingestion, intense muscular pain,
difficulty breathing, weakening of pulse and blood pressure,
heart damage, and various nervous disorders may occur,
eventually leading to death due to heart failure, respiratory
complications, or kidney malfunction, all due to larval
migration.
In pigs, infection is usually subclinical, but large worm
burdens can be fatal in some cases.

Diagnosis and symptoms :

Muscle biopsy may be used for trichinosis detection. Several
immunodiagnostic tests are also available. Typically, patients
are treated with either mebendazole or albendazole, but
efficacy of such products is uncertain. Symptoms can be
relieved by use of analgesics and corticosteroids.
In pigs, ELISA testing is possible as a method of
diagnosis. Anthelmintics can treat and
prevent Trichinella infections.
 Malaria
Malaria is a mosquito-borne infectious disease affecting
humans and other animals caused by single-celled
microorganismsbelonging to the Plasmodium group.  Malaria
causes symptoms that typically
include fever, tiredness, vomiting, and headaches.  In severe
cases it can cause yellow skin, seizures, coma, or death.
Symptoms usually begin ten to fifteen days after being bitten
by an infected mosquito.  If not properly treated, people
may have recurrences of the disease months later.  In those
who have recently survived an infection, reinfection usually
causes milder symptoms.  This partial resistance disappears
over months to years if the person has no continuing
exposure to malaria.

Types :
The disease is most commonly transmitted by an infected
female Anopheles mosquito. The mosquito bite introduces
the parasitesfrom the mosquito's saliva into a person's blood.
The parasites travel to the liver where they mature
and reproduce.  Five species of Plasmodium can infect and be
spread by humans.  Most deaths are caused
by P. falciparum because P. vivax, P. ovale,
and P. malariae generally cause a milder form of malaria.
The species P. knowlesi rarely causes disease in humans.
Malaria is typically diagnosed by the microscopic
examination of blood using blood films, or with antigen-
based rapid diagnostic tests. Methods that use
the polymerase chain reaction to detect the
parasite's DNA have been developed, but are not widely used
in areas where malaria is common due to their cost and
complexity.
Symptoms:
The signs and symptoms of malaria typically begin 8–25 days
following infection but may occur later in those who have
taken antimalarial medications as prevention. Initial
manifestations of the disease—common to all malaria
species—are similar to flu-like symptoms,  and can resemble
other conditions such as sepsis, gastroenteritis, and viral
diseases.  The presentation may
include headache, fever, shivering, joint
pain, vomiting, hemolytic anemia, jaundice, hemoglobin in
the urine, retinal damage, and convulsions.
Complications
Malaria has several serious complications. Among these is
the development of respiratory distress, which occurs in up
to 25% of adults and 40% of children with
severe P. falciparum malaria. Possible causes include
respiratory compensation of metabolic acidosis,
noncardiogenic pulmonary oedema,
concomitant pneumonia, and severe anaemia. Although rare
in young children with severe malaria, acute respiratory
distress syndromeoccurs in 5–25% of adults and up to 29% of
pregnant women.  Coinfection of HIV with malaria increases
mortality.  Renal failure is a feature of blackwater fever,
where hemoglobin from lysed red blood cells leaks into the
urine.
Infection with P. falciparum may result in cerebral malaria, a
form of severe malaria that involves encephalopathy. It is
associated with retinal whitening, which may be a useful
clinical sign in distinguishing malaria from other causes of
fever.  Enlarged spleen, enlarged liver or both of these,
severe headache, low blood sugar, and hemoglobin in the
urine with renal failure may occur. Complications may
include spontaneous bleeding, coagulopathy, and shock.
Malaria in pregnant women is an important cause
of stillbirths, infant mortality, abortionand low birth weight,
[20] particularly in P. falciparum infection, but also
with P. vivax.

Life Cycle :
In the life cycle of Plasmodium, a female Anopheles mosquito
(the definitive host) transmits a motile infective form (called
the sporozoite) to a vertebrate host such as a human (the
secondary host), thus acting as a transmission vector. A
sporozoite travels through the blood vessels to liver cells
(hepatocytes), where it
reproduces asexually(tissue schizogony), producing
thousands of merozoites. These infect new red blood cells
and initiate a series of asexual multiplication cycles (blood
schizogony) that produce 8 to 24 new infective merozoites, at
which point the cells burst and the infective cycle begins
anew.
Other merozoites develop into immature gametocytes, which
are the precursors of male and female gametes. When a
fertilized mosquito bites an infected person, gametocytes are
taken up with the blood and mature in the mosquito gut. The
male and female gametocytes fuse and form an ookinete—a
fertilized, motile zygote. Ookinetes develop into new
sporozoites that migrate to the insect's salivary glands, ready
to infect a new vertebrate host. The sporozoites are injected
into the skin, in the saliva, when the mosquito takes a
subsequent blood meal
Only female mosquitoes feed on blood; male mosquitoes
feed on plant nectar and do not transmit the disease.
Females of the mosquito genus Anopheles prefer to feed at
night. They usually start searching for a meal at dusk and will
continue throughout the night until taking a meal Malaria
parasites can also be transmitted by blood transfusions,
although this is rare.
 Liver trematode

