Ascaris lumbriocides Hookworm Strongyloides stercoralis Trichuris trichiura

Nomenclature (General
CN: Giant intestinal CN: Old world hookworm (A. CN: threadworm CN: whipworm
roundworm/roundworm of man duodenale), New world Hookworm Ashkanazy – pathology of strongyloidiasis Dis: Trichuriasis
Disease: Ascariasis (N. americanus) Fullerborn – life cycle of worm Habitat: small intestine (cecum, Li
overview)

Oviparous Habitat: Small intestine Nishigoii – Auto-infection Colon)

STH Infective Stage: Filariform Ovoviviparous 2nd most common intestinal nematod
Habitat: Small intestine Oviparous Habitat: Small intestine Holomyrian
Host:Man N Hosts: dogs & apes Oviparous
Infective stage: filariform
  Unfertilized Egg Egg Egg Egg
85-95m x 38-45m N.americanus: 64 -76 x 36-40 um 50 – 58 x 30 -34 um  50-54 um x 22-23 um
- unembryonated, amorphous A. duodenale: 60 x 40 um Clear, transparent thin shell, hyaline  Barrel or Football – Japanese
mass of protoplasm Ovoid lantern/bipolar mucus plug
- thin shell Elongated, ovoid shape Contains well-developed larvae  Yellowish outer & transparent
- heavy albuminous coating Thin& transparent, hyaline eggshell Present in 2,4,8 cell stage inner shell
- disorganized Yolk cells cleavage
Rhabditiform
225 x 16 um
Elongated esophagus w/ pyriform posterior
bulb
Short buccal capsule
Large genital primordium

Filariform
550 um (L)
Non-feeding larvae & slender
Forked tail (notched)
Larvae Long esophagus
(Rhabditiform)
 Fertilized Egg
0.25 – 0.3mm long x 17 um
40-75m x 30-50m Adult
Open mouth, long narrow buccal
2 x 0.04 mm Adult
- infective stage capsule
Colorless, transparent body  Size:
- undeveloped unicellular embryo Flasked-shaped esophagus
Finely striated cuticle 3.5 x 5.5 mm (F)
- thick chitin wall Inconspicuous genital primordium
Short buccal cavity 3.0 x 3.5 mm (M)
- organized Sharply pointed tail
Long slender esophagus  Pinkish/flesh colored
Vulva located 1/3 from posterior end  Anterior 3/5: burrows intestinal
Fertilized Corticated Egg(more wall) (Filariform) Parthenogenic mucosa
0.5 – 0.6 mm long Free-living  Posterior 2/5: reproductive tract
Closed mouth
Capillary esophagus  Narrow esophagus w/stichocyte
Thin-transparent sheath  Tail:
With cross striations (N. Straight (F)
americanus) Coiled (M)
W/o (A. duodenale)
Sharply pointed tail

Adults
N.americanus:
 7 – 9 mm long(M),
9-11(F)
 6,000 – 10,000 eggs
Fertilized decorticated egg (less wall) produced
 Cylindrical (S-shaped)
 Grayish-yellow
 2 types of Life cycle:
1. Ingestion of embryonated eggs 1. Infective third stage
contain larva larva penetrates Free-Living or heterogenic Cycle
2. Larva emerges from the eggs in SI through the skin of - cycle is outside the environment
3. Larva penetrate the intestinal wall the host Parasitic Cycle
and transports into liver to lung by 2. Filariform larva goes - cycle is on human and environment
entering in the blood vessels to blood & lympathic - Direct
4. Inside the lung, the larva burrow to system - Indirect
the capillaries, alveoli, then migrate 3. Blood carries the - Autoinfection
in bronchi larvae to the lungs,
5. Larvae will transfer through penetrate capillaries,
1. Third-stage filariform larva
coughing then pharynx swallowed enter alveoli
penetrates through the skin of the
back into the intestine and mature 4. Migration continues
host 1. Ingestion of embryonated eggs in
into adult worms in the bronchioles
2. Larva migrates to the SI and molts contaminated food, water soil
6. Adult worms produce eggs in the SI where they coughed
to become adults. 2. Eggs hatch in SI, intestinal villi, where
and then excrete unembryonated & and swallowed into
3. Female live and produce eggs in the larva transform into immature adults
embryonated egg via feces the intestine.
Life Cycle

