2.13 - Nemathelminthes

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Nemathelminthes

Nematodes or roundworms are unsegmented, bilaterally symmetrical worms with


elongated, cylindrical bodies. The life cycle of these parasites consists of three stages:
embryonated egg or ova, larva, and adult worms. The body covering is called the cuticle.
These parasites have separate sexes, with the female worm being larger than the male
worm. Adult worms are equipped with a complete digestive system, a simple nervous
system, an excretory system, and a reproductive system.

Nemathelminthes
• The digestive system consists of three structures • The larvae mature into adult worms in the small intestines,
o Stomodeum: mouth, esophagus, and buccal cavity where they lay their eggs that are eliminated with the feces.
o Intestines • The eggs are capable of surviving in soil, sewage, or water for
o Anus: called proctodeum several years
• The nervous system is made up of two nerves that run along DISEASE AND SYMPTOMS
the length of the body of the worm on both the dorsal • Ascariasis
(back) and ventral (front) sides. o Asymptomatic infection is usually seen with low
• Both nerves are connected to a nerve center found at the worm burden.
head of the worm. o The patient may not be aware of the presence of
the parasite until the adult parasite is passed out
• Nematodes have a sensory organ which is usually located in
with the hers.
the anterior end of the head region of the worms.
o Symptomatic infection occurs due to migration of
• In some (e.g., the aphasmids Trichuris and Trichinella), the
the parasite through the host.
amphids are found in the posterior head region.
o During larval migration, the larvae may induce
• Some nematodes are equipped with a pair of caudal allergic reactions, manifesting as asthmatic tacks
chemoreceptors called phasmus (These are Ascaris, Necator, accompanied by eosinophilia (called Loeffler's
and the filarial worm Wuchereria) syndrome).
• Unlike the more primitive worms, nematodes are equipped o Penetration of the lung apillaries by the larvae as
with excretory canals along each side of the body for the they enter the air sacs can lead to pneumonia.
elimination of waste materials. o The presence of multiple adult worms in the
• Soil requirement: warm, moist soil intestines can lead to abdominal pain (most
ommon complaint), vomiting, fever, and
Intestinal Nematodes abdominal distention.
o Mature worms may entangle with each other
Ascaris Lumbricoides forming a mass that can cause intestinal
obstruction.
• Also known as “Giant roundworm” or “Large Intestinal o due to the erratic nature of the mature worms, the
Roundworm” adult parasite can travel to different organs of the
• Ascaris lumbricoides is the largest intestinal roundworm body
infecting humans. o An adult worm can obstruct the appendix leading
• The adult worm is creamy-white in color with an outer to appendicitis.
covering of cuticle. o Other organs that can be obstructed include the
• They appear in the Small Intestine liver and the bile ducts.
– KathleenVenus