Liver fluke is a collective name of a polyphyletic group of

parasitic trematodesunder the phylum Platyhelminthes. They
are principally parasites of the liver of various mammals,
including humans. Capable of moving along the blood
circulation, they can occur also in bile ducts, gallbladder, and
liver parenchyma. In these organs, they produce pathological
lesions leading to parasitic diseases. They have complex life
cycles requiring two or three different hosts, with free-living
larval stages in water.

Biology:
The body of liver flukes is leaf-like, and flattened. The body is
covered with a tegument. They are hermaphrodites having
complete sets of both male and female reproductive
systems. They have simple digestive systems, and primarily
feed on blood. The anterior end is the oral sucker opening
into the mouth. Inside, mouth lead to a small pharynx which
is followed by an extended intestine that runs through the
entire length of the body. The intestine is heavily branched
and anus is absent. Instead the intestine runs along an
excretory canal that opens at the posterior end. Adult flukes
produce eggs which are passed out through the excretory
pore. The eggs infect different species of snails (as
intermediate hosts) in which they grow into larvae. The
larvae are released into the environment from where the
definitive hosts (humans and other mammals) get the
infection. In some species, another intermediate host is
required, generally a cyprinid fish. In this case, the definitive
hosts are infected from eating infected fish. Hence, they are
food-borne parasites.
Pathogenicity:
Liver fluke infections cause serious medical and veterinary
diseases. Fasciolosis of sheep, goats and cattle, is the major
cause of economic losses in dairy and meat
industry.Fasciolosis of humans produces clinical symptoms
such as fever, nausea, swollen liver, extreme abdominal pain,
jaundice and anemia.
Clonorchiasis and opisthorchiasis (due to Opisthorchis
viverrini) are particularly dangerous. They can survive for
several decades in humans causing chronic inflammation of
the bile ducts, epithelial hyperplasia, periductal fibrosis and
bile duct dilatation. In many infections these symptoms cause
further complications such as stone formation, recurrent
pyogenic cholangitis and cancer
(cholangiocarcinoma).Opisthorchiasis is particularly the
leading cause of cholangiocarcinoma in Thailand and the Lao
People's Democratic Republic. Both clonorchiasis and
opisthorchiasis are classified as Group 1 human biological
agents (carcinogens) by International Agency of Research on
Cancer (IARC).

