MT 639 (Clinical Parasitology)

Nematodes Specimen with

Labels
Joanah J. Fangonilo
Carl Anthony T. David
2NMT
 Ascaris lumbricoides
Common Name Giant/Large intestinal roundworm
Habitat Small intestine

Mode of Transmission Ingestion, oro-fecal route

Specimen for Stool
Diagnosis
DFS, Kato Katz
Adult worms from small intestine,
Laboratory Diagnosis
gallbladder, liver , appendix
ELISA test
Ascariasis
Due to larval migration: Petechial
hemorrhages, granulomatous
Pathology
formations
Due to adult worms: secondary
bacterial infection
Treatment Albendazole, mebendazole

Infective stage Embryonated egg

Diagnostic stage Unembryonated egg

 Mamillary coat
(protein/albuminoid
Mamillary coat
(protein/albuminoid coat
coat
Glycogen layer
Ascaris lumbricoides - egg
A fertilized corticated Ascaris egg, still at
the unicellular stage, as they are passed
in stool. All membranes are present. The
Innermost lipoidal outher *mammillary coat, the middle
vitelline membrane glycogen and the innermost vitelline
layer.

*Lacking in decorticated ova

Innermost
lipoidal
Glycogen layer vitelline
membrane

Ascaris lumbricoides – Fertilized, corticated egg

 *absence of inner lipoidal
vitelline membrane

Albuminoid
coat
Ascaris lumbricoides – egg
The chitinous layer and
albuminous coat are thinner than
those of the fertilized eggs
Glycogen
without ascaroside and fertilizing
layer membrane. The content is made
of many refractile granules
various in size.
Mass of lecithin
granules

Ascaris lumbricoides – Unfertilized, corticated egg

 Ascaris lumbricoides – egg
Unfertilized Corticated
• Oval-shape
• Structures inside: coarse
lecithin/refractile granules
• Glycogen layer surrounds the
granules
• Mamillary/albuminous coat
(corticated)

Unfertilized decorticated
• No mamillary coat

Ascaris lumbricoides – Unfertilized, corticated egg

 Ascaris lumbricoides male (cross
section)

Common name: Giant intestinal

roundworm

Habitat: small intestine

Infective stage: embryonated egg

MOT: ingestion

Ascaris lumbricoides male x.s.

 Cuticle and
hypodermis

Testis Longitudinal
muscle layer

Vas deferens

Pseudocoelom
Intestine
– white area

Seminal
vesicle

Lateral line with

excretory canal

Ascaris lumbricoides male x.s.

Ascaris lumbricoides male adult
 Ascaris lumbricoides female
(cross section)

Common name: Giant intestinal

roundworm

Habitat: small intestine

Infective stage: embryonated egg

MOT: ingestion

Ascaris lumbricoides female x.s.

 Cuticle and
hypodermis
Intestine

Longitudinal
Oviduct muscle layer

Ovaries

Pseudocoelom
– white area

Uterus
with eggs

Ascaris lumbricoides female x.s.

Ascaris lumbricoides female adult
Ascaris lumbricoides female (left) and male (right) x.s
Ascaris lumbricoides – trilobate/triradiate lips
 Trichuris trichiura
Common Name Whipworm
Habitat Large intestine/colon/cecum

Mode of Transmission Ingestion of embryonated egg

Specimen for
Stool
Diagnosis
DFS, Kato Katz
Zinc Sulfate Flotation Method
Laboratory Diagnosis
Adult worms visible on
macroscopic exam
Trichuriasis
Pathology
Increased rectal prolapses
Treatment Albendazole, mebendazole

Infective stage Embryonated egg

Diagnostic stage Unembryonated egg

Ova: Japanese lantern, Barrel-
Shape shaped, Football-shaped, Lemon-
shaped
 Bipolar mucus Trichuris trichiura egg
plugs (mucoid
bipolar plugs) Common name: Human whipworm

