Extra - Intestinal Nematodes

Extra - Intestinal Common Associated Morphology Clinical Symptoms Laboratory Diagnosis Treatment
Nematodes Name Disease

Trichinella spiralis Trichina Trichinosis Size Shape ➔ “Great imitator” - infected ➔ Examination of the skeletal ➔ Plenty of rest
worm Trichinellosis patients may experience a muscle (tissue and biopsy ➔ Adequate fluid intake
ENCYSTED LARVAE - coiled ENCYSTED LARVA variety of symptoms that often medicine – method of choice ➔ fever reducers and pain relievers
ave. size - 75 to 120 um by 4 to 7 um Notable feature - inflammatory infiltrate mimic those of other diseases ➔ muscle biopsy ➔ SEVERE INFECTION – prednisone
Settle by coiling up in muscle fibers and present and around nurse cell and conditions ➔ eosinophilia and or thiabendazole
becoming encysted ➔ Light infection-diarrhea, fever, flu leukocytosis ➔ steroids
NURSE CELL - striated muscle cell; ADULTS or asymtpmatic ➔ serologic tests - uncommon
surrounds the coiled larva Female - blunt, rounded posterior end and ➔ Heavy infection (Intestinal ➔ clinical chemistry tests - - trichinellosis - can be asymptomatic
Ave. mature size (fully developed larva) - a single ovary with a vulva located in the invasion) - gastrointestinal Elevated serum muscle for years
up to 1 mm in length anterior fifth of the body symptoms such as vomiting, enzyme levels, such as
Male - thin anterior end with a small mouth, nausea, abdominal pain, lactate dehydrogenase,
ADULTS long and slender digestive tracts; curved diarrhea, headache, fever aldolase, and creatinine
Female - 4 by 0.5 mm posterior end with two somewhat rounded ➔ Larval migration into the muscle phosphokinase
Male - 2 by 0.04 mm appendages tissues - one week after infection
claspers - cloaca; clasping papillae - Eosinophilia, pain in the pleural ↑ in creatinine - kinase
Similar to both: thin anterior end; small area, fever, blurred vision, ↑ in lactate dehydrogenase
mouth; long slender digestive tract edema, cough eventually death ↑ in SGPT
➔ muscular discomfort, edema, - this are the basic muscle
local inflammation, overall enzyme
fatigue and weakness - larvae
settle into striated muscle
➔ Myocarditis, CNS involvement,
and pneumonitis

Dracunculus Guinea Dracunculosis LARVAE - two larval stage LARVAE ➔ Symptoms are usu. asso. with ➔ may be recovered by TOTAL WORM REMOVAL
medinensis worm Dracunculiasis rhabditiform larvae - 1st stage; diagnostic rhabditiform - tail makes up ⅓ of the body allergic reactions as migration of observing infected ulcers for 1. Placing the affected body part, in the
Guinea worm stage; 620 by 15 um in size length and culminates in a point the organism occurs the emergence of the worms form of a blister, in cool water.
Fiery serpents - resp. infection 3rd stage - reside in the intermediate host ➔ secondary bacterial infections ➔ induced rapture of the 2. In this step, the adult worm breaks
for the plague that ADULTS ➔ ulceration and subsequent toxic infected ulcers by immersing through the blister,
affected the Israelites ADULTS - one of the largest adult Female - elongated; has a prominent blunt, reactions in cool water reveals the first 3. It is important at this juncture to clean
who lived by the RED nematode rounded anterior end ➔ due to unsuccessful worm stage larvae the resulting wound thoroughly.
SEA Female - 840 mm by 1.5 mm Male - anterior end coils itself at least once removal – nodule formation, 4. Manual extraction of the entire worm
Male - 21 by 0.4 mm death and calcification of an by winding it around a stick or a
adult worm similar item that creates tension.
– visible to the naked eye 5. Once the worm is removed, apply
topical antibiotics to the wound site to
avoid 2ndary infection.

