PARASITIC WORMS (HELMINTHS)

Has 2 Phyla: III. INTESTINAL NEMATODE: ANCLYLOSTOMA

1) Platyhelminthes (Flatworms) DUODENALE
-Lack true body cavity Pathogenesis, diagnosis and treatment are all the
-Flat in dorsoventral section same in all hookworms.
2 types: 1. Ancylostoma ceylanicum
a. Cestode - tapeworms - a hookworm both of humans and of other mammals such
b. Trematode - flukes as dogs, cats and golden hamsters
2) Nemathelminthes/Nematodes
-worm like 2. Ancylostoma braziliense
-separated-sexed - cat hookworm
-unsegmented roundworms
*Adult stage of a parasitic helminth; found in definitive host 3. Ancylostoma caninum
*Each larval stage of a parasitic helminth; requires - species of nematode known as a hookworm
intermediate host - infects small intestine of dogs
METAZOA
A. Intestinal Nematode or True Roundworms IV. INTESTINAL NEMATODE: ANCLYLOSTOMA
-elongated, cylindrical, filiform with a definite antero- DUODENALE
posterior axis Pathogenesis, Pathology and Symptomatology:
-segmented with fundamental bilateral symmetry and tri- -From fecally contaminated soil containing the larvae that
radiate symmetry in the anterior (mouth and esophagus) can grow into adult free living worm producing many larvae
-free living/parasitic -> penetrating the skin -> infecting the human
-ingestion of eggs; 1. Filariform larva
•Trichuris trichiuria -when it penetrates the skin; produces patechial
•Enterobius vermicularis hemorrhages, congestion and edema, violent pruritus at the
•Ascaris lumbricoides site of skin penetration
-larvae penetration; -in the lungs; delay in larval migration due to host response
•Necator -they mature in the lung parenchyma and invade the
•Strongyloides stercoralis bronchial epithelium causing destruction and consolidation
-encysted larvae; of the lungs (strongyloides pneumonitis)
•Trichinella spiralis (by undercooked meat containing the 2. Adult
larvae, penetrates through the muscle) -by mechanical or chemical irritation
-produce intestinal disturbances; severe diarrhea,
I. INTESTINAL NEMATODE: ASCARIS LUMBRICOIDES abdominal pain, severe infection
Pathogenesis: damage in man may be due to migrating -produce hyper-eosinophilia
larva or adult worm Diagnosis:
Diagnosis: 1. Demonstration of rhabditiform form larva and adults in
•Katokatz Method stool
-detecting eggs with thick shells by mixture of glycerine and 2. In the lungs; demonstration of adult larva from sputum
malachite green sol'n and bronchial washing
ASCARIS LUMBRICOIDES **Entero-test: a long nylon string is swallowed and later
-aka "giant roundworm" pulled back out of the mouth.
-large intestinal roundworm infecting humans
-infection; due to ingestion of infective eggs V. INTESTINAL NEMATODE: ENTEROBIUS
-in the small intestine; VERMICULARIS
the eggs hatch into larvae -> bloodstream -> lungs -> Pathogenesis:
alveoli -> bronchi -> trachea -> swallowed -> intestines -eggs are viable shortly after being laid by directly on the
(adult stage) peri-anal skin by the gravid female
-viable eggs; can then be scratched from the pruritic skin
II. INTESTINAL NEMATODE: NECATOR AMERICANUS surface and accidentally ingested or passed on fingers,
Pathogenesis, Pathology & Symptomatology: clothing or fecal flecks to others -> usually children.
1. Larval lesions -cause; minute ulceration & hemorrhages from the
-when it penetrates the skin; produces maculopapules and ulceration which may become infected causing intolerable
localized erythema itching called "ground itch" or "dew itch" itchiness
-if many migrate thru the lungs; bronchitis or pneumonitis -nocturnal pruritus and very mild tingling sensation to an
may result in sensitized individuals acute pain resulting to scratching till the area is scarfied
(eczematous lesions or dermatitis)
2. Adult lesions Diagnosis:
-a chronic infection with no acute symptoms 1. Anal swab or Graham scotch tape method
-most prominent characteristic in moderate or heavy
chronic infection; progressive secondary microcytic VI. INTESTINAL NEMATODE: TRICHURIS TRICHIURA
hypochromic anemia of nutritional deficiency type due to Pathogenesis:
loss of blood -mild infection; no symptoms
Diagnosis: -large number of worms; may cause symptoms such as
1. Direct fecal smear abdominal discomfort, anemia, bloody stools, tenesmus to
- used in the detection of motile protozoan trophozoites toxin produced
using 85% NSS
2. Concentration technique Diagnosis:
3. Copro-culture 1. Direct fecal smears; concentration methods
- to differentiate hookworm from Strongyloides sedimentation
4. Baerman's technique 3. Egg counts to determine warm burden
5. Stool dilution egg count surveys 4. Katokatz method