Habitat: large intestine

nonstriated
Infective stage: embryonated egg

Shape: Japanese lantern

Barrel-shaped
Football-shaped
Lemon-shaped

Trichuris trichiura egg

 Protuberant plugs (compared to
Capillaria philippinensis)

Bipolar mucus
nonstriated plugs (mucoid
bipolar plugs)

Trichuris trichiura egg

 Note: The adult worm looks like a “whip”

Coiled
posterior end
Thin anterior that
penetrates
intestinal mucosa

Trichuris trichiura male (human whipworm)

 Straight posterior
end

Thin anterior

Trichuris trichiura female (human whipworm)

 Enterobius vermicularis
Oxyuria vermicularis
Pinworm, seatworm, worm of
Common Name
civilization, society worm
Habitat Large intestine
Ingestion of embryonated egg,
Mode of Transmission airborne, retroinfection,
autoinfection
Specimen for Perianal swab (cellulose tape
Diagnosis swab)
Cellophane tape prep
Laboratory Diagnosis
Nail clippings
Enterobiasis/Oxyuriasis
Pathology
Pruritus Ani (Intense Itching)
Albendazole, mebendazole,
Treatment
pyrantel pamoate
Infective stage Embryonated egg

Diagnostic stage Unembryonated egg

 Curved
side

Enterobius vermicularis egg

“D” shaped egg (flat on one side and

curved on the other side)
Flat side
Infective stage: embryonated egg

Readily infective 4-6 hours after

deposition

Enterobius vermicularis egg

 Enterobius vermicularis egg

Morphology: The egg of E. vermicularis

is approximately 25 x 60 um in size. It
has a thin shell and one of the sides is
flattened. Egg are collected by
swabbing the perianal area during the
early morning with an adhesive tape
and then examining the tape with a
microscope.

Enterobius vermicularis egg

 Cephalic alae

Enterobius vermicularis female adult

E. vermicularis have a long, pointed tail

(arrow) leading to the common name
of pinworm. They are about 8-13 mm
in length.

Enterobius vermicularis - female adult (showing anterior part)

 Enterobius vermicularis egg

Common name:
Seatworm/pinworm/society worm

Habitat: large intestine

Flask-shaped Mass of “D”

esophagus shaped ova

Straight
posterior end
(not seen)

Enterobius vermicularis - female adult

 Cephalic alae

Esophagus –
flask shaped

Enterobius vermicularis male adult

w/ spicule Morphology: Note the esophageal

bulb, characteristic of the species, in
the anterior end (black arrow) and the
Curved posterior
curled posterior tail with a spicule,
Enterobius vermicularis male adult characteristic of t he male (red arrow).

The adult male is about 2-5 mm in

length and has a curved, relatively
blunt posterior end (arrow).

Enterobius vermicularis male adult

 Straight
posterior end

Enterobius vermicularis - female adult

 Capillaria philippinensis
Common Name Pudoc worm
Habitat Small intestine
Mode of Ingestion of undercooked fish containing
Transmission larva
Specimen for
Stool
Diagnosis
Fecal sample
Laboratory Diagnosis
Acid-Ether or FECT
Pudoc disease
Borborygmi or gurgling stomach
Histologically, the intestines show
Pathology flattened & denuded villi & dilated
mucosal glands
Malabsorption of fats & sugar, protein-
losing enteropathy
Albendazole, mebendazole, high protein
Treatment
diet and electrolyte replacement
Infective stage Infective larva

Diagnostic stage Unembryonated egg

Final host Man

Intermediate host Glass fish, Ipon fish, Batoc fish, Bagsit fish

Shape Ova: Peanut/guitar shaped

 “Peanut/guitar shaped”
Smaller than Trichuris trichuria ova

Flattened No mucus
mucus plug plugs

Striated
shell

Capillaria philippinensis - Typical egg

 Common name: Pudoc worm

Habitat: small intestine

Infective stage: Larva

Hair-like, delicate tiny worm

Capillaria philippinensis
 Characterized with chitinized spicule &
long spicule sheath extending beyond
the length of the worm