intestinal mucosa of SI via 3. Immature adults attach to cecum/colon

7. Unembryonated will not develop, 5. Larva develop into
parthogenic. to mature,reproduce eggs and exit thru
embryonated will develop through adults in SI
4. Rhabditiform larva emerges from feces
warm soil. 6. Adults produce egg
the egg in the intestinal lumen (LI) it 4. Unembryonated eggs embryonate in
8. Egg continues to molt into infective in intestine and
can either be passed in stool or warm, moist soil
stage and then ready to be ingested excreted via feces
initiate auto-infection. 5. Cycle repeats when embryonated eggs
again. 7. Eggs then hatches
5. If it passes in stool, they develop is ingested
into 1st stage
into free-living adults
rhabditiform in the
6. Eggs are reproduced by fertilized
soil
female worm
8. Molts into infective
7. Rhabditiform hatches from the egg
stage and cycle
and molt.
continues. When
8. Developing into infective stage: third
ingested
stage filariform.
9. Cycle repeats when it intacts into
human skin.
10. If autoinfection, rhabditiform molts
into filariform , penetrate intestinal
mucosa and migrate to other
organs.
 Ingestion of contaminated  Skin penetration  Skin Penetration  Ingestion of embryonated egg,
Transmission

embryonated egg  Ingestion of  Autoinfection contaminated food,water,soil

Mode of

contaminated
food.water,soil with
filariform larva
 Autoinfection
  Enteritis  Lesions in  Chronic gastrointestinal  Asymptomatic:
intestinal mucosa Slight anemia/light infection
 Inflammation of intestinal inflammation
 Severe anemia  Symptomatic:
 Obstruction  Eosinophilia
 Eosinophilia 5,000 eggs/g
Pathology in the Host

 Toxicity  Pneumonitis  Anemia 20,000 eggs/g-

 Eosinophilia  Erythema  Diarrhea  Heavy worm burden – damage to
 Dyspnea intestine
 Hemorrhage  secondary bacterial infections
 Ancylostomiasis  Rectal Prolapse – rectum edema
 trauma by penetrating adults  biliary and pancreatic  Eosinophilia
 Uncinariasis
 Ascariasis  Necatoriasis inflammation  Severe anemia
 Cutaneous Larvae  Hemorrhage
Migrans  Diarrhea

 DFS  DFS Zinc-sulfate floatation  DFS

 NSS  Harada-Mori culture Enterotest  Cellophane thick smear
 ELISA  Filter paper slant ELISA  Concentration techniques
 Baermann gauze funnel technique  Acid ether & formalin-ether acetate
 Acid ether  Charcoal culture Antibody Detection  FLOTAC
 Kato katz  Kato Katz  Indirect Fluorescent Antibody  Kato thick smear
 Zinc Sulphate  Concentration  Indirect Hemagglutination  Kato Katz Technique – 91% - 94%
Laboratory Diagnosis

 CBC Methods  Enzyme Immunoassay –

 sputum  PCR recommended
 Stoll’s technique  ELISA  Baermman funnel gauze method
 Multiplex PCR  Permanent stain  Harada – Mori culture -successful
smear method in parasitic identification
 Aspiration of lesions  Nutrient Agar plate -also
recommended
 Beale string test
 Duodenal aspiration
 Small bowel biopsy

 Albendazole  Mebendazole  Albendazole

 Mebendazole  Pyrantel pamoate  Mebendazole
Treatment

 Pyrantel pamoate  Albendazole  Oxantel-Pyrantel

 Levasimole  Ivermectin
 Peperazine citrate
 Corticosteroid
  Proper sanitation  Proper sanitation  Proper disposal  Drug administration of children
Prevention &  Avoid using human feces as  Personal Hygiene  Safe water  Safe water, environmental sanitation
Control fertilizer  Proper fecal disposal  Environmental Sanitation  Hygiene education
 Prevent walking barefooted

