Nematodes - roundworms Unfertilized Corticated

- phylum: nematoda

Roundworms:
- non segmented, elongated, cylindrical
- complete with digestive system (Mouth to Anus)
- separate sexes
- size: Female > Male
- Male: curve posterior end

Ascaris lubricoides

CN: Giant Intestinal Roundworm (Largest of has albumin

Nematodes)
Habitat: Small Intestine; Cycle: goes to Lungs
(larvae) Unfertilized Decorticated
FH: Man - 1 layer
IS: Embryonated egg (occurs in the soil) - STP (Soil - no albumin
Transmitted Parasite)
DS: Egg
MOT: Ingestion of Embryonated ova

Fertilized Corticated

Features:
- Triangular buckle cavity
- covered by cuticle
- cavity inside: pseudocoele - fine granulation
- triradiate lips
Fertilized Decorticated
- no structures - outer
- fine granulation - inside
Egg Morphology

Unfertilized vs Fertilized

- coarse - fine granulation

 Adult Morphology
Embryonated Ova - fleshy part - posterior
- threadlike part - anterior
- Size: Female > Male

Egg Morphology
- barrel shaped/football shaped
- with protruding ends
- attachment: pin fashion manner ( anterior end)

Pathology of Ascaris lubricoides

- asymptomatic Pathology
- intestinal obstruction - Asymptomatic
- Loeffler’s Syndrome: travels into the lungs - Blood in stool
- Pneumonitis: travels inside the lungs - diarrhea
- Rectal prolapse
Treatment:
- Albendazole, Mebendazole (used on almost all Diagnosis
soil transmitted parasite) - DFS
- K2Katz
Diagnosis: - FECT
- DFS
- Kato Katz Treatment
- FECT - Mebendazole
- Surgery for removal

Enterobius vermicularis
Trichuris trichina
- not Soil transmitted parasite
CN: Whipworm - D shaped
H: Large Intestine - flattened on 1 side
FH: Man - causes perianal pruritus
IS: Embryonated Egg
DS: Egg CN: Pinworm, Seatworm, Worm of Society (can
MOT: Ingestion of Embryonated Egg infect)
Habitat: Large Intestine
FH: Man
IS: Embryonated Egg
DS: Egg
MOT: Ingestion , Inhalation, Autoinfection,
Retroinfection
 Necator americanus:
- pair of cutting plates

Pathology
- volvuvaginatis
- Insomnia
- secondary bacterial infections
- nocturnal pruritus ani

Diagnosis

- perianal swab/Scotch tape swab

- before waking up in the morning
- Ancylostoma Necator americanus
duodenale
Hookworms:
P: Copulatory Spicules P: Bursa
MOT: Skin Penetration
D: fingerlike structures D: tree like structures
IS: Fliariform / L3 Larvae
DS: Egg
H: Small Intestine

Adult Morphology:

- dental patterns Egg Hookworm

- 2 pairs of true ventral teeth - 8 - 16 segmentation
- Ancylostoma duodenale
Larval Morphology (L1) Rhabditiform Ancylostoma caninum
- short & stout -3 pairs (dogs)
- open mouth
- always eaten
- mataba

Pathology
- Cutaneous Stage: Ground Itch
- Pulmonary Stage: Pneumonitis
- Intestinal : Blood loss; Iron Deficiency Anemia

Pathology (Animal Hookworm)

- Cutaneous Larval Migrans;
- Eosinophilic Enteritis

Tuksucuria anis: dog

Ascaris suum: pig
L3 (Filariform)
- thin smear Diagnosis:
- mapayat - Harada Mori (Culture)
- same as enterebius

Treatment:
- Albendazole
- Mebendazole

Strongyloides sterocoralis

- Thread Worm
- Habitat: Small Intestine
- Infective Stage: Filariform Larva
- MOT: Larval Penetration