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 2) Brugia malayi: mosquitoes
VI. INTESTINAL NEMATODE: CAPILLARIA >Mansonia spp.
PHILIPPINENSIS >Anopheles spp.
Disease: Intestinal Capilliariasis; Mystery disease (ILOCOS)
Diagnosis: 3) Loa loa
1. Direct fecal smears; concentration methods >Chrysops spp. (deer flies)
sedimentation 4) Onchacerca volvulus
Mode of Transmission: Undercooked marine fish >Simulium damnosum (black flies)
Treatment: THIABENDAZOLE
5) Dracunculus medinensis
VII. INTESTINAL NEMATODE: TRICHINELLA SPIRALIS >Cyclops spp. (small crustaceans)
Diagnosis:
1. Muscle biopsy Disease:
- use the gastronomies or biceps; do a double slide -HUMAN filarial worms that cause 'ELEPHANTIASIS':
compression method (morbid gros enlargement of limbs, breast and and genitalia
2. Bachmans-Intradermal Test due to invasion of the nematodes in lymph tissues)
- a skin test for trichinosis in which an extract of Trichinella > Wuchereria bancrofti
larvae is suspended in saline, and injected intradermally. > Brugia malayi
- an immediate 'wheal and flare' reaction or a delayed Diagnosis:
response; indicates infection 1. In all cases; do blood smear except in Onchacerca
3. Serological test volvulus, wherein one should do a skin biopsy or skin
- demonstrate appearance of antibodies by precipitin test snip of the subcutaneous nodules
4. Xenodiagnosis 2. In Wuchereria bancrofti and Brugia malayi; blood
-feed scrap meal to laboratory animal; detect for viable smear should be taken- night; In Loa loa - during day
larva afterward time

B. Blood and Tissue Nematode: FILARIAL PARASITES ANISAKIASIS

(WORMS) -caused by the accidental ingestion of larvae of the
Gen. Characteristics: nematodes (roundworms) Anisakis simplex and
A. Adult stage Pseudoterranova decipiens
-thread-like and creamy in appearance, varies in length -eating raw or pickled marine fish
-formed in different lymphatics or body cavities
B. Larval stage TREMATODA
-eggs laid are embryonated; when hatched are called A. Gen. Characteristics:
"microfilaria" 1) broadly oval or leaf-like in shape with an oral sucker, pre-
C. If it escapes from shell; it is "unsheathed", pharyngeal tube, a pharynx and esophagus and a
if not "sheathed" bifurcated intestinal ceca which ends blindly except in the
-snake like in appearance with column of cells from the blood flukes
anterior most portions down to the posterior end 2) vary in size and shape
-larval stages; extruded in the peripheral circulation 3) digestion; predominantly an extracellular process
Blood and Tissue Nematode 4) respiration; essentially anaerobic
C.1 Sheathed Microfilaria: and their habitat (adults) 5) excretory system; bilaterally symmetrical and open at
1) Wuchereria bancrofti -> lower lymphatic the posterior end of the body with flame cell or
2) Brugia malayi -> upper lymphatic 'aclenocytes'
3) Loa loa -> subcutaneous tissue 6) nervous system; composed of a group of paired ganglion
cells disposed liked saddle on the dorsum of the pharynx or
C.2 Unsheathed Microfilaria: and their habitat (adults) esophagus
1) Onchacerca volvulus -> subcutaneous nodules -main pair each of posteriorly and anteriorly directed nerve
2) Dracunculus medinensis -> viscera, in subcutaneous trunks in the dorsal
tissue 7) hermaphrodites; except for the human blood flukes
8) sexually mature diagnostic trematoda; found in the
D. Location of microfilaria in man: definitive host
1) Peripheral blood: 9) both male and female reproductive organ system; have
• W. bancrofti end common opening known as the 'genital pore'
• B. malayi 10) male reproductive system; composed of the prostate
• L. loa enclosed by 'narcus pouch' or sac followed by dilatation
• M. ozzardi
-egg -> miracidia -> go to mollusks -> sporocyst -> more
2) Lymph spaces of skin & subcutaneous nodules: sporocyst and/or redia -> more rediae and/or cercaria ->
• O. volvulus penetrate the second immediate host -> mesocercaria or
metacercaria or adults depending on the specie -> ADULTS
3) No microfilaria stage in man; female discharges
rhabditiform larvae: **Mesocercaria - a cercaria little modified but resting
• D. medinensis **Metacercaria - a cercaria encysted and resting