Worldwide, cosmopolitan Tropical and subtropic Tropics & subtropics  Temperate & tropical regions
countries  25% affected worldwide
Epidemiology

 Prevalent: East Asia & Pacific

 Moist,warm soil
 Philippines: 80% - 90% prevalence

Capillaria philippinensis Dracunculus medinensis Enterobius vermicularis Trichinella spiralis Angiostrongylus cantonens

CN: pudoc worm/ mystery CN: Guinea worm/Serpent Worm, CN: seatworm/pinworm CN: CN: Rat lungworm
disease fiery serpents of Israelites, ON: Oxiyuris vermicularis porkworm/muscleworm/tric Origin: Canton, China described b
Disease: intestinal malabsorption, medina worm, dragon worm Habitat: Large intestine hinaworm Chen
chronic diarrhea, borborygmi Habitat: subcutaneous & cutaneous Host: man Dis: Trichonosis, Habitat: rat lungs
(gargle in stomach) Disease: Dracunculosis, Disease: Trichiniasis. Trichinellasis Disease: Eosinophilic
General Overview

Origin: Bacarra, Ilocos Norte Dracunculiasis, Guinea worm Enterobiasis/Oxuyuriasis Host: man Meningoencephalitis
Superfamily: Trichinelloidea infection Infective stage: Embryonated Habitat: mucosa large 1945 first reported in Taiwan
Intermediate host: fish freshwater Reservoir host: dogs egg intestine Definitve host: rats
(hypselotris bipartita - bagsit) Viviparous Oviparous Larviparous/viviparous Intermediate host: molluscan
Habitat: Small intestine No embryonation requirement Carnivourous parasite (snails,slugs)
Natural host: fish-eating birds Shortest incubation period (1- Seen by: James Paget Incidental host: human
Intermediate host: human 4hrs) Described by:
Sharpest buccal capsule Richard Owen
Retro-infection – anus to
colon
Nocturnal worm
 Adult Adult Adult Adult Adult
 Female  Largest adult nematode  Size:  Sizes:  Size:
2.3 x 5.3 mm  840 x 1.5 mm (Female), 8-13 x 0.3 – 0.5 mm 3.50 x 0.50 x 0.06 19 – 33 x 0.28 – 0.50mm
prominent blunt, rounded (F) mm (F) 16 - 22 x 0.25 – 0.35
1. Typical Female: interior end. 2 -5 x 0.1 – 0.2 1.50 x 0.04 mm (M) mm(M),
oviparous,8 – 10 eggs  21 x 0.4 mm (Male), mm(M)  Shape:
2. Atypical Female: coiled ends  Whitish/brownish Thread-like  Characteristics:
Larviparous, 40 - 45  Spindle-shaped  Small, orbicular,
eggs Larvae  Posterior: non-papillated
kidney shaped and single
Diagnostic Stage/1st stage Long, sharp mouth
lobed bursa(M)
 Male Rhabditifprm pointed (F)  Tail: curved w/ 2
1.5 x 3.9 mm - 620 x 15 um Ventrally curved (M) lobular appendages
uterine tubules (F),
Chitinized spicule, - 1/3 of the body ,  Anterior: Lateral (M)
transparent cuticle,blunt
unspined sheath tail length wings/Cephalic alae, Round bluntly (F)
shaped posterior, lay egg
Anus subterminal Third-stage Larvae posterior esophageal  Viviparous
15,000 eggs
- Reside in bulb
intermediate host
Morphology