skin penetration of the larvae

Filariform larvae - infective stage

Strongyloides stercoralis & ancylostoma duodenalis

is the same

62 MEDICAL PARASITOLOGY
Genital
primordium
(GP)
A.
B.
50 µ
Figure 62-19 Hookworm and Strongyloides stercoralis larvae. A, S. stercoralis
rhabditoid larva in human stools. Note the short size of the buccal cavity and the
large genital primordium (GP). B, Hookworm rhabditoid larva as seen in a few
instances in stools left for at least 24 hours at room temperature. The buccal cavity
is longer, and the genital primordium is smaller.
Disease presentation is variable and may depend on the strain acquired
(Genta, 1989). Early migration of filariform larvae may produce irritation,
redness, and pruritus at the site of entry, whereas later migration through
the lungs may produce Löffler syndrome (Purtilo, 1974). The presence of
Rhibditiform larvae - open mouth; feeding
intestinal symptoms is related to the intensity of the infection. The affected
individual may have symptoms of peptic ulcer, abdominal pain, and
diarrhea. A malabsorption syndrome has been reported with chronic
infection.
Genital primordial The ability of the parasite to autoinfect may result in persistence of the
infection for decades, as was recognized in allied troops who were held as
- Strongyloides > Hookworm
prisoners of war in southeast Asia during World War II (Gill, 1979). In
otherwise healthy patients, autoinfection may produce larva currens (linear
urticarial lesions). In immunocompromised, alcoholic, or malnourished
patients, autoinfection may result in a life-threatening hyperinfection
syndrome caused by rapid multiplication of the parasite (Maayen, 1987;
Genta, 1992). Severe pneumonia is often a presenting manifestation of
hyperinfection, followed by marked diarrhea, enteritis, and septicemia.
Strongyloides larva L1
Patients who have lived in endemic areas should be screened for Strongy-
loides prior to receiving immunosuppressive therapy (Strickland, 2000).
Diagnosis is made on recovery and identification of typical rhabditi-
form larvae in stool specimens, although the routine O&P examination
does not always reveal their presence (Fig. 62-18, D) (Pelletier, 1988;
Genta, 1989; Garcia, 2007). Strongyloides rhabditiform larvae must be
1222
Red arrow: anterior portion
; short buccal canal &
genital primordial
Blue arrow: rhabditoid
esophagus
Strongy larva L3
Filariform Larvae
-posterior end
-Hookworm: pointed
-
differentiated from those of hookworms and are characterized as having a
short buccal cavity and a prominent genital primordium (see Fig. 62-19).
Strongyloides filariform larvae have a notched tail and an esophagus approxi-
mately half the length of the body. Either stage of larvae is readily seen in
fresh saline wet mounts under low power. If infective filariform larvae are
detected in a recently passed specimen, the diagnosis of superinfection is
warranted (Eveland, 1975; Murray, 2007).
Examination of duodenal aspirates or string test specimens may be
helpful in suspicious cases in which routine stool examinations are non-
productive. The Baermann funnel concentration method or one of the
-Strongyloides: Forked/
coproculture techniques (see earlier under Laboratory Methods) may also
demonstrate the infection (Ash, 1987; Genta, 1989; Clinical and Labora-
notched
tory Standards Institute, 2005; Garcia, 2007). Larvae may be found in
sputum or other pulmonary specimens, especially in the hyperinfection
syndrome. Serologic tests are useful when infection is suspected but cannot
be demonstrated by other methods. EIA and other tests display good
sensitivity and specificity, although cross-reactions may appear with filaria-
sis and some other nematode infections. These tests generally do not
differentiate between past and current infection but may be useful in
monitoring therapy (Wilson, 1995).
Anisakiasis
See later under Tissue Helminths.
CESTODES
Cestodes or tapeworms are ribbon-like platyhelminths that live in the
intestinal tract of vertebrates as adults and in the tissues or body cavities
of various intermediate hosts as larvae. They attach to intestinal mucosa
by means of a scolex, or attachment organ, at the anterior end that may
display suckers, grooves (bothria), or a rostellum with hooks, depending
Pathoology
on the species. The body of the worm, or strobila, comprises an actively
- Vietnam Diarrhea
growing neck region and a series of proglottids that undergo sequential
development through immature, mature, and, finally, gravid stages at the
posterior end. Each proglottid has a complete set of male and female
- Cochin China Diarrhea
gonads and is capable of producing fertile eggs. Eggs of most cestodes
infecting humans (Diphyllobothrium being an exception) may be readily
- Honeyform appearance of intestinal mucosa
differentiated from those of other helminths by the presence in each of a
six-hooked embryo. Depending on the species, eggs are released directly
into the fecal stream or are passed in intact proglottids. It is not uncommon
(endoscopy)
in some species for long lengths of strobila to be passed intact, or for
proglottids to actively migrate out of the anus. Large species of Taenia and
- Larva Currens
Diphyllobothrium may grow to 25 feet or longer and may live for 20 years.
Cestode larval stages develop to the infective stage in invertebrate or
- LARVA: migrants
vertebrate hosts, depending on the species, and complete their life
cycle when ingested by a definitive host. Larval stages of several species
may infect humans, causing cysticercosis, hydatidosis, sparganosis, and
coenurosis. These conditions are covered more fully later under Tissue
Helminths.
Taenia saginata
Dx:
Humans are the sole definitive host for Taenia saginata, the beef tapeworm.
Although it is distributed worldwide, the worm is especially common in
- FECT: larva
the Middle East, Africa, Europe, Asia, and Latin America. It occurs rarely
and sporadically in the United States. Larval cysticerci (Cysticercus bovis)
- Baermann Technique
develop in the tissues of cattle that graze on land contaminated by human
waste. When humans ingest infected raw or incompletely cooked beef, the
- Harada Mori
cysticercus develops into a reproductive adult in the small intestine in 2–3
months. Symptoms are rare but may include abdominal discomfort and
diarrhea. Unlike T. solium, the eggs of T. saginata are not infectious to
humans, and their ingestion does not result in cysticercosis.
Diagnosis is made by finding eggs in the stool, using direct or concen-
tration techniques, or in the perianal folds, using the cellophane tape
technique. Eggs are spherical and measure 31–43 μm in diameter (Fig.
62-20, A). The shell is thick, is radially striated, and contains a six-hooked
Capillaria philippinensis
embryo. Eggs of all Taenia species are indistinguishable and should be
reported only as Taenia eggs.
Species identification may be made on recovery of proglottids or, more
rarely, the scolex. Proglottids of taeniids have a characteristic lateral pro-
- Pudoc worm (name of town where it is discovered
trusion known as the genital pore. Careful injection of India ink through
the genital pore, using a tuberculin needle and syringe, may succeed in
outlining the uterus. The gravid uterus of T. saginata has 15–20 lateral
- liocos)
branches, whereas that of T. solium has 7–13 lateral branches (Figs. 62-20,
B, and 62-21). Proglottids may also be cleared overnight in glycerol or
- FH: Man / Vertebrates
stained with carmine or hematoxylin using published procedures (Ash,
- IH: Glass Fishes (Freshwater) ; kinilaw
- IS: Larva
Male:
Spicule
Sheath;
copulatory
organ
Female:
Ova ,
layers of
egg
 Capillaria Trichuris Characteristics
philippinensis trichiura