E. Vector 11) female reproductive system; consists of a sac-like

1. Wuchereria bancrofti: mosquitoes structure called the uterus which opens into the seminal
Anopheles: receptacle, then the on type than the oviducts ending in a
>Minismusflavirostris: RURAL single ovary
>Aedes poecilus: URBAN 12) all trematoedes; lay eggs which upon embryonation
>Culex pians quinque fasciatus give rise to a ciliated embryo known as 'miracedium'

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13) all eggs to trematodes are provided with a lid called
'operculum'
14) trematodes; need body of water to complete the life
cycle
-all require two intermediate hosts except the blood flukes
which only has one intermediate host
Manner of transmission:
-ingestion of metacercaria through improperly cooked food
-intermediate host skin penetration by fork-tailed cercaria in
flukes
Habitat: walls of the small intestines
First Intermediate host:
-Gyraulus convexiusculus (planorbid snail)
Second Intermediate host:
-Pila conics or Pila luzonica (kuhol)
-Ellocaris tuberosa (water chestnut)
Diagnosis:
1. Recovery of un-embryonated egg of the parasite in the
hosts stool
Treatment: HEXYLRESORCINOL CRYSTOIDS,
TETRACHLOROETHYLENE, OLEORESIN OF ASPIDIUM

VI. TREMATODA: PARAGONIMUS WESTERMANI

I. TREMATODA: FASCIOLA HEPATICA Diagnosis: Recovery of un-embryonated egg of the
Mode of transmission: Watercress parasite in the hosts sputum
Diagnosis: Direct fecal smear Treatment: BITHIONOL (ACTAMER), CHLOROQUINE
Treatment: EMETINE HCL, BITHIONOL
Pathogenesis, Pathology & Symptomatology: TREMATODA: SCHISTOSOMES (BLOOD FLUKES)
a. Immature adults A. Gen. Characteristics
-ectopic lesions in the intestinal wall, orbit, lungs, brain, 1) elongately cylindrical in shape with prominent oral and
blood vessels and subcutaneous tissues ventral suckers
b. Mature adults 2) have separated sexes (dioecious)
-irritation and inflammation of the bile ducts; including 3) intestine; bifurcates and unites at a certain level to forth
biliary obstruction due to pressure toxic metabolites the united intestinal ceca
-development of parenchymal atrophy and perioportal 4) male adult; provided with gynecephoral canal on the
cirrhosis ventral side -> the function which is to cuddle the
-enlarged tender liver, jaundice, diarrhea, anemia female throughout its entire life except during
-in the later course; there is tenderness and enlargement of oviposition
the liver with jaundice which is hepato-cellular and -since they are always in perpetual copula; they are known
obstructive in type-- leukocytosis with 60% esinophilia as the most romantic parasites
5) life span; may be as long as 30 years
II. TREMATODA: CLONORCHIS SINENSIS 6) the only trematodes found in the bloodstream; can also
Habitat: distal biliary passages be isolated in stool or urine (S. haematobium)
First Intermediate host: 7) Ova; embryonated and not operculated
-Melanoides tuberculatus 8) the only trematodes that require only one intermediate
-Certhidia host
-Thiara 9) since they have no metacercariae; the infective stage is
-Bulimus the cercaria which has a characteristic fork-tailed
Second Intermediate host: appearance