MODE OF TRANSMISSION o Due to the tough, flexible body of the worm, it


• Ingestion of eggs from fecally contaminated soil or food may cause perforation of the intestines, leading to
peritonitis which can be fatal.
• Upon entry into the small intestines, larvae are released from
o Secondary bacterial infections may also occur in
the eggs, penetrate the intestinal wall, enter the blood to go
the damaged tissues.
initially to the liver, and finally localizes to the lung.
LABORATORY DIAGNOSIS
• In the lungs, the larvae gain entrance into the air sacs and
migrate into the bronchioles. • finding of the eggs in a stool specimen
• The larvae are then coughed up with the sputum which is • In cases of heavy worm burden, the adult worm may be
swallowed thereby returning the worm to the intestines present in the stool or be regurtitated.
• Larvae may be recovered from the sputum
TREATMENT MODE OF TRANSMISSION
• mebendazole, albendazole, and pyrantel pamoate • Ingestion of eggs from fecally contaminated soil
PREVENTION DISEASE AND SYMPTOMS
• proper disposal of human feces, health education of the • Trichuriasis
population, and improved personal hygiene. o ulcerative colitis, a chronic inflammatory
• It is also recommended to avoid using human feces as condition of the colon that has an autoimmune
fertilizer. etiology
• A program of mass chemotherapy is recommended especially o chronic dysentery (bloody, mucoid diarrhea),
for children and in areas with high incidence of parasitism. severe anemia, or growth retardation.
o Rectal prolapse and hyperperistalsis are also seen in
Enterobius Vermicularis infected children.
o Rectal prolapse occurs due to irritation and
• Also known as “Pinworm” or “Seatworm” straining during defecation.
• It can be found in the cecum of the large intestine, appendix, o Manifestations in adults resemble those of
and ascending colon inflammatory bowel disease and include
• It lay up to 15,000 eggs at night abdominal pain and tenderness, weakness, and
• The egg of E. vermicularis is typically oval and flat on one dysentery.
side. LABORATORY DIAGNOSIS
• The adult worms are small and yellowish-white in color. • Diagnosis is confirmed by demonstrating the presence of
• The common name pinworm is based on the appearance of a characteristic eggs in stool specimens.
clear, pointed tail of the adult female that resembles a TREATMENT
pinhead. • mebendazole or albendazole
• Pinworm infection occurs worldwide, especially in temperate PREVENTION
regions. • Effective preventive and control measures include health
• People at risk for pinworm infection are children, their education, proper sanitation, good personal hygiene, and
caretakers, institutionalized persons, and those in unsanitary avoidance of use of human feces as fertilizer
and crowded living conditions.
MODE OF TRANSMISSION
• Ingestion of eggs Ancylostoma Duodenale

Necator Americans
Self-contamination or autoinfection
DISEASE AND SYMPTOMS
• Enterobiasis
• The two types of Hookworms
o Most cases of enterobiasis are asymptomatic.
• Ancylostoma Duodenale is also known as “Old World
o intense itching with inflammation in the anal
Hookworm”
area (pruritus ani) or the vaginal area which occurs
• Necator Americanus is also known as “New World
most frequently at night
Hookworm”
o intestinal irritation and mild nausea
o Since the itchiness occurs at night, infected MODE OF TRANSMISSION
persons may be deprived of sleep and become • Larvae in soil penetrate skin
irritable. DISEASE AND SYMPTOMS
LABORATORY DIAGNOSIS • Hookworm Infection
• demonstration of the eggs or adult females using the Scotch o Penetration of the skin by the filariform larvae
Tape method or cellophane tape method produces a pruritic papule or vesicle. This is called
• The small size of the eggs may make recovery from stool "ground itch."
difficult. o Pneumonia with cosinophilia may occur during
TREATMENT the lung phase.
o The presence of adult worms in the intestines can
• albendazole, mebendazole, or pyrantel pamoste
manifest nausea, vomiting, and diarrhea.
PREVENTION o As the worm feeds on blood, a microcytic,
• Good personal hygiene hypochromic anemia akin to iron-deficiency
• clipping of fingernails anemia may occur.
• thorough washing of beddings and prompt treatment of o Intestinal sites may be secondarily infected by
infected persons contribute to the control and prevention of bacteria
the parasite spreading to other individuals. LABORATORY DIAGNOSIS
• To avoid ingestion and/or inhalation of the eggs, it is • Stool examination will show the characteristic thin-shelled
recommended to thoroughly clean the house using a damp eggs.
mop in areas including the floor under the beds, the
– KathleenVenus