Capillaria philippinensis male

 Eggs Female Adults exhibiting eggs in utero:
Typical: 8 to 10 eggs in single row
Atypical: 40 to 45 eggs in 2-3 rows

Capillaria philippinensis female

 Hookworm
Necator americanus: American Hookworm,
American Murderer, New World Hookworm
Common Name Ancylostoma duodenale: Old world hookworm
Ancylostoma caninum: Dog hookworm
Ancylostoma braziliense: Cat hookworm
Habitat Small intestine
Skin penetration;
Mode of Transmission Ancylostoma: can be through oral (eating
vegetables with larvae)
Specimen for Diagnosis Stool
Ancylostomiasis, necatoriasis
Ground itch (intense allergic itching at
Pathology
penetration site), Cutaneous Larva Migrans
Pernicious and Microcytic Hypochromic anemia
Iron replacement effective in asymptomatic
Treatment
patients, mebendazole, pyrantel pamoate
Infective stage Filariform (L3) larvae

Diagnostic stage Unembryonated egg

Final host Man

Necator americanus: semi-lunar cutting plate
Ancylostoma duodenale: 2 pairs of teeth
Dentition
Ancylostoma caninum: 3 pairs of teeth
Ancylostoma braziliense: 2 pairs of teeth
 Very thin shell

Developing blastomeres (1-

2-4-8) cell stage

Hookworm egg
Hookworm egg
 Long buccal capsule

Small genital
primordium

Hookworm rhabditiform larva (L1) - feeding open mouth stage

 Pointed posterior

sheathed

Hookworm filariform larva (L3) infective stage

 2 pairs of ventral teeth

Common name: Cat hookworm

Ancylostoma braziliense adult (Dental Pattern)

 3 pairs of ventral teeth

Buccal cavity

Ancylostoma caninum adult

 Strongyloides stercoralis
Common Name Threadworm
Habitat Small intestine

Mode of Transmission Larval penetration

Specimen for Diagnosis Fresh stool sample

Zinc sulfate concentration, n fresh stool
Laboratory diagnosis samples and duodenal aspirates,
enterotest, serologic tests
Cochin China Diarrheia
Strongyloidiasis
Pathology
Urticaria (hives) with eosinophilia: allergic
reaction at the site of penetration
Treatment Albendazole, ivermectin

Infective stage Filariform (L3) larvae

Diagnostic stage Rhabditiform (L1) larvae

• Facultative parasite
• Parthenogenetic (parasite female)
Distinct characteristics • Smallest of the nematodes
• Three ways of life cycle: direct,
indirect, autoinfection
 unsheathed

Notched of
forked tail

Strongyloides stercoralis – filariform larva (L3)

 Notched of
forked tail

unsheathed

Strongyloides stercoralis – filariform larva (L3)

 Short buccal capsule

Prominent genital
primordium

Strongyloides stercoralis – rhabditiform larva (L1)

 Trichinella spiralis
Trichina worm, muscle worm,
Common Name
garbage/trash worm
Small intestine, striated muscle
Habitat Larval stage: ocular area of the eye,
tongue, deltoid, pectorals, heart
Ingestion of undercooked or raw pork
Mode of Transmission
(other meat) infected with larva
Specimen for Diagnosis Muscle biopsy
Clinical symptoms & patient history
Muscle biopsy
Laboratory Diagnosis Serum muscle enzymes (LDH,
Aldolase, CPK)
No tests: 100% accurate
Pathology Trichinellosis (PH); Trichinosis (US)

Treatment Prednisone (severe)

Infective stage Encysted larvae

Diagnostic stage Encysted larvae

Final host Pig, deer, bear, walrus, rat

Accidental host Man

 Encysted larva in Common name: Muscle worm;
striated muscle Trichina worm

Trichinella spiralis
Trichinella spiralis