Villanueva, John Carlo G.

BSMT2 – Sanguis A 02/23/21

Prelim-Lecture Lesson 2 (e-Module EXTEND)
Intestinal Nematodes
EXTEND
 Chunking the data. Complete the template given. Writ e down the important terms,
concepts/ideas, and your additional insights in this unit. (You may use separate sheet
and submit to your teacher/facilitator using your MS Team)

Ascaris lumbricoides

Important Terms Important Concepts/Ideas

Albendazole - Ascaris is a Greek word for worm
Ascariasis
- Lumbricoides is a Latin word for
Ascaris suum worm

Bolus - In the past, Romans called this

parasite as Lumbricus teres as its
Corticated
scientific name is mostly similar to
Decorticated earthworms.

Direct Fecal Smear - Ascaris suum infects pig

Embryonated Egg - Toxocara canis infects dog

Fertilized Egg
- Toxocara cati infects cat
Giant Intestinal Roundworm
- Ascaris suum, Toxocara canis,
Ivermectin and Toxocara cati are visceral
larval migrants.
Kato Technique

Kato-Katz Technique
- Capable of Heart-Lung Migration

Lipoidal - In female adults, the vulva is near

the posterior end.
Mebendazole
- Decorticated egg has smooth
Pyrantel Pamoate
lining
Spicules
- Corticated egg has rough lining
Toxocara canis and it functions as a protection for
the egg from extreme
Toxocara cati
environment.
Trilobite Lips
- Kato technique is used for mass
Unfertilized Egg examination
Visceral Larval Migrants
- Ivermectin is teratogenic, which is
Vitelline harmful to pregnant women and
neonates.
Vulva
 Insights Learned

Ascaris lumbricoides is a soil-transmitted helminth and also called the "Giant Intestinal Roundworm."
It is the 2nd most common parasite that causes infection. This parasite's diagnostic stage is eggs in
feces. Its infective stage is an embryonated egg. The life cycle of this parasite starts when the adult
stage in the intestine lays eggs. Adult worms live inside the lumen of the small intestine. Around
200,000 eggs per day that are passed through the feces can be produced by a female. Unfertilized
eggs are likely swallowed but not infectious. Depending on the environmental conditions, larvae grow
into infection within fertile eggs after 18 days to several weeks (optimum: moist, warm, shaded soil).
Since infected eggs are swallowed, the larvae hatch, invade the intestinal mucosa, and are
transported through the portal, then systemic circulation to the lungs. In the lungs, the larvae develop
further (10 to 14 days), penetrate the alveolar walls, rise to the throat of the bronchial tree, and are
swallowed. They grow into adult worms upon reaching the small intestine. The unfertilized egg of
Ascaris lumbricoides is longer and narrower with a thin shell and irregular mammilated coating filled
with refractile granules. The fertilized egg is characterized by having a thick and transparent outer
layer and delicate vitelline, lipoidal, and highly impermeable inner layer. This parasite is Dioecious,
thus it has male and female characteristics in the adult stage. In a male adult, it has a curved posterior
end with two spicules. While in a female adult, it is longer, paired reproductive organs in the posterior
two-thirds and has a posterior tail. This parasite is incorporated with its infection and can cause the
disease called amebiasis. The symptoms of ascariasis are severe abdominal pain, fatigue, vomiting,
malnutrition, and worms in stool. It can be cured by treating it with an antihelminthic drug preferably
albendazole. This is diagnosed through direct fecal smear, Kato technique, and Kato-Katz technique.
 Trichuris trichiura

Important Terms Important Concepts/Ideas

Albendazole - Not capable of Heart-Lung
Migration
Amebic Dysentery

Appendicitis - Whip-like structure

Bipolar Plugs - Capable of laying eggs up to 7000

per day.
Coiled Tail
- Known for its bipolar plug
Direct Fecal Smear
structure of its egg
Embryonated Egg
- Trichuriasis causes to serve an
FECT optimum environment for a
Ivermectin
protozoan as it causes amebic
dysentery
Kato-Katz Technique

