Helminthology - Nematodes

Stadium
Species Life Cycle Clinical Features
Egg Larvae Adult
a. fertilized Female 1. STH, orofecal

2. Anesthetion
intervention,
chemotherapy, or
b. unfertilized fever could cause
erratic migration
Ascaris
Male
lumbricoides 2. Focus ectpic:
L3 in lungs
bile duct,
peritonium,
c. decorticated Loeffler syndrome:
worm vomit
1. Ascaris pneumonia
2. Asmatic attact
3. DOC:
3. Edema, uticaria Mebendazole

Female
blunt end posterior 1. Not migrate to
lungs

2. stab intestinal
mucose ->
hemorrage->
anemia
Trichuris hipochromic
Male, bended curved 1- microcytic
trichiura
1. barrel shaped lives beneath 2x with spiculae
2. mucoid plug submucosal, not 3. Prolaps Recti
in the lumen
4. DOC:
Albendazole
 Hookworms
Rhabditiform (both) Semilunar cutting plate Intestinal Hookworm Infection 1. N. americanus
only infects
long buccal cavity, bulbus
cutaneously, A.
esophagus, feeding stage
duodenale via skin
and by ingetion

2. L3 enters
Hookworms systemic circulation
and become L4 in
(Necator Female bigger than male
lungs.
americanus ) Filariform (Necator) Male has bursal copulatrix
3. Habitate in
thin, striated tail, infective duodenum, has
stage, has cuticula sheath anticoagulant that
caused Iron
Deficiency Anemia
ovoid,
(faster in
transparant
A. duodenale)
hyalin-layer,
smooth
eggshell, can't 4. Complain with
Hookworms two pairs ventral teeth Cutaneous larva migrant
black bloody
be distinguished Filariform (Ancylostoma)
(Ancylostoma diarrhea
between Not striated, thin, has
duodenale )
N.americanus cuticula sheath 5. Filariform of A.
and
duodenale excreted
A. duodenale
Cutaneous in milk and infects
larva migrant infants
(A.braziliense
& A.caninum ) 6. Cutaneous larva
migrant only in form
of L1 (paratenic
Visceral larva host)
migrant
(not shown) (not shown) (not shown) 7. DOC: Albendazole
(Toxocara canis
& Toxocara cati )
 Rhabditiform Parasitic female (only
Short buccal cavity, female parasite in 1. Autoinfection +
parthenogenesis
prominent genitalia, Row of eggs
lead to
hyperinfection

2. Free living form

adult, female is
(not shown) S. smaller than in
Strongyloides parasitic female
stercoralis is
stercoralis ovoviviparous
Filariform Free living adult 3. L3 could be found
notched tail in pleura, sputum,
duodenum, CSF

4. DOC:
Thiabendazole

Female 1. Habitat caecum &

Pin-like-tail colon
(not shown)
Cervical alae is special in 2. Infect via orofecal,
retroinfection,
E.vermicularis
autinfection,
Pinworm inhalation
(Enterobius
Male 3. Pruritus ani
vermicularis /
especially in night
Transparent, Bended to ventral
Oxyuris
planoconvex,
vermicularis ) 4. Could cause
asymetric, thick appendicitis
hyalin layer, sticky,
found in peranal 5. DOC: Albendazole
 Become encysted in active Female 1. Swollen uncooked
striated muscle (diaphragm, jaw, meat
extraocular,biceps
Encysted larvae 2. L1 penetrates
intestinal mucosa ->
systemic circulation -
> muscle
(not shown)
Trichinella
T. spiralis is Male
spiralis 3. Could be calcified
viviparous has caudal appendages in the tissue
Teased larvae
4. Esophagus form
stychocyte

4. DOC: Albendazole
and Thiabendazole

Filaria Lymphatic
Pale stained with Giemsa, CS 1:1, regular
nuclei, no caudal nuclei

Wuchereria 1. Could be chronic in

10-15 years. Chronic
bancrofti
is late to be cured.