FLATTENED PROTRUDING Bipolar Plugs Pathology:

Peanut shaped Barrel shaped SHAPE - Trichinosis

- Induce Great eosinophilia in man
Egg is same with Trichuris trichiura
Dx:

- Muscle Biopsy - existing larvae in muscle

- Beck’s Xenodiagnostic Test
- Bentonite Flocculation Test
- Bachman Intradermal Test

(Detection of Antigens )

Wuchereria bancrofti

- Bancroft’s Filarial Worm

- FH: Man
- IH: Mosquito
Pathology - Habitat: Lymphatic System
- IS: L3 Stage Larva
- Pudoc Disease
- Mystery Disease - Diagnostic Stage: Microfilaria
- Human Intestinal Capilliarisis - Aedes
- Borborygmus - persitent sound of tummy - Diagnosis : blood examination, smears
- Malabsoprtion

Dx:

- DFS, Kato Katz, Doudenal Fluid Exam

- FECT

Trichinella spiralis

- Muscle Worm, Trichina Worm

- FH: Pig, Brown/Black Rats

- Accidental Host: Man

- infective Stage: Encysted Larva

- MOT: Insufficiently cooked pork

a, c & d - hematoxylin
b - Giemsa stain

Periodicity: Nocturnal (10pm - 2pm)

Vectors:
- Aedes poecilus (common)
- Anopheles flavirostris
- Culex
Disease: filariasis / elephantiasis

Brugia malayi
- Malayan Filarial Worm
- FH: Man
- IH: Mosquito
- Habitat: Lymphatic System
- IS: L3 Stage Larva
- Diagnostic Stage: Microfilaria
- Diagnosis : blood examination, smears

Ova/Eggs are extended until the end of the tail unlike

in Wuchereria bancrofti

Vectors:
- Mansonia bonnae’
- Mansonia uniformis

Periodicity: Subperiodic

Dx:
1. Microscopy of Giemsa Stained Blood Smears
2. Knott’s Concentration Technique
3. Filtration using millipore
4. DEC Provocative Test
5. Antigen Detection test