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Medical Parasitology-1
Helminthology (worms)
Dr. Munirah Albaqshi
Lecture 1
• Parasitology is the study of parasites, their hosts and
the relationship between them.
• A parasite is an organism depends physiologically

upon another organism.
• Host is the organism in or on which the parasite lives

and may causes harm.
• Symbiosis is the relationship between two living

organisms.
3 types of symbiosis
• Commensalism: one benefits and other not harmed or helped.
• Mutualism: beneficial to host and parasite.
• Parasitism*: is harmed and other benefits
• Pathogenic parasites: live in host and cause harm or disease.

• Medical parasitology: Study of parasites that infect humans.
• Helminths: worms
• Medical helminthology: Study of worms that infect humans.

Why do we study Parasitology?
Medical importance
• Life expectancy of Egyptian is short due to
Schistosomes (bilharzia).
• Millions of children die every year from malnutrition

due to parasites.
• Over 1 million African children die every year from

malaria (caused by parasite).
Global distribution of Malaria
Importation of parasites to the world
• Movements of people have spread parasitic diseases.
• Vacations in tropics spread malaria.
• Employment and immigration spread parasitic

infections.
Transmission
• Direct from man, animal, insect or vector.
• Indirect from air, soil, food and water.
• Epidemiology: major occurrence of the parasitic

infection or disease.
• Parasites are global but major in tropics and poor
sanitation and personal hygiene.
• Prevention: how to avoid parasitic infection.

Factors which enhance spread of
parasites:
• Climate: rain, forest and heat (tropical weather).
• Lack of hygiene
• Feeding habits
• Religious habits
• Poverty
Pathology caused by parasites:
• physiological damage
• mechanical damage
• immunological damage
The source of infection:
• Patient: people who have parasites in their body and show clinical
symptoms.
• Carrier: people who have parasites in their body but not show clinical
symptoms.
• Reservoir host: animals that harbor the same species of parasites as

humans and can transmit it to humans.
• Infection: when parasite infect humans and might cause
disease.
• Disease: illness or sickness characterised by specific signs

or symptoms
• Infective stage: Stage of parasite that causes the infection.
• Diagnostic stage: Stage of parasite that can be seen in the

diagnosed sample.
• Parasitemia: Presence of parasite in blood of human.

• Habitat: The location of parasite in the host body.
• An endoparasite: a parasite lives inside host or human body–

e.g. Ascaris.
• An ectoparasite: a parasite that lives on the external surface

of a host or human body– e.g. lice, ticks.
• Life cycle: The whole process of parasite growing and

developing.
• Direct or simple life cycle: Only one host (no intermediate

host).
• Indirect life cycle: with more than one host (intermediate host
and definitive host).
Direct life cycle - Hookworm
Indirect Life Cycle – Tape worms
Definition of host
• Definitive host: the organism in which the adult or sexually

mature stage of the parasite lives.
• Intermediate host: the organism in which the parasite lives

during a period of its development only.
• Vector: Insect or Arthropod which transfer the parasite to

human or animal.
Taxonomic classification of
helminths (worms)
Sub Phylum Class Genus –
Kingdom kingdom examples
Metazoa Nemahelminths Ascaris (roundworm)
Animalia Round worms; appear
Trichuris (whipworm)
Ancylostoma (hookworm)
round in cross section,
they have body cavities, a
Nematoda Necator (hookworm)
straight alimentary canal Enterobius (pinworm or
and an anus threadworm)
Strongyloides
Platyhelmints Cestoda Taenia (tapeworm)

Flat worms; dorsoventrally Adult tapeworms are found in
flattened, no body cavity the intestine of their host
and, if present, the They have a head (scolex) with
alimentary canal is blind sucking organs, a segmented
ending body but no alimentary canal
Each body segment is
hermaphrodite
Trematoda Fasciolopsis (liver fluke)

Schistosoma (not leaf
Non-segmented, usually leaf- shaped!)
shaped, with two suckers but
no distinct head
They have an alimentary canal
and are usually hermaphrodite
and leaf shaped
Schistosomes are the
exception. They are thread-
like, and have separate sexes
3 classes of worms
• The helminths/worms of medical importance belong to 3 Classes:
• Nematoda
• Trematoda
• Cestoda
Phylum
Nemahelminthes
(Nematoda)
Characteristics of Nematoda
1. Body is non-segmented and cylindrical in shape.
2. Variable size: 5 mm to 1 meter
3. Two sexes are separated:
Female (♀) is larger with a straight tail and Male (♂) is smaller
with a curled tail
4. They have a complete digestive tract.
5. The body cavity is a round.
6. Life cycle includes egg, larva and adult worm.

Egg
Ovum
L1
Life cycle
L4 L2
L3
Nomenclature
• The parasite’s names are written as follows:
genus name then species name
In italic
eg. Ascaris lumbricoides
A.lumbricoides
Underlined
eg. Ascaris lumbricoides
A. lumbricoides
Nematodes
• Intestinal Nematodes:
-with tissue stage
A.lumbercoides
Hookworms
Strongyloides stercoralis
-without tissue stage
Entrobius vermicularis
Trichuris trichiura
• Systemic Nematodes
-tissue and blood dwelling

e.g. Filarial worms
Ascaris Lumbricoides
• round worm of man.