Mebendazole

Rectal Prolapse

Refractile Sheath

Spicule

Trichuriasis

Whip Worm

Insights Learned

Trichuris trichiura is a soil-transmitted helminth and is also called as "Whip Worm." It is the 3rd most
common roundworm. This parasite's diagnostic stage is eggs in feces. Its infective stage is an
embryonated egg. The life cycle of this parasite starts when the female adult lay eggs in the cecum.
Then, the unembryonated egg is passed on to the feces. Eggs mature into a 2-cell stage in the soil,
an early stage of cleavage, and then embryonate; eggs become contagious in 15 to 30 days. The
eggs hatch in the small intestine after ingestion (soil-contaminated hands or food), and release larvae
which mature and establish themselves in the colon as adults. In the cecum and ascending colon, it
is where the adult worms (approximately 4 cm in length) reside. In that location, the adult worms are
fixed, with the anterior portions threaded into the mucosa. 60 to 70 days after infection, the females
start ovipositing. About 3,000 and 20,000 eggs per day are shed by female worms in the cecum. The
eggs of Trichuris trichiura is lemon-shaped. It has protruding bipolar mucus/hyalinated plugs. This
parasite is Dioecious, thus it has male and female characteristics in the adult stage. In a male adult,
it has a coiled posterior with a single spicule and refractile sheath. While in a female adult, it has a
bluntly rounded posterior end. This parasite can cause trichuriasis. It can also cause amebic
dysentery, appendicitis, and heavy infections such as abdominal pain, rectal prolapse, and blood-
streaked diarrhea. Trichuriasis is associated with rectal prolapse, wherein it is a serious infection that
leads to edema with a high number of implanted worms in the rectum. These infections can be treated
by using antihelminthic drugs, preferably Mebendazole.
 Hookworm

Important Terms Important Concepts/Ideas

Albendazole - Capable of Heart-Lung Migration
Ancylostoma braziliense
- Necator americanus (New World
Ancylostoma caninum Hookworm) causes 96% of
infection
Ancylostoma duodenale
- Ancylostoma duodenale (Old
Bipartite
World Hookworm) causes 2% of
Blood Sucking Nematodes infection

Concentration Method - The remaining 2% is mixed

infection by the 2 Hookworms
Culture Method

Cutaneous Larval Migrants

- Necator americanus has a semi-
lunar cutting plates buccal capsule
Direct Fecal Smear
- Ancylostoma duodenale has 2
Filariform Larvae pairs of teeth on its buccal capsule
Kato technique
- Ancylostoma braziliense has 1 pair
Larval Migration of teeth

Larval Penetration - Ancylostoma caninum has 3 pairs

of teeth
Mebendazole

Morula Ball - This parasite can cause anemia,

that is why for its treatment,
Morulation together with anithelminthic drug
it should be incorporated with
Necator americanus
adequate diet and iron supplement
Rhabditiform Larvae

Tripartite

Insights Learned

Hookworm, also known as "Blood Sucking Nematode," is a soil-transmitted helminth and is capable
of skin penetration. The hookworms that infect humans are Necator americanus (New World
Hookworm) and Ancylostoma duodenale (Old World Hookworm). This parasite's diagnostic stage is
eggs in feces. Its infective stage is filariform larvae. The life cycle of this parasite starts when the adult
lays eggs in the intestine. Eggs are passed through the stool, and larvae hatch within 1 to 2 days
under favorable conditions (humidity, warmth, shade), and become free-living in contaminated soil.
These released rhabditiform larvae emerge in the feces and/or the soil, and become infectious
filariform (third-stage) larvae after 5 to 10 days (and two molts). The larvae enter the skin upon contact
with the human host, usually bare feet, and are transferred through the blood vessels to the heart and
then to the lungs. They join the pulmonary alveoli, climb to the pharynx in the bronchial tree, and are
swallowed. The larvae enter the small intestine's jejunum, where they live and develop into adults.
The egg is the same for all species which is ovoid in shape, thin and colorless. It can also be described
as a "Morula ball" in which morulation occurs. In rhabditiform larvae, Necator americanus and
Ancylostoma duodenale are indistinguishable. They differ in their filariform, wherein Necator
americanus has a conspicuous buccal spear while the Ancylostoma duodenale has an inconspicuous
buccal spear. They also differ in their adult stage in which the Necator americanus S-shaped
curvature, bipartite male copulatory bursa, and a semi-lunar cutting plate buccal capsule, while in the
Ancylostoma duodenale has C-shaped curvature, tripartite male copulatory bursa, and a buccal
capsule of 2 pairs of teeth. This parasite causes Hookworm Infection or Uncinariasis wherein through
larval penetration and larval migration. This infection can cause symptoms such as allergic reaction,
abdominal pain, steatorrhea, and even anemia. This is diagnosed through Direct Fecal Smear, Kato
technique, Concentration Methods, and Culture Methods. This infection can be treated by taking up
antihelminthic drugs preferably albendazole. If a person is experiencing anemia caused by this
infection, it is recommended to take an adequate diet and iron supplement.
 Strongyloides stercoralis