-Fresh water fishes (bangus, tilapia, kanduli, etc) 10) Mode of transmission: skin penetration by fork-tailed
Diagnosis: cercaria
1. Direct fecal smear 11) majority of the schistosomes; parasitic in lower animals
3. Duodenal aspirate
4. Non-specific immunological tests SCHISTOSOMA
Treatment: EMETHINE HCL, BITHIONAL, Na Antimonyl -aka "blood flukes"
Tartrate -non-hermaphroditic (diecius)
-obligate intracellular parasites
III. TREMATODA: OPISTORCHIS FELINEUS Mode of transmission:
Habitat: distal biliary passages -Snails: intermediate hosts
First Intermediate host: -Humans: definitive hosts
-Melanoides tuberculatus > matures in the superior mesentric artery (take blood from
Second Intermediate host: fresh fish (cyprinoids) the aorta and distribute it to a large portion of the GI tract)
Diagnosis: > adult type:
1. Direct fecal smear -S. japonicum (veins that drain the small intestine)
5. Duodenal aspirate -S. mansoni (veins that drain the large intestine)
Treatment: CHLOROQUINE PHOSPHATE, EMETINE HCL, -S. haematobium (rectal venules and urinary plexus)
PRAZIQUANTEL -Sexual stage happens
Disease:
IV. TREMATODA: FASCIOLOPSIS BUSKI -for most patients; it is asymptomatic
Habitat: mucosa of the small intestines -for chronic infection; it will be asymptomatic characterized
First Intermediate host: by "swimmer's itch" or "clam digger's itch" (pruritic
-Segmentina papules)
Second Intermediate host: • S. mansoni (manson's blood fluke); Bilharziasis: GI
-Trapa natans hemmorhage, hepatomegaly, splenomegaly
-Ellocaris tuberosa (water chestnut) • S. japonicum (oriental blood fluke); Katayama's Disease:
Diagnosis: same with Bilharziasis but could lead to Hepatic
1. History of the case dysfunction & Portal Hypertension
6. Stool exam • S. haematobium (vesical blood fluke); Vesical or Urinary
Treatment: HEXYLRESORCINOL CRYSTOIDS, BEPHENIUM Bilharziasis: Hematuria

V. TREMATODA: ECHINOSTOMA ILOCANUM I. SCHISTOSOMES: SCHISTOSOMA JAPONICUM

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Pathogenesis: 9) genital organs; elaborately developed in each proglottid
1) Ability to produce irritation and inflammation -testes; usually multiple and are distributed throughout the
5) Ability of miracedia to produce toxic metabolites median plane of each mature proglottid
6) Lytic property which enable them to penetrate the -ovary; commonly a bilobed organ posterior to the
mucosa and submucosa of the small intestines equatorial plane of each proglottid
7) Possibility of using the spine to penetrate the mucosa 10) eggs; essentially spherical, non-operculated, almost
Diagnosis: fully embryonated when they escape from the mother
1. DFS proglottid
7. Concentration technique like acid -except for the pseudophyllideans where in the eggs are
8. other CT and glycerine CT ovoidal, operculated and immature when laid
9. Rectal biopsy 11) they require at least 1 intermediate host for
10. Circumoval Precipin Test (COPT) transmission; except for D. latum (where 2 intermediate
11. Serological Test using Cercarial antigen hosts are required) and H. nana (where no intermediate
Treatment: TARTAR EMETIC (Potassium Antimony host is required)
Tartrate) **Infections; generally by encysted larva