Slender shaped
Thick and shorter tail
ends Egg
 50 – 60 um x20 -30 Larvae
um
 Spear-like
 Asymmetrical,elongat burrowing tip
ed, ovoid, Letter “D”
 80 – 120 x 5.6 um
appearance
 Has digestive tract Egg
 Shell:
but no reproductive
outer thick hyaline  46-48 x 68-74 um
 Infective Stage:
albuminous shell,  Elongated ovoidal shape
encysted larva
inner embryonic  Hyaline
(coiled)
lipoidal membrane  Unmbryonated when
 Encystation:
 Female dies after ovideposited
hatching of larva
deposition and
from egg
release itchy mucus. Larva
1st stage Rhabditiform : found in lu
of rodent, small knob near the tip o
tail

2nd stage rhabditiform: two well-

developed chitinous rods below
buccal cavity, has expanded knob
like tips
 1. Ingestion of infected raw 10. Ingestion of contaminated 1. Ingestion of 1. Ingestion of 1. Rats ingest infected larv
or uncooked fish water with infected (third contaminated food, encysted egg from and travels to the intestin
contaminated stage) copepods initiate water with egg of pork and penetrate through th
2. Larva develop into infective stage and E.vermicularis or 2. Encysted larva bloodstream migrating in
mature male and emerges into SI. inhalation released from CNS.
(viviparous) female 11. Larva matures into adults, 2. Infective stage stomach then goes 2. Undergo two molts in 2
worm in the SI. penetrate the intestinal Larvae will hatch in to SI weeks before reaching
3. Larva are produced from wall, proceeds to SI 3. Maturation occurs maturity. Early developm
the female atypical worm connective tissues/body 3. Adult worms migrate 4. Through copulation, occurs in the brain.
4. Larvae develop into cavities. to colon/cecum and Female produce 3. Young adults migrate and
mature male worm and 12. Adult worms mate, the copulate. larvae and enter the live in pulmonary arteries
(oviparous) female gravid migrates into 4. Male dies after blood and lymph complete development. A
5. Adult worm inhibits the SI subcutaneous tissue, and mating and female 5. Encysted larva then 2 weeks adult worms
mucosa and lay eggs. lay first-stage larvae. worm migrates to the migrates to produce eggs.
6. Unembryonated eggs 13. After the release, females rectum. intestinal lympathics 4. The eggs will then be
and larvae are passed may escape the body or 5. Gravid female moves (may travel to brain, transported to smaller
out in the feces migrate into deeper tissue migrate outside the CNS, myocardium, vessels of the lungs thru
7. Eggs embryonate in leaving and infected ulcer. anus and lay eggs body cavities) bloodstream
freshwater and ingested 14. Such contacts with (15,000 eggs) in the 6. Larva matures and 5. 1st stage filariform emerg
by freshwater fishes freshwater, the ulcer perianal region. forms nurse cell and penetrate respiratory
8. Upon ingestion, eggs ruptures and releases the 6. Eggs will become larva complexes in tract
hatch in the intestine of larva on water. fully matured within 6 striated muscles. 6. Passes through trachea,
the fish and develop into 15. Copepods consume the hours. 7. Circulation happens alveoli, orophranyx and
infective larva in the first-stage larvae and serve 7. If ingested, it will to different organs swallowed again and
Life Cycle

gastric mucosa. as intermediate host. pass through 8. Cycle happens expelled in the feces.
9. Cycle continues when 16. Maturation occurs in the duodenum and SI again if ingestion of 7. The molluscan intermedi
fish is ingested by human copepods. then to Cecum where encysted egg host will then ingest the
host. 17. Ingestion of contaminated it develops into adult feces of rats or actively
water begin the cycle worm penetrate the host
again. (mollusc).
8. The larva will develop int
active infection 3rd stage
filariform

(with Incidental host)

9. Ingestion of 3rd stage
infected larva undercook
or raw mollusk, ingestion
paratenic host(crabs,shri
etc), ingestion of leafy
vegetables with infective
mucus, and drinking
contaminated water, will
  Ingestion of  Copepods  Anus to mouth  Eating raw or  Ingestion of raw
contaminated raw or  Ingestion of contaminated (Autoinfection) undercooked flesh intermediate ho
uncooked fish and water with infected  Airborne  Ingestion of infective stage l
Mode of Transmission

contaminated water copepods (Retroinfection) encysted egg from  Ingestion of leaf