2. W. bancrofti can
Stained well Giemsa, CS 2:1, irregular nuclei,
closed caudal nuclei
caused edema in all
part of the body.
(not shown) Brugia sp. only below
Burgia malayi elbow and knee
infective stage is (not shown)
microfilaria
3. Speciment is
Pale stained with Giemsa, CS 3:1, irregular
collected from
nuclei, apart caudal nuclei periphery at night

4. DOC:
Brugia timori Dietilcarbamasine
 1. Summer is peak of
infection
(not shown)
2. clinical features
(not shown) Larvae is infective stage, emerge as adult
Draculunsus D. medinensis is migrate from intestine to worm migrate to
medinensis viviparous subcutan subcutan
1. Habitate in
3. No therapy except
subcutan
surgeon, sometimes
with stick

Male, has kidney shaped bursa 1. Habitate in rat

copulatrix and bursal rays
pulmonary artery

2. Eosinofilic
menginitis, found
hypereosinophilia in
Angiostrongylus (not shown) CSF
cantonensis found in rat's lungs
Female, has Barber's pole 3. Only symptomatic
L3 infective larvae met in pattern therapy and
Thiabendazole (anti-
wet mount
infalmmation)

Onchocerciasis
Nodule in subcutaneous
Onchocerciasis can
(onchocercoma) cause pruritus,
dermatitis,
onchocercomata
and
Onchocerca lymphadenopathies
(not shown)
volvulus . Infects by fly.
Microfilaria also found in Ocular lesions that
can progress to
subcutaneous nodule blindness.
has uterus and intestine
 Intestinal Cestodes
Morphology
Species Life Cycle Clinical Features
Egg Scolex Proglotid Gravid

1. Habitate in small
intestine

2. Intestinal
Taenia solium irritation and
obstruction
narrow neck, round, 4 7-13 pairs uterus
sucker, round lateral branch 3. Persistent
rostellum with 2 line diarrhea,
appendicitis (loosed
proglotid),
peritonitis (intestinal
perforation)

4. T. solium cause
Round,
Taenia cycticercosis
brownies,
saginata thick wall with cellulosae
radial line, Long neck, cuboid, 4 15-30 pairs uterus 5. Diagnostic and
contains sucker, no rostellum, lateral branch, lateral infective stage: egg
onchosphere
no hooklet genitalia pole and proglotid
with 3
hooklets
6. Swollen uncooked
well of beef and
pork

7. T. asiatica also
Taenia asiatica found in Samosir
island
Round, 4 sucker, 11-32 pairs uterus
8. DOC: Praziquantel
rostellum with 2 line lateral branch
 1. Rodent control
and healthy
lifestyle in child is
Ovoid, the best
Hymenolepis
transparent, preventive
nana Globular, 4 Proglotid gravid
hyalin layer,
suckers,short trapezium 2. DOC:
has polar
filaments, retractile 1 lined Praziquantel
contains hooklet rostellum
onchosphere
with 3 hooklets

1. Tribolium
confusum as as an
intermediate host,
found in cake or
Ovoid, yellowish, flour
4 suckers,
double thick rudimenter
Hymenolepis 2. Asymptomatic
wall, no polar rostellum, no witdh > lenght,
diminuta to severe infection
filament, hooklet uterus with regular
onchosphere eggs line
3. DOC:
with 6 hooklets
Praziquantel
 1. Diagnostic stage D.
latum is egg, no
proglotid found in
feses. Diagnostic
stage D. mansoni is
Diphyllobothrium
plerocercoid.
latum
Ovoid, yellow-
brown, has 2. Habitate in colon
operculum & lumen. D. latum cause
knob anemia hypochromic
macrocytic

3. Sparganosis in
uncooked fish flesh. If
Spoon like scolex
eaten become
with two diphyllobothriasis in
Diphyllobothrium dorsoventral cleft, no human
mansoni / rostellum, no Hermaphrodit, uterus
Spirometra Ovoid, asymetric, hooklet full of eggs, 2 big 4. D. latum found in
erinacei has sharp ovarium lobes, cat feses, D. mansoni
operculum opening ventral found in human feses
genitalia pole
5. DOC: Praziquantel

