Lesson 8: Nematodes Part 1
Presence of sensory organs (with exceptions)
INTRODUCTION TO NEMATODES
METAZOANS (multi-cellular organisms)
Nematoda
Intestinal Ascaris lumbricoides
Capillaria philippinensis
Enterobius vermicularis
Hookworm
Strongyloides stercoralis
Trichuris trichiura
Extraintestinal Angiostrongylus cantonensis
Filarial worms
Trichinella spiralis
Cestoda
Cyclophyllidea Dipylidium caninum
Echinococcus spp.
Hymenoplepis diminuta
Hymenoplepis nana
Railientina garrisoni
Taenia saginata
Taenia solium
Pseudophylilidea Diphyllobotrium latum
Spirometra
Trematoda
Clonorchis sinensis
Echinostoma ilocanum
Fasciola gigantica
Fasciola buski
Heterophyids
Opistorchis spp.
Paragonimus wetermani
Schistosoma spp
GENERAL CHARACTERISTICS OF NEMATODES
1. Elongated worms, cylindrical (round in cross
section)
2. Not segmented
3. Have a complete digestive system
4. Have separate sexes (though some maybe
parthenogenic)
5.
amphids (anterior) and phasmids (posterior)
6. Mostly are intestinal parasites
Note:
 Parthenogenic: asexual reproduction in which
the offspring develops from unfertilized eggs
 Amphids: These are the cuticular depressions
present on the lips surrounding the mouth in
nematodes and serve as chemoreceptors.
 Phasmids: very useful in the grouping of the
nematodes, neurons that were recently shown
to function in modulation of chemorepulsion
behavior (Chemorepulsion is the directional
movement of a cell away from a substance.)
CLASSIFICATION OF NEMATODES
A. Presence or Absence of Chemoreceptors
1. Phasmid nematode – minute receptor organs
Ex. Ascaris lumbricoides, Enterobius vermicularis,
Hookworm, Strongyloides stercoralis,
Angiostrongylus cantonensis, Filarial worms
2. Aphasmid nematode – without
chemoreceptors
Ex: Trichuris trichiura, Trichinella spiralis,
Capillaria philippinensis
B. Habitat
1. Intestinal
a. small intestines: Ascaris, hookworms,
Strongyloides, Capillaria
b. large intestines: Trichuris, Enterobius
2. Extraintestinal
a. Lymph nodes/vessels: Wuchereria and
Brugia
b. Eyes and meninges: Angiostrongylus
c. Muscles: Trichinella
C. Infective stages and Modes of Transmission NOTE:
1. Ingestion of embryonated eggs – Ascaris,
 Soil transmitted helminth infections are disease
Trichuris, Enterobius
of the poverty and may contribute to
2. Ingestion of infective larva – Capillaria,
malnutrition and impairment of cognitive
Trichinella, Angiostrongylus
performance.
3. Skin penetration of L3 – hookworms and
Strongyloides
4. Vector-borne – Wuchereria and Brugia MORPHOLOGY
5. Autoinfection – Strongyloides and
MALE FEMALE
Enterobius
10-31 cm 22-35 cm
6. Transmission through inhalation –
Ventrally curved Straight end
Enterobius and Ascaris (eggs or ova)
posterior with 2
DEVELOPMENTAL STAGES spicules

1. Egg
2. Larva
a. L1 : rhabditiform larva Trilobate lips with
b. L2 : sensory papillae
c. L3 : filariform larva
3. Adult
NOTE:

 Ascaris lumbricoides  Ascaris has been shown to produce pepsin

- Most common nematode of man inhibitor 3 (PI-3) that protects the worm from
- Occurs most frequently in the tropics digestion and phosphorylcholine that
suppresses lymphocyte proliferation.
 Common name : Giant intestinal/round worm
 Final Host : man
 Habitat : small intestine
 Diagnostic stage : fertilized and unfertilized egg Corticated, Unfertilized egg
 Infective stage : embryonated egg
 Source of ex. to inf. : soil-transmitted helminth
(along with Trichuris trichiura and hookworms)
 MOT : Ingestion Corticated, Fertilized egg
 Pathology : Ascariasis
 Diagnosis : Stool Exam, Concentration
technique
 Drug of choice : Albendazole (Mebendazole
Decorticated, Fertilized egg
and Pyrantel Pamoate)
* Ascaris suum – Ascaris of Pigs