Species:
Species of liver fluke include:
 Clonorchis sinensis (the Chinese liver fluke, or the
Oriental liver fluke)
 Dicrocoelium dendriticum (the lancet liver fluke)
 Dicrocoelium hospes
 Fasciola hepatica (the sheep liver fluke)
 Fascioloides magna (the giant liver fluke)
 Fasciola gigantica
 Fasciola jacksoni
 Metorchis conjunctus
 Metorchis albidus
 Protofasciola robusta
 Parafasciolopsis fasciomorphae
 Opisthorchis viverrini (Southeast Asian liver fluke)
 Opisthorchis felineus (Cat liver fluke)
 Opisthorchis guayaquilensis
 Intestinal trematode
INTRODUCTION
Intestinal flukes (trematodes) are flat hermaphroditic worms
that range in size from a few millimeters to several
centimeters. Approximately 70 trematode species have been
reported to colonize the human intestinal tract. The
geographic distribution is worldwide; the highest prevalences
are in East and Southeast Asia. Infection in the United States
can be acquired via importation as well as locally; the most
common species include Nanophyetus, Alaria,
and Heterophyes . Intestinal trematodes are among the
commonest parasitic infections in humans and animals but
are less associated with mortality than many other parasites .
Sources for transmission of human infection include fish,
crustaceans, and aquatic plants, and endemicity of infection
is associated with cultural and eating habits.
Four of the most frequently described intestinal flukes will be
reviewed here: Fasciolopsis buski, Heterophyes
heterophyes, Metagonimus yokogawai,
and Echinostoma species.
FASCIOLOPSIASIS
F. buski is the largest intestinal fluke of humans; pigs are also
mammalian hosts. The infection is common in Southeast Asia
and the Far East, especially in areas where humans raise pigs
and consume freshwater plants.
Life cycle :
The life cycle begins with release of immature eggs in
mammalian stool (figure 1). These eggs become
embryonated in water and release miracidia, which enter
snail intermediate hosts. In the snail, the parasites undergo
several developmental stages (sporocysts, rediae, and
cercariae). The cercariae are released from the snail and
encyst as metacercariae on aquatic plants, where they can
survive for prolonged periods (often up to a year).
Mammalian hosts become infected by ingesting
metacercariae on the aquatic plants. After ingestion, the
metacercariae excyst in the duodenum and attach to the
intestinal wall, where they develop into adult flukes in
approximately three months. Adult worms are 2 to 7.5 cm
long and 1 to 2 cm wide; they have a lifespan of about one
year and produce approximately 25,000 eggs daily .
 General characteristics of Helminths
A. Introduction
1. Phylum Platyhelminthes (flatworms) - includes the
tapeworms & flukes
a. General Characteristics
(1) Multicellular animals characterized by a flat, bilaterally
symmetric
body. It is dorsoventrally flattened and is solid (no body
cavity).
(2) Hermaphroditic, having both male and female
reproductive
organs in the same individual.
(3) Overall size varies greatly, some members are as small as
1mm,
and others may be 20 meters or longer.
(4) The classes Cestoda (tapeworms) and Trematoda (flukes)
contain species parasitic to humans.
b. The Cestodes
(1) Adult worms have a flat, ribbon-like white to yellowish
body
consisting of an anterior attachment organ (scolex) and a
body
(strobila) consisting of a chain of segments called proglottids.
(2) Scolex - the head. Characterized by the presence of
sucking
disks or lateral grooves, and hooks. This is important in
speciation, but seldom recovered.
(a) Rostellum – present on the scolex of “armed”
tapeworms. This is a small button-like structure on top of
the scolex from which the hooks protrude. It may be
retractable.
(3) Strobila – the body of the tapeworm
(a) Length - varies from a few inches to 20 meters or more.
 General characteristics of Cestoda
Cestoda is a class of parasitic worms in
the flatworm phylum (Platyhelminthes). Most of the species -
and the best-known - are those in the subclass Eucestoda;
they are ribbonlike worms as adults, known as tapeworms.
Their bodies consist of many similar units, known as
proglottids, which are essentially packages of eggs which are
regularly shed into the environment to infect other
organisms. Species of the other subclass, Cestodaria, are
mainly fish parasites.

Characteristics :
Cestodes have a head, called a scolex, which has suckers.
These suckers are used to attach to a person's intestinal tract.
Some cestodes also have hooks on their head as well.
Although cestodes can be found in a person's digestive tract,
ironically they don't have one themselves. They absorb
nutrients through a skin-like covering instead.
Cestodes don't have a body cavity. Instead, their insides are
filled with spongy cells that suspend their internal organs.
And when it comes down to reproduction, cestodes are
monecious. In other words, they are hermaphrodites. They
are also oviparous, or egg-laying.
 General characteristics of trematode

Trematoda is a class within the phylumPlatyhelminthes. It

includes two groups of parasitic flatworms, known as flukes.
Characteristics :
Trematodes are flattened oval or worm-like animals, usually
no more than a few centimetres in length,
although species as small as 1 millimetre (0.039 in) are
known. Their most distinctive external feature is the
presence of two suckers, one close to the mouth, and the
other on the underside of the animal.
The body surface of trematodes comprises a
tough syncitial tegument, which helps protect
against digestive enzymes in those speciesthat inhabit the
gut of larger animals. It is also the surface of gas exchange;
there are no respiratory organs.
The mouth is located at the forward end of the animal, and
opens into a muscular, pumping pharynx.
The pharynx connects, via a short oesophagus, to one or two
blind-ending caeca, which occupy most of the length of the
body. In some species, the caeca are themselves branched.
As in other flatworms, there is no anus, and waste material
must be egested through the mouth.
Although the excretion of nitrogenous wasteoccurs mostly
through the tegument, trematodes do possess an excretory
system, which is instead mainly concerned
with osmoregulation. This consists of two or
more protonephridia, with those on each side of the body
opening into a collecting duct. The two collecting ducts
typically meet up at a single bladder, opening to the exterior
through one or two pores near the posterior end of the
animal.
The brain consists of a pair of ganglia in the head region,
from which two or three pairs of nerve cords run down the
length of the body. The nerve cords running along the ventral
surface are always the largest, while the dorsal cords are
present only in the Aspidogastrea. Trematodes generally lack
any specialised sense organs, although
some ectoparasitic species do possess one or two pairs of
simple ocelli.