Important Terms Important Concepts/Ideas

Agar Plate Method - Capable of Heart-Lung Migration
Albendazole
- This parasite is a facultative
Autoinfection nematode which is capable of free-
living existence
Beale's String Test
- They can live out their existence
Bearmann Funnel Gauze Method
just in the soil
Duodenal Aspiration
- Parthenogenic parasite
Facultative Nematode
- There are Free-living stage and
Filariform Larvae Parasitic stage in the adult form
Free-Living Female
- Parasitic male is not yet identified
Free-Living Male
- Gubernaculum is a scrotal
Gubernaculum ligament
Harada-Mori Culture Technique - The Hookworm and Strongyloides
Ivermectin
stercoralis are somehow similar

Larva Currens - This parasite is capable of

autoinfection
Modified Harada-Mori
- They are associated with swamp
Parasitic Female
itch
Rhabditiform Larvae

Small Bowel Biopsy

Swamp Itch

Thiabendazole

Threadworm

Insights Learned

Strongyloides stercoralis is a soil-transmitted helminth and is capable of skin penetration and is also
called a "Threadworm." Strongyloides stercoralis is the only species of this genus that is naturally
pathogenic to humans because most of these species have been reported in mammals and birds.
This parasite's diagnostic stage is a rhabditiform larva in feces. Its infective stage is filariform larvae.
The life cycle of Strongyloides stercoralis is complex, alternating, and involving autoinfection between
free-living and parasitic cycles. In the free-living cycle: in the stool of an infected definitive host,
rhabditiform larvae pass into infectious filariform larvae (direct development) or free-living adult males
and females who mate and create eggs from which rhabditiform larvae hatch and eventually become
infectious filariform larvae. When skin meets soil, filariform larvae in infected soil penetrate human
skin and migrate to the small intestine. The filariform larvae are believed to migrate to the lungs
through the bloodstream and lymphatics, where they are ultimately coughed up and swallowed.
Filariform larvae, however, seem capable of migrating through alternate routes to the intestine (e.g.
through abdominal viscera or connective tissue). The larvae molt twice in the small intestine to
become adult female worms. The females live embedded in the small intestine submucosa and
produce eggs through parthenogenesis (there are no parasitic males) that yield rhabditiform larvae.
In the feces, the rhabditiform larvae will either pass or induce autoinfection. The eggs of Strongyloides
stercoralis is rarely seen, but it can be characterized by an oval-shaped and thin-shelled resembling
the eggs of hookworm. The rhabditiform larvae have an elongated esophagus with a pyriform posterior
bulb. While the filariform larvae are similar to hookworm but are smaller with a distinct cleft at the tip
of the tail. In the free-living state, the male has a ventrally curved tail and 2 spicules with gubernaculum
but no caudal alae. While in the female, it has a muscular double-bulbed esophagus. In the parasitic
state, only females are identified with 4 indistinct lips, finely striated cuticles, slender tapering anterior
end, and is semi-transparent. This parasite is capable of infecting disease which is the effect of its
larval migration, wherein it is diagnosed by many methods; there could be copro culture, string test,
and many more. This infection can be treated by an antihelminthic drug, preferably albendazole.
 Enterobius vermicularis

Important Terms Important Concepts/Ideas

Albendazole - Not capable of Heart-Lung
Migration
Enterobius gregorii

Esophageal Bulb - Formerly known as “Oxyuris

vermicularis”
Graham's Scotch Adhesive Tape Swab
- 16,000 eggs per day
Inner Shell
- After deposition, the female worm
Mebendazole
dies
Outer Shell
- The eggs in the perianal region
Oxyuris vermicularis become embryonated within 6 hrs.
Perianal Region
- Pyrantal pamoate is only
Pinworm secondary drug of choice because
it is contraindicated with
Puritus ani hypersensitivity
Pyrantal Pamoate