Most vulnerable: Children who likes to play in the Embryonated egg

soil
NOTE:
 Unfertilized egg: longer and narrower than
fertile eggs, thin shell and irregular
mammilated coating filled with refractile
granules. They may be difficult to identify.
 Fertile eggs
 Corticated: outer, coarsely mammilated
albuminous covering
 Decorticated: w/o coarsely mammilated
albuminous covering
- Thick, transparent, hyaline shell with
a thick outer layer as supporting
structure
- Delicate vitelline, lipoidal, inner
membrane which is highly
impermeable
 Embryonated: when ingested, it will hatch on
the lumen of the small intestine and released in
the larva
LIFE CYCLE
Diagnostic stage:
 Unfertillized egg will not undergo further
development
 Fertilized egg will further develop to become
embryonated egg
Embryonated egg with L3 larva (hatch in the lumen
of the small intestine)  Larva will migrate into the
cecum or proximal colon where they penetrate the
intestinal wall  they enters the venules then go
to the liver through portal vein  heart and
pulmonary vessels
 Heart-lung migration
NOTE:
 Female Ascaris produces about 200,000
eggs per day. Eggs are deposited in the soil
and it takes about 2 to 3 weeks for the eggs
to develop under favorable conditions with
suitable temperature, moisture and
humidity.
 The larvae undergo two molts to reach their
3rd stage within the egg and become
embryonated. Only when this infective egg
is swallowed can humans become infected
with Ascaris.
PATHOLOGY
A. Due to larva
*Ascaris pneumonitis or Loeffler’s
Syndrome
 occurs during lung migration resulting in
allergic reactions such as lung infiltration,
asthmatic attacks and edema of the lips,
similar symptoms of pneumonia, vague
abdominal pain
 Eosinophilia is present
B. Due to adult worm
 worm bolus (accumulation that form a ball)
causing bowel obstruction
 diarrhea
 abdominal pain
Erraticity: if worm migrates to ectopic sites
(gallbladder, hepatobilliary tree, appendix and
pancreas)  maybe regurgitated and vomited, may
escape through the nostrils or inhaled to the
trachea. Maybe due to medication, spicy-diet and
fever
DIAGNOSIS
A. Stool Examination
1. Direct Fecal Smear - less sensitive compared
to Kato-Thick and Kato-Katz technique
(useful for both individual or mass screening
in schools or community)
2. Kato-thick
3. Kato-katz - provides quantitative diagnosis in
terms of the intensity of helminth infection
in eggs per gram (unit of measurement) of
stool, useful in monitoring the efficacy of
treatment in clinical trials
 Kato-katz and Kato-thick : use cellophane to
visualize the parasite
B. Concentration Technique
1. Formalin Ether/Ethyl Acetate Concentration
Technique (FECT)
2. Merthiolate Iodine Formaldehyde
Concentration technique (MIFCT)
3. Brine floatation
4. Zinc sulfate floatation technique
C. X-ray (extra-intestinal ascariasis  lungs)
D. CBC (demonstrate eosinophilia)
PREVENTION AND CONTROL
1. Sanitary disposal of human feces
2. Health education
3. Mass chemotheraphy
4. Avoid using night soil
5. Proper food preparation
Integrated Helminth Control Program (DOH)
Targets and Doses
1. Children aged 1 year to 12 years old
For children 12 – 24 months old
 Albendazole - 200 mg, single dose every 6
months. Since the preparation is 400mg, the
tablet is halve and can be chewed by the child
or taken with a glass of water
Or
 Mebendazole - 500 mg, single dose every 6
months
For children 24 months old and above
 Albendazole - 400 mg, single dose every 6
months
Or
 Mebendazole - 500 mg, single dose every 6
months
Note: If Vitamin A and deworming drug are given
simultaneously during the GP activity, either drug
can be given first.
2. Adolescent females
 It is recommended that all adolescent
females who consult the health be given
anthelminthic drug
o Albendazole 400 mg once a year
Or
o Mebendazole 500 mg once a year
3. Pregnant women
 It is recommended that all pregnant women
who consult the health be given anthelminthic
drug once in the 2nd trimester of pregnancy.
 In areas where hookworm is endemic:
 Where hookworm prevalence is 20 – 30%
o Albendazole 400 mg once in the 2nd
trimester
Or
o Mebendazole 500 mg once in the 2nd
trimester
 Where hookworm prevalence is > 50%,
repeat treatment in the 3rd trimester
4. Special groups, e.g., food handlers and MORPHOLOGY
operators, soldiers, farmers and indigenous
MALE FEMALE
people
30-45 mm 35-50 mm
 Selective deworming is the giving of
Coiled posterior with a Rounded/blunt
anthelminthic drug to an individual based on single posterior
the diagnosis of current infection. However, spicule and retractile
certain groups of people should be given sheath
deworming drugs regardless of their status
once they consult the health center.
 Attenuated anterior 3/5– slender, hairlike,
 Special groups like soldiers, farmers, food
transversed by a narrow esophagus resembling
handlers and operators, and indigenous
“string of beads” – used for attachment
people are at risk of morbidity because of
their exposure to different intestinal parasites  Robust posterior 2/5 – contains the intestines
in relation to their occupation or cultural and single set of reproductive organs
practices.
 For the clients who will be dewormed
selectively, treatment shall given be anytime
at the health centers.