 Sexual intercourse undercooked meat vegetables con
 Hand to mouth with mollusk m
carrying the l3 la
 Eating of parate
such as fish, s
carrying L3 larva
 Drinking of cont
water
  Borborygmi or gurgling  Dracuncoliasis  Enterobiasis  Asymptomatic: light Incubation: 6 – 15 days
stomach  Dracunculosis  Perianal itchiness – infection (10 larvae)  Confusion
 Abdominal pain  Allergic reaction most common  Symptomatic:  Coma
 Diarrhea  Second bacterial infection symptoms moderate infection  Nausea
 Dehydration  Painful ulcer  Sleep disturbances (50-500)  Acute,severe, b
 Malaise  Nodule formation (swelling)  Bacterial infection of  Gastroenteritis headache
 Anorexia excoriated skin –  Diarrhea  Diplopia
 Ulcer most common  Abdominal pain  Intraocular hem
implication  Trichinellosis (100-  Eosinophilia M
 Appendicitis 300)
 Endometriosis  Severe Infection
 Peritonitis (1,000 – 3,000
 Vaginitis larvae)
Pathogenesis

 Difficulty sleeping
 Irritation  Myocarditis,
Encephalitis,
3 stages: Meningitis –
1. Site of attachment – common clinical
minute ulceration and diseases of
abscess Trichinella
2. Egg-laying – intense
itching cause scar  Diarrhea
3. May go beyond perianal  Vomiting
– vagina(vulvoganitis) &  Abdominal cramps
fallopian tube(salpingitis)  Malaise
 Nausea
 Eosinophilia
 Pericardial pain
 Severe myalgia
  DFS  Observe infected ulcers  Graham Scotch  Muscle biopsy  Difficult to diagn
 Acid ether or formaline  Rupture of infected ulcers Adhesive Tape Microscopic exam is located in the
Laboratory Diagnosis
ether concentrated in cool water Technique or PCR  Examination of
technique  Anal Swab Method  Skin test = Meningitis
 Duodenal aspiration  Scotch-tape Method  Biochemical Test  Computed tomo
 ELISA  Serologic Test scan
 Animal inoculation  Magnetic resona
(MRI)
Muscle enzyme: Creatinine  ELISA (dot-blot
Phosphokinase & Lactic  PCR
Dehydrogenase
 Mebendazole  Total worm removal –  Mebendazole  Prednisone  Mebendazole
 Albendazole hihilain yung worm wind  Pyrantel pamoate  Mebendazole  Albendazole
the use of stick and use  Albendazole  Albendazole  Antihelminthic
Treatment

antibiotics when done  Corticosteroids  Surgery

 Analgesics &  Analgesics
antipyretics  Lumbar punctu
 Prednisone
 Steroids
 Prevent eating uncooked  Filter water using mesh  Cut fingernails short  Do not eat  Proper eating ha
and raw fish filter  Handwashing undercooked or raw food preparation
Prevention & Control

 Improve sanitation  Drinking in a properly  Proper Hygiene meat  Do not eat raw m
 Health education treated water  Change bedsheets  Do not feed garbage unwashed vege
 Boiling of water  Drug administration to hogs  Handwashing
 Prohibit drinking in the among children  Do not deep  Use of molluscic
freshwater, ponds etc. freezing copper barriers
 Educate hygiene  Extermination of contamination o
farm rats  Education in pre
control
  Philippines (1962)  Africa  Children are more Countries where people eat  Taiwan
 Thailand  India affect than adult pork  China
 Japan  Asia  Women are more  Thailand
 Korea  Pakistan infected then men  Japan
Epidemiology

 Egypt  Middle east  10 % rural, 75%  Australia

 Iran  Freshwater (step wells) urban  Philippines
 Colombia   E. vermicularis  India
maybe responsible
 
for transmission of
Dientamoeba
fragilis