Insights Learned

Enterobius vermicularis is an intestinal nematode and is known as "Pinworm." This parasite is also
known to be the most common parasite that causes parasitic infection in humans. Its mode of
transmission is a fecal-oral route, that is, by the transfer of infective pinworm eggs fecal-oral route that
is by the transfer of infective pinworm eggs from the anus to someone's mouth. The diagnostic stage
of this parasite is an egg in perianal folds. Its infective stage is an embryonated egg. The life cycle of
this parasite starts when the adult lays eggs in the intestine. Eggs are laid on perianal folds by Gravid
adult female Enterobius vermicularis. Infection happens by self-inoculation (transfer of eggs to the
mouth through hands that have scratched the perianal region) or through environmental exposure to
eggs (e.g. contaminated surfaces, clothes, bed linens, etc.). The larvae hatch in the small intestine
after ingestion of infected eggs and the adults settle in the colon, usually in the cecum. Gravid females
migrate beyond the anus nocturnally and oviposit while creeping on the perianal area's skin. Under
optimum conditions, the larvae found inside the eggs develop (the eggs become infectious) within 4
to 6 hours. Eggs can rarely become airborne and can be inhaled and ingested. Retroinfection, or
movement from the anal skin of newly hatched larvae back into the rectum, may occur, although it is
unclear how frequently this occurs. The egg of this parasite is characterized by a D-shaped, triple
albuminous covering, and embryonic lipoidal membrane. The adult stage has an anterior end
structure, which is a lateral wing cuticular cephalic alae and a posterior esophageal bulb. The female
adult has a long pointed tail and uteri that is distended with eggs on it. While in the male adult, it has
a curved tail and a single spicule. This parasite is capable of infecting diseases such as enterobiasis,
in which its classical sign is "Puritus/Pruritus ani" or itching in the perianal area. This is diagnosed by
performing Graham's Scotch Adhesive Tape Swab. This infection can be treated by taking an
antihelminthic drug preferably mebendazole.
 Capillaria philippinensis

Important Terms Important Concepts/Ideas

Albendazole - Not capable of Heart-Lung
Migration
Bagsang

Bagsit - Stichosome is the entire

esophageal structure
Bagtu
- Stichocytes is the rows of
Birot
secretory cell in the esophagus
Borborygmi
- The eggs can embryonate either in
Concentration Methods soil or in water

Direct Fecal Smear - The embryonated egg is mostly

Duodenal Aspiration
ingested by brackish/fresh water
fish such as Ipon, Birot, Bagsang,
ELISA Bagtu, and Bagsit.
Hyselothris bipartite - Flesh-eating Birds are the natural
Incidental Host host of Capillaria philippinensis

Intermediate Host - Humans are incidental host

Ipon - Intermediate host re the

Hyselothris bipartite
Mebendazole

Natural Host

Pudoc Worm

Stichocytes

Stichosome

Insights Learned

Capillaria philippinensis is an intestinal nematode, also known as "Pudoc Worm." Its first human
infection was reported in 1963 in a 29-year-old male from North Luzon, in the Philippines. This parasite
can be acquired through the consumption of infected raw or improperly cooked small freshwater fish.
The diagnostic stage of Capillaria philippinensis is eggs in feces. While it’s infective stage is the
infective larvae in fish. The life cycle begins when the adult lays eggs in the intestine. Usually,
unembryonated, thick-shelled eggs pass through the human stool and become embryonic in 5-10
days in the exterior environment; larvae emerge, enter the intestine, and migrate to the tissues after
ingestion by freshwater fish. Ingestion of raw or undercooked fish results in human host infection. The
adults of Capillaria philippinensis are very small and live in the human body's small intestine, where
they burrow in the mucosa. In addition to the unembryonated, shelled eggs that move into the
environment, females may also contain shell-less eggs (possessing only a vitelline membrane) that
are embryonized in the uterus or intestine of the female. The larvae released can invade the intestinal
mucosa again and cause internal autoinfection. Hyperinfection can occur in this process (a massive
number of adult worms). The eggs of this parasite resembled the eggs of Trichuris trichiura. Wherein,
it has peanut-shaped with striations and it is flattened instead of a convex bipolar plug. The male
adult can be characterized by a chitinized spicule and unspined sheath. While in females, it can be
identified by the presence of eggs in its utero. This parasite is capable of causing capillariasis. This
disease may have symptoms such as abdominal pain and diarrhea. Borborygmi is also associated
with this disease, in which it is a peculiar gurgling sound in the stomach. This infection is diagnosed
by many procedures, but the usage of ELISA is recommended, as it has 100% sensitivity and
specificity in the diagnosis of capillariasis. This infection can be treated by taking up antihelminthic
drugs such as mebendazole and albendazole.