 Trichuris trichiura

 Lemon shaped/barrel-shaped/football
 Common name : Whipworm shaped/ Japanese lantern with plug-like
 Final Host : man translucent polar prominences a.k.a
 Habitat : large intestine “mucoid bipolar plugs”
 Diagnostic stage : egg
 Infective stage : embryonated egg LIFE CYCLE
 Source of ex. to inf. : soil-transmitted
helminth
 MOT : Ingestion
 Pathology : Rectal prolapse, IDA, diarrhea
 Diagnosis : Stool Exam, Concentration
technique
 Drug of choice : Mebendazole (Albendazole as
alternative drug)

 Albendazole + Ivermectin better cure and egg

reduction rate than Albendazole alone

* Usually observed occurring together with Ascaris

lumbricoides
Unembryonated eggs passed in feces  2-cell
stage  Advanced cleavage  Embryonated eggs
are ingested (infected in 15-30 days)  eggs hatch
in the small intestine and release larva  Adult in
the colon
 The worms secrete a pore-forming protein
called the TT47 that allows them to imbed their
entire whip-like portion into the intestinal
walls.
PATHOLOGY
1. Rectal prolapse
- a condition in which the rectum (the
lower end of the colon, located just
above the anus) becomes stretched
out and protrudes out of the anus.
Weakness of the anal sphincter
muscle is often associated with rectal
prolapse at this stage, resulting in
leakage of stool or mucus.
2. Appendicitis and granulomas due to
irritation and inflammation brought by the
worms
3. Blood streaked diarrheal stools, abdominal
pain, tenderness, anemia and weight loss
DIAGNOSIS
A. Stool Examination
1. Direct Fecal Smear
2. Kato-thick smear - highly recommended in
the diagnosis of Trichuriasis.
3. Kato-katz - quantitative method used to
assess the efficacy of anthelminthic drugs in
terms of cure rate and egg reduction rate
PREVENTION AND CONTROL
1. Treatment of infected individuals
2. Sanitary disposal of human feces 
construction of toilets
3. Washing of hands
4. Health education (sanitation and hygiene)
5. Proper food preparation practices
 Enterobius vermicularis
 Common name : Pinworm, Seatworm,
Society worm*
 Final Host : man
 Habitat : (cecum) large intestine
 Diagnostic stage : ova
 Infective stage : embryonated egg
 Source of ex. to inf. : contact-borne
 MOT : Ingestion, inhalation
 Pathology : Enterobiasis or oxyuriasis
 Diagnosis : Scotch tape swab
 Drug of choice : Pyrantel pamoate
 (Mebendazole and Albendazole as
alternative)
* Familial disease
Familial or group disease: extremely contagious
and can easily spread among members of the
family or in institutions
NOTE:
 Can cause autoinfection and retroinfection
(the migration of newly hatched larvae from
the anal skin back into the rectum)

 FLOTAC technique has also been shown to be

more sensitive in the diagnosis of Trichuriasis.

B. Concentration Technique
1. FECT
2. MIFCT
3. Brine floatation
4. Zinc sulfate floatation technique
MORPHOLOGY LIFE CYCLE

“Cephalic alae”

lateral wing or
cuticular alar
expansions at the
anterior end

Prominent
posterior
esophageal bulb
or “bulbus”

MALE FEMALE
2 to 5 mm 8-13 mm Eggs on perianal folds  Embryonated eggs
Curved tail and has a long pointed tail ingested by human (Self-inoculation)  Larvae
single hatch in small intestine  adults in lumen of
spicule cecum  Gravid female migrates to perianal
*rarely seen because region at night to lay eggs (Nocturnal)
they die
after copulation
PATHOLOGY
1. Mild catarrhal inflammation of the intestinal
mucosa
2. Nocturnal Pruritus ani – “perianal itching”
which may lead to secondary bacterial
infection and lack of sleep
3. Other complications: appendicitis, vaginitis,
endometritis and peritonitis.
4. Poor appetite, weight loss and abdominal
D-shaped eggs of E. vermicularis pain
 Asymmetrical, with one side flattened and DIAGNOSIS
the other side is convex
1. Graham’s scotch adhesive tape swab
 Translucent shell – triple albuminous outer
(Perianal cellulose tape swab)
layer for mechanical protection and inner
- provides the highest percentage of
embryonic lipoidal layer for chemical
positive (+) results
protection
 Ovum develops into a “tadpole-like
embryo” PREVENTION AND CONTROL
1. Personal cleanliness and hygiene are
essential
2. Hand washing
3. Boiling of linen and clothing