• largest of the intestinal nematodes parasitizing humans.
• most common worm found in human.
• worldwide in distribution and most prevalent through out the tropics, sub-
tropics.
• more prevalent in the countryside than in the city
Morphology
• Adult: The adults are cylindrical in shape, creamy-white or pinkish
in color. The female averages 20-40 cm in length, the largest 49cm.
The male is smaller, averaging 15-20 cm in length and distinctly
more slenderical than the female.
The lips of Ascaris lumbricoides
The three lips are seen at the anterior end. copulatory spines of male
Eggs: are usually described in terms of size, color,
shape, shell and content.
1- Fertilized egg:
• An average size 60×75µm.
• Broad oval in shape.
• Brown in color.
• The shell is thick and consists of albuminous coat.
• The content is a fertilized ovum.

Eggs are normally at
unicellular stage
• There is a crescent clear space at each end inside
when passed in the
the shell. stool.
Fertilized Ascaris Egg
The ova begin fission

2- Unfertilized egg
• Longer and slender than a fertilized egg.
• The layer of albuminous coat is thinner than

fertilized eggs
• The content is made of many retractable granules

various in sizes.
Unfertilized and Fertilized Eggs
The albuminous coat gives the corticated appearance of

the egg.
3. Decorticated (bold) eggs Both fertilized and unfertilized eggs sometimes
may lack their outer albuminous coats and are colorless.
The eggs may appear from light Fertilized egg of A. lumbricoides

to dark brown in color.
Embryonated Eggs of Ascaris
• Eggs containing larvae are

the infective stage if
swallowed.
Points from Life Cycle
• Habitat: small intestine.
• Infective stage: embryonated eggs.
• Transmission: by mouth.
• Direct life cycle only one host (human).
• Life span of the adult worm: about 1 year.
• feeding on the intestinal contents, where the fertilized female lays eggs.
• An adult female can produce approximately 240,000 eggs per day, which are
passed in feces.
• When passed, the eggs are unsegmented and require outside development of 2
weeks until a motile embryo is formed within the egg.
Symptoms or pathogenesis
Two phases in ascariasis:
1. The blood-lung migration phase of larvae
• Pneumonia: low fever, cough, bloody sputum asthma.
• Large numbers of worms leads to allergic symptoms.
• Eosinophilia (Loeffler’s syndrome).
2. The intestinal phase of the adults

• Few adults abdominal pain & colic.
• A heavy worm burden malnutrition
Most common complication
A large mass of Ascaris
Intestinal obstruction biliary ascariasis

Diagnosis
(1) Direct fecal film: stool sample
• simple and effective.
• method is the first choice.
The eggs are easily found due to a large number of the
female oviposition. approximately 240,000 eggs per worm
per day.
(2) Ascaris pneumonitis: Examination of sputum for

Ascaris larvae is sometimes successful.
(3) Recovery of adult worms:

found in feces or vomit and tissues and organs from the
human infected with ascaris.
Epidemiology
Worldwide distribution, especially in the countryside.
Factors favoring the spread of the transmission:
1. Simple life cycle.
2. Enormous egg production ( 240,000 eggs/ day/ female ).
3. Highly resistant eggs ( remain viable for several years).
Treatment: Mebendazole
Albendazole
Prevention:
• Sanitary disposal of feces.
• Cleaning of hands before meals.
• Health education.

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Medical Parasitology-1

• A parasite is an organism depends physiologically

• Host is the organism in or on which the parasite lives

• Symbiosis is the relationship between two living

• Commensalism: one benefits and other not harmed or helped.

• Mutualism: beneficial to host and parasite.

• Parasitism*: is harmed and other benefits

• Pathogenic parasites: live in host and cause harm or disease.

• Medical helminthology: Study of worms that infect humans.

• Millions of children die every year from malnutrition

• Over 1 million African children die every year from

• Movements of people have spread parasitic diseases.

• Vacations in tropics spread malaria.

• Employment and immigration spread parasitic

• Epidemiology: major occurrence of the parasitic

• Prevention: how to avoid parasitic infection.

• Climate: rain, forest and heat (tropical weather).

• Reservoir host: animals that harbor the same species of parasites as

• Disease: illness or sickness characterised by specific signs

• Infective stage: Stage of parasite that causes the infection.

• Diagnostic stage: Stage of parasite that can be seen in the

• Parasitemia: Presence of parasite in blood of human.

• An endoparasite: a parasite lives inside host or human body–

• An ectoparasite: a parasite that lives on the external surface

• Life cycle: The whole process of parasite growing and

• Direct or simple life cycle: Only one host (no intermediate

• Definitive host: the organism in which the adult or sexually

• Intermediate host: the organism in which the parasite lives

• Vector: Insect or Arthropod which transfer the parasite to

Platyhelmints Cestoda Taenia (tapeworm)

Trematoda Fasciolopsis (liver fluke)

1. Body is non-segmented and cylindrical in shape.

2. Variable size: 5 mm to 1 meter

3. Two sexes are separated:

4. They have a complete digestive tract.

5. The body cavity is a round.

6. Life cycle includes egg, larva and adult worm.

-tissue and blood dwelling

• round worm of man.

• Broad oval in shape.

• The shell is thick and consists of albuminous coat.

• The content is a fertilized ovum.

The ova begin fission

• The layer of albuminous coat is thinner than

• The content is made of many retractable granules

The albuminous coat gives the corticated appearance of

The eggs may appear from light Fertilized egg of A. lumbricoides

• Eggs containing larvae are

2. The intestinal phase of the adults

A large mass of Ascaris

Intestinal obstruction biliary ascariasis

(2) Ascaris pneumonitis: Examination of sputum for

(3) Recovery of adult worms:

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