1. Found most in
child under 8 yrs,

2. Habitate in
intestine

Diphylidium 3. infected food

caninum (orofecal) or via flea
capsulated, vase like,
Capsulated egg, Rhomboidal, 4 2 pairs genital, lateral 4. Infective stage:
egg ball/cluster, suckers, protrude
contains emryo rostellum with 1-7 genitalia pore cysticercoid
with 6 hooklets lines hooklets (rose
5. DOC: Praziquantel
like)
 1. Diagnostic stage:
hydatid cyst, Infective
stage: egg

2. 3 type hydatid cyst:

Round,
unilocular, osseus,
brownies, alveolar
thick wall with
radial line,
3. 3 layer of cyst: host
Echinococcus contains Globular, 4 suckers,
tissue, laminated
granulosus Proglotid I: immature
onchosphere protrude rostellum membrane, germinal
sexual organ layer
with 3 with 2 lines hooklets, Proglotid II:
hooklets reproductive organ 4. 2 type protoscolex:
Proglotid III: gravid with invaginated &
1 center 12-15 evaginated

5. If hydatid cyst
Hydatid cyst circulate in blood:
contains: brood anapylatic reaction
capsule,
6. DOC: surgeon,
protoscolex,
praziquantel
daughter cyst
 Intestinal Trematode
Morphology
Species Life Cycle Clinical Features
Egg Adult Worm

1. Infective stage:
Metacercaria

2. 2nd intermadiate
host: water plants

3. Fasciolopsis attach
Fasciolopsis 1. Ellipsoid, leaf like body
Ellipsoid, yellow- to duodenum mucose
buski brown, thin 2. Ventral sucker > oral sucker
wall -> inflammation +
walled, small 3. No cephalic cone, no shoulder
ulceration -> decrease
operculum, 4. 2 tandem dendritic testis
B12 serum -> decrease
unembryonated 5. Glandula vitellaria along body
hematocryte
6. Coiled uterus
4. DOC: Praziquantel

1. Infective stage:
Metacercaria

2. 2nd intermadiate
host: fish
Heterophyes (not shown)
3. Sometimes egg
heterophyes embryonated egg 1. Pyriformis, rounded anterior, widen could enter into
posterior systemic circulation,
2. Has 3 sucker: ventral sucker > oral lympatic,
sucker, genotyl sucker extraintestinal organ
3. 2 sided testis in posterior
4. Round ovarium in anterior testis 4. DOC: Praziquantel
5. long coiled uterus
 1. Ventral sucker > oral
sucker 1. Infective stage:
Metacercaria
2. Has circumoral
spines in anterior 2. 2nd intermadiate
host: mollusca, fish,
4. 2 caecum, uterus tode
Ellipsoid, yellow- contains egg, round
Echinostoma 3. Attach to intervillus
brown, thin walled, ovarium in anterior
space in intestine ->
small operculum, testis
inflammantion +
unembryonated
ulceration
(smaller than F. buski) 5. 2 lobulated tandem
testis
4. DOC: Praziquantel
6. glandulla vitellaria
three-fourth

1. Infective stage:
Metacercaria

2. 2nd intermadiate
host: fish

3. Egg could deposited

Metagonimus (not shown) in brain tissue, spinal
yokogawai embryonated egg cord, heart
1. Similar to H. heterophyes
2. Has two sucker, oral and ventral
4. Infected if eaten
sucker
sushi fish in endemic
3. Oral sucker in lateral, ventral sucker area
right curved
4. Uterus between testis and vental 5. DOC: Praziquantel
sucker
 Liver Trematodes
Species Morphology Life Cycle Clinical Features
Egg Adult Worm

1. Infective stage:
Metacercaria

Fasciola 2. 2nd intermediate

hepatica
1. Flattend dorsoventral, leaf like host: water plants
2. has cephalic cone, has shoulder
3. Branching caecum 3. F. hepatica infects
4. Oral sucker similar to ventral sucker humans, F. gigantica
5. Glandula vitellaria along the body infects animals
6. short uterus, 2 tandem dendritic
testis 4. F. hepatica migrate
from duodenum
Ovoid, small penetrate to
operculum, peritonium cavity ->
yellow-brown, not liver -> bile duct
segmented,
unembryonated 5. Can cause
hiperplasia,
desquamation bile
duct
Fasciola 1. Flattend dorsoventral, leaf like,
gigantica longer than F. hepatica 6. DOC:
2. Longer cephalic cone Trichlabendazole or
3. Branching caecum alternatively
4. Ventral sucker > oral sucker
5. Glandula vitellaria along the body
6. short uterus, 2 tandem dendritic
 1. Oral sucker > ventral 1. Infective stage:
sucker Metacercaria