• Occult blood in the stool and blood eosinophilia are


windowsills, and overdoors. frequent findings.
• Peripheral blood smear will show microcytic, hypochromic
Trichuris Trichiura anemia.
• Larvae may be recovered from sputum
• Also known as “Whipworm”
• It is found in the Large Intestine
TREATMENT
• mebendazole and pyrantel pamoate.
• Children are at highest risk for development of infection
when they play in contaminated soil. • Iron replacement therapy is recommended for the anemia.
• Adult worms burrow their hair-like anterior ends into the • In severe cases, blood transfusion may be necessary.
intestinal mucosa but do not cause significant anemia.
• Also known as “Whipworm” TREATMENT
• It is found in the Large Intestine • ivermectin with mebendazole and thiabendazole as
• Children are at highest risk for development of infection alternative drugs.
when they play in contaminated soil. PREVENTION
• Adult worms burrow their hair-like anterior ends into the • thorough health education of the population at risk, proper
intestinal mucosa but do not cause significant anemia. sanitation and sewage disposal, wearing of protective
PREVENTION footwear, and prompt treatment of infected individuals
• Wearing shoes or any protective footwear is also important,
especially in endemic areas
Capillaria Philippinensis
Strongyloides Stercoralis • Also known as “Pudoc Worm”
• First discovered in 1963 in Northern Luzon, Philippines
• Also known as “Threadworm” • Can be found in the Small Intestine
• Found in the Small Intestine MODE OF TRANSMISSION
• Threadworn infection occurs worldwide but is more • Ingestion of undercooked or raw infected fish
common in tropical, sub-tropical, and warm, temperate DISEASE AND SYMPTOMS
areas.
• Intestinal Capillariasis
• The parasite is frequently seen in agricultural areas where o abdominal pain with a gurgling stomach
there is constant contact with soil. (borborygmus) and chronic diarrhea.
MODE OF TRANSMISSION o The chronic diarrhea leads to weight loss which is
• Larvae in soil penetrate skin aggravated by the accompanying loss of appetite
• Autoinfection (rare) (anorexia), nausea, and vomiting.
DISEASE AND SYMPTOMS o Malabsorption of fat, carbohydrates, and proteins
• Strongyloidiasis as well as electrolyte abnormalities can be fatal.
o Also known as “Cochin China Diarrhea” LABORATORY DIAGNOSIS
o Patients with light infection are usually • demonstration of the characteristic eggs in stool specimens.
asymptomatic. In high worm burden, larvae as well as adult worms may also
o skin irritation at the site of entry is seen. be demonstrated in stool.
o Migration of the larvae into the lungs lead to TREATMENT
pneumonitis just like that of hookworm and • albendazole, with mebendazole as alternative, especially for
Ascaris infections. adult patients.
o The presence of numerous adult worms in the
• Chemotherapy is given for at least 20 days in order to totally
intestines lead to diarrhea and abdominal pain.
eradicate the parasite.
o In some patients, the parasite can stimulate
• Relapses may occur if the treatment regimen is not followed.
recurrent allergic reactions resulting to urticaria
and eosinophilia. • Patients with severe infection with electrolyte loss and
o In patients with very high worm burden, which is malabsorption must be managed with electrolyte
seen in autoinfection, malabsorption syndrome replacement and a high-protein diet
may occur due to involvement of the biliary ducts, PREVENTION
pancreas, small intestines, and colon. • adequate and thorough cooking of seafood before
o This can lead to steatorrhea (fat in the stool) and consumption, especially in endemic areas.
resulting nutrient deficiencies, epigastric pain and • Other measures include proper human waste disposal, health
tenderness, and increasing diarrhea. education, and prompt treatment of infected persons
o These symptoms constitute a hyper-infection
syndrome. Blood and Tissue Nematodes
o In some instances, disease presentation is mistaken
for peptic ulcer disease.
o Autoinfection can also lead to development of Wuchereria Bancrofti
chronic infection, increasing the risk of
developing hyper-infection syndrome, which can Brugia Malayi
prove fatal in patients who are
immunocompromised (commonly in patients • Wuchereria Bancrofti is also known as “Bancroft’s Filarial
under corticosteroid therapy or other Worm”
immunosuppressive therapies). • Brugia Malayi is also known as “Malayan Filial Worm”
o Aside from the potentially fatal electrolyte • They are both mosquito-borne parasites
abnormalities, fatal complications of the hyper- MODE OF TRANSMISSION
infection syndrome include bacterial sepsis, • Bite of mosquitoes transit larvae
– KathleenVenus