II. SCHISTOSOMES: SCHISTOSOMA MANSONI I. PSEUDOPHYLLIDEAN: DIPHYLLOBOTHRIUM LATUM

Habitat: inferior mesentric plexus or portal venous system First Intermediate host:
Intermediate host: -Copepods (Diaptomus vulbaris, Diaptomus gracilis,
-Australorbis Cyclops)
-Biomphalaria Second Intermediate host: Fresh water fish
-Planorbis Diagnosis:
Diagnosis: 1. Based on recovery of characteristic eggs in patients face
1. Recovery of eggs from urine or feces (more in feces) Treatment: NICLOSAMIDE (YOMESAN), DICHLOROPHEN,
12. COPT ATABRINE
13. CFT II. CYCLOPHYLLIDEAN: TAENIA SOLIUM
14. Intradermal test Diagnosis:
Treatment: TARTAR EMETIC, NIRIDAZOLE, STIBOPHEN, A. Taeniasis
ASTIBAN 1. DFS
18. Double slide compression method of gravid
III. SCHISTOSOMES: SCHISTOSOMA HAEMATOBIUM segments
Habitat: vesical and pelvic plexuses of the venous 19. cysticercosis; do excision biopsy and examine the
circulations specimen for larval form form under the microscope
Intermediate host: 20. intradermal test
-Bulinus 21. high penetration x-ray; to see calcification which is
-Planorbis not specific
Diagnosis: 22. Perineal swab
1. Recovery of eggs from urine or stool (more in urine) Treatment: QUINACRINE, NICLOSAMIDE, BITHIONOL
15. Aspirated materials from cystoscope & proctoscope
16. Fairley's complement fixation test III. CYCLOPHYLLIDEAN: TAENIA SAGINATA
17. COPT in chronic cases Diagnosis:
Treatment: TARTAR EMETIC, NIRIDAZOLE, FAUDIN, 1. DFS
NILODON 23. recovery of gravid segments
24. Double slide compression method
CESTODA 25. count the lateral uterine branches
A. Gen. Characteristics Treatment: QUINACRINE, NICLOSAMIDE, BITHIONOL
8) Ribbon like parasites; segmented, flattened
dorsoventrally, varies in length from a few mm to IV. CYCLOPHYLLIDEAN: DIPHYLIDIUM CANINUM
several meters Intermediate host:
9) Composed of anteriorly of an attenuated structured; -Flea Ctenocephalidea sp. (Man is only an accidental host)
"Scolex" Diagnosis:
-main function of scolex; attachment 1. Recovery of the characteristics eggs in the mother
-the neck; follows the scolex, site of proliferation capsule or/
-the strobila or body; consists of segments differentiated 26. Pumpkin seed shape proglottids in the stool or
into: around the anus
• Immature Treatment: QUINACRINE, NICLOSAMIDE, PARANOMYCIN
• Mature
• Gravid proglottids V. CYCLOPHYLLIDEAN: HYMENOLYPIS NANA
3) Immature segment; lies proximal to the neck -smallest tape worm
-composed of immature reproduction organs -vector flea
-followed by the middle or mature segments; which contain -only tapeworm that can complete entire life cycle in a
the well-developed reproductive organs single host
-distal most portion; gravid segment: characterized by its Diagnosis:
uteri filled with eggs 1. Based on the identification of characteristic eggs
4) they are hermaphrodites (monoecious) Treatment: QUINACRINE, HEXYRESORCINOL
5) adults; attached to the intestinal wall by means of
suckers or by hooks found at the anterior portion VI. CYCLOPHYLLIDEAN: HYMENOLYPIS DIMINUTA
6) there is no special digestive tract; nutrition is mainly Intermediate host:
derived from absorption of digested materials through its -All corpozoic or scavenger in their habits during their larval
integument of adult stage (lepidopterans, earwig, myriapods, fleas,
7) excretory system; as primitive as that of trematodes beetles, cockroaches)
8) nervous system; confined primarily to the scolex Diagnosis:

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1. Recovery of the characteristics eggs in the mother
capsule or/
27. Pumpkin seed shape proglottids in the stool or
around the anus
Treatment: QUINACRINE, NICLOSAMIDE

VII. CYCLOPHYLLIDEAN: ECHINOCOCCUS

GRANULOSUS
Habitat: Lives attached to the villi of small bowel of dog
and other canine hosts
Definite Hosts: Dogs (optimal)
Intermediate Hosts: Man, Sheep
Diagnosis:
1. X-ray
28. Immunologic
a. Intradermal Casoni's test
-an immediate hypersensitivity skin test used in the
diagnosis of hydatid disease introduced by casoni
b. Precipitin Test
c. Fluorescent Antibody test
Treatments:
-surgical technique; helpful only in patients with unilocular
cysts in operatable sites
-all non-surgical procedure; usually non-successful

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