2. Lancet like body 2. 2nd intermediate

host: fish
3. 2 lobulated tandem
testis 2. Habitate in bile duct
Clonorchis Ovoid, bulb like, predispotition to
sinensis convex operculum, 4. glandulla vitellaria cholangiocarcinoma
yellow-brown, Rim one-third in
near operculum, mediolateral 3. Not penetrate
contains mirasidium intestinal wall, but
5. long caecum with no migrate to liver via
branch ampulla vaterii

4. DOC: Praziquantel

1. Infective stage:
Metacercaria
1. Oral sucker sub
terminal, ventral 2. 1st intermediate host O.
felineus: Bulimus spp.
sucker 1/5 anterior
3. 1st intermediate host O.
2. Lancet like body viverrini: Bithynia spp.

Opisthorchis Ovoid, thick wall, 3. 2 lobed oblique 4. Habitate in intrahepatic

felineus & convex operculum, testis bile duct and pancreatic
Opisthorchis yellow-brown, No rim duct, cholangio Ca
viverrini near operculum, 4. Round ovarium in predisposition
contains mirasidium midline
5. Not penetrate intestinal
wall, but migrate to liver
5. glandulla vitellaria
via ampulla vaterii
one-third in
mediolateral 6. DOC: Praziquantel
 Lung Trematodes
Morphology
Species Life Cycle Clinical Features
Egg Adult Worm
1. Infective stage:
Metacercaria

2. Habitate cyst in lungs,

2nd Intermediate host:
ketam

Paragonimus 3. Clinical feature similar

westermani 1. Ellipsoid, robust like to Tb (dyspneu, fever,
Ovoid, operculum, 2. Spined cuticula red sputum, chest pain)
yellow-brown, 3. brown-golden color
thickened posterior 4. Ventral sucker = oral sucker 4. DOC: Bitionol or
wall, 5. lobed testis, side by side alternatively
6. lobed ovarium, posterior ventral Praziquantel
sucker
Blood Trematodes
Morphology
Species Life Cycle Clinical Features
Egg Adult Worm
1. Infective stage:
Serkaria, infects
percutaneous, adult in
hepar

2. Schistosoma egg
secrete proteolitic that
can penetrate intestinal
Schistosoma wall
japonicum
3. Habitate: V.
Ovoid, transparent to mesenterica superior
pale yellow, small 1. No tubercle (Apple's skin) (small intestine)
spine in lateral, 2. 6-8 testis
contains mirasidium 3. Medial ovarium 4. Intermediate host:
snail (Oncomelania)

DOC: Praziquantel
 1. Infective stage:
Serkaria, infects
percutaneous

2. Schistosoma egg
secrete proteolitic that
can penetrate intestinal
Schistosoma wall
mansoni
(Bilharziasis) Ellipsoid, pale yellow, 3. Habitate: V.
mesenterica inferior
prominent triangular
(colon)
spine in
1. Rough tubercle (Durian's skin)
posterolateral, thin
2. 8-9 testis 4. Intermediate host:
smooth wall, contains
3. Anteromedial ovarium snail (Biomphalaria)
mirasidium
DOC: Praziquantel

1. Infective stage:
Serkaria, infects
percutaneous

2. Schistosoma egg
secrete proteolitic that
can penetrate intestinal
wall
Schistosoma
3. Hematuria, polyuria,
haematobium disuria

Ellipsoid, grey pale 3. Habitate: V. Vesica

yellow, prominent 1. Smooth tubercle (Salak's skin) Urinaria , telur keluar
di urine
terminal spine , thin 2. 4-5 testis
smooth wall, contains 3. Posteromedial ovarium 4. Intermediate host:
mirasidium snail (Bulinus)