peritonitis, and endocarditis. DISEASE AND SYMPTOMS


LABORATORY DIAGNOSIS • Filariasis
• Eggs may be recovered from stool of patients with heavy o Also called Elephantiasis
worm burden who have severe diarrhea. o It has different stages – Asymptomatic, acute, and
• recovery of the rhabditiform larva in fresh stool samples. chronic
• Examination of duodenal aspirates may also yield the larvae. • Asymptomatic Stage
• Larvae may also be recovered from sputum. o is characterized by the presence of thousands of
• Striking eosinophilia may occur in a massive infection. microfilariae in the peripheral blood. Adult worms
• Serologic tests such as ELISA may be found in the lymphatic system without
clinical manifestations of filariasis.
acute inflammatory episodes.
• Acute Stage of Infection DISEASE AND SYMPTOMS
o involvement of the lymphatics of the breast may • Trichinosis, Trichinellosis
be seen. o Enteric Phase: The enteric or intestinal phase may
o Recurrent attacks are characterized by manifest with diarrhea, abdominal pain, and
epididymitis (inflammation of the epididymis), vomiting
orchitis (inflammation of the testes), retrograde o Invasion Phase: Symptoms may include periorbital
lymphangitis, and localized inflammation of the and facial edema, conjunctivitis, fever, muscle
arms and legs. pain myalgia), splinter hemorrhages, rashes, and
o The acute stage is also called adenolymphangitis. peripheral eosinophilia. Involvement of the heart
o Transient swellings of subcutaneous tissues may an lead to life-threatening myocarditis.
also occur called Calabar swellings o Convalescent Phase: the manifestations start to
• Chronic Filariasis decline. The disease is self-limiting, hence full
o develops slowly after several years of infection. recovery is expected. Rare causes of death are
chronic edema and repeated acute inflammatory congestive heart failure and respiratory paralysis.
episodes. LABORATORY DIAGNOSIS
o The edema and fibrosis gradually lead to • encysted larvae in muscle biopsy specimen.
lymphatic obstruction of the legs and genitalia • Blood examination results include eosinophilia, leukocytosis,
(especially the scrotum). and elevated serum muscle enzyme levels (lactate
o The enlarged extremity hardens with loss of skin dehydrogenase, aldolase, creatine phosphokinase).
elasticity producing elephantiasis. • Serologic tests are available.
o Obstruction of the lymphatics of the tunica TREATMENT
vaginalis of the testes lead to accumulation of • The disease is self-limiting and therefore does not require
edema fluid in the scrotum (called hydrocele). medication.
o Hydrocele, chronic epididymitis, and • bed rest as well as the giving of analgesics and anti-pyretics to
lymphedematous thickening of the scrotal skin relieve muscle pain and fever.
are commonly seen in bancroft's filariasis.
• Corticosteroids may be given for severe infections.
o Deformities resulting from Malayan filariasis are
• Thiabendazole may be given during the early stages of the
not as severe and include enlargement of the
disease, especially during the first week, to kill the adult
epitrochear, inguinal, and axillary lymph nodes.
worms.
o In more advanced cases of Malayan filariasis,
elephantiasis of one or more limbs, usually • The drug has no effect on the migrating larvae.
involving the area below the knee may occur PREVENTION
however the scrotum is rarely involved. • Health education is important in preventing infection.
LABORATORY DIAGNOSIS • thoroughly and adequately cook meat before consumption.
• Examination of Giemsa-stained peripheral blood smear • Freezing meat may also kill the encysted larvae.
• blood specimen (approx. 1 mL.) may be immersed in 10 mL • Avoidance of feeding pork scraps to hogs may help break the
of a 29% formalin solution to lyse the red blood cells. life cycle of the parasite.
• Antigen detection methods and serologic tests • strict meat inspection and keeping pigs and other farm
animals in rat-free pens
TREATMENT
• diethylcarbamazine (DEC) and ivermectin in combination
with albendazole.
• Both DEC and ivermectin are effective in killing the
microfilariae, however, higher doses are necessary to kill the
adult worms.
• Microsurgery may be necessary to remove the obstructing
parasite from the lymphatics.
• anti-inflammatory drugs to reduce the inflammation.
• The use of elastic bandages or elevation of the involved limbs
may help reduce the size of the involved limb.
PREVENTION
• mass treatment in endemic areas
• mosquito nets and repellents, the use of insecticides to
control the mosquito vectors, wearing of protective clothing,
and thorough health education of the population.

Trichinella Spiralis
– KathleenVenus

• Also known as “Muscle Worm”


• Infection with T. spiralis is seen worldwide, especially in parts
of Europe and the United States where meat can be eaten raw
MODE OF TRANSMISSION
• Ingestion of animal meat infected with pathogenic cysts
(undercooked)

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