Angiostrongylus Rat common cause of LARVAE ADULTS ➔ Incubation period of A. - There is no specific treatment
cantonensis lungworm human eosinophilic 1st stage - about 0.3 mm long and 0.015 Female - “barber pole” shape down the cantonensis ave. 1 to 3 weeks but - There is some evidence that certain
meningitis (neural mm in width middle of the body, which is created by the has a range from 1 day to >6 supportive treatments may reduce
angiostrongyliasis) 2nd stage - about 0.45 by 0.03 mm twisting together of the intestine and uterine weeks the severity of headache and the
and occasional 3rd stage - similar in size, though a little tubules ➔ People present with symptoms of duration of symptoms
ocular disease thinner Male - have a small copulatory bursa at the bacterial meningitis, such as
4th stage - reach about 1.0 by 0.4 mm posterior nausea, vomiting, neck stiffness,
and headaches that are often
newly molted sub-adults - about 2 mm by global and severe
0.06 mm; they grow to about 12 mm ➔ Additionally, abnormal sensations
 (females) and 11 mm (males) before of the arms and legs can occur
leaving the rat’s brain and migrating to the
pulmonary arteries where they mature,
reaching a size of up to about 35 by 0.6
mm (females) and 25 by 0.4 mm (males)

ADULTS
Female - 21 - 25 mm in length
Male - 15 - 19 mm in length

Visceral Larva Migrans - affect the visceral organs

Toxocara canis Dog Patent infections EGGS EGGS ➔ Main clinical presentation: ➔ For both VLMand OLM, a Albendazole
roundworm are more prevalent T. canis - slightly larger (80-85 um) Toxocara eggs are golden in color, ◆ Visceral larva migrans (VLM) presumptive diagnosis rests Mebendazole
T. canis - infects among young T. cati - 66-75 um spherical to slightly pear shaped, ◆ Ocular larva migrans (OLM) on clinical signs, compatible Symptomatic therapy
essentially all wild and puppies than older thick-shelled , and have a pitted surface. It ➔ Larvae invade multiple tissues exposure history laboratory
domestic canids dogs LARVAE is extremely hardy and can persist in the (commonly liver, lung, skeletal findings(including
Toxocara spp. developed to third stage (L3) environment for years muscle, occasionally heart) and eosinophilia), and the
larvae in ovo. cause various nonspecific detection of antibodies to
Toxocara cati Cat Patent infections LARVAE - straight esophagus extending symptoms (e.g fever, myalgia, Toxocara spp.
roundworm are slightly more L3 larvae (when hatched) - 350-400 um about a third of the body length weight loss,cough, rashes, ➔ ANTIBODY DETECTION -
t. cati - found in wild common in kittens long and about 15-20 um in max. width hepatosplenomegaly) usu. the only means of confirming
and domestic fields of ADULT accompanied by Toxocara spp.
all ages ADULT - have “three lips”on the anterior end of hypereosinophilia. ◆ Enzyme immunoassays
Female - 6 -10 cm long the worm ➔ Neurotoxocariasis (neural larva (EIA) withlarvalstage
Male - 4-6 cm long - possess large, spear-shaped cervical migrans)-eosinophilic antigens extracted from
ale, which are broader in T. cati than T. meningoencephalitis. Death can embryonated eggs or
canis occur in instances of severe released in vitro by culture
T. cati - broad/ cervical ale with striations cardiac,pulmonary, or neurologic third-stage larvae.
Toxocara cati - prominent digiform point at involvement. ◆ Toxocara
the posterior extremity ➔ OLM - ophthalmologic lesions, excretory-secretory
andmaycause diffuse unilateral antigens(TES) - preferable
subacute neuroretinitis(DUSN) than the larval extract bec.
it is convenient to produce
and absorption and
purification step is not
required for obtaining max.
specificity
- cultured in vitro
◆ TES-ELISA used at CDC
measures total
Toxocara-specific
immunoglobulin and results
are reported as an endpoint
titer. A titer of ≥ 1:32 is
considered positive.

Cutaneous larva Creeping FILARIFORM LARVAE FILARIFORM LARVAE ➔ Incubation period may take Cutaneous larva migrans (CLM) ➔ Signs and symptoms may resolve
migrans: eruptions - Infective 3rd (L3) stage - 500 - 600 um long Infective 3rd (L3) stage - pointed tail and several days and may be delayed is clinical diagnosis based on without medical intervention
zoonotic striated sheat; found in the environment for several weeks and months the presence of characteristics, ➔ Treatment may be done to alleviate
Ancylostoma disease that ADULT and infect the human host by penetration of ➔ The most common symptom is signs and symptoms, and signs and symptoms and prevent
braziliense don’t use Male - approx. 8-12 mm long the skin intense pruritus, which usually exposure history to zoonotic secondary bacterial infection
Ancylostoma caninum humans as Female - approx. 10 - 15 mm long Male - bursate with 2 spicules that do not develops first, followed by the hookworm. ➔ Anti- parasitic drugs may be used:
Uncinaria stenocephala definitive Adults of both sexes have a buccal capsule
host. containing either:
A. Caninum - 3 pairs of teeth
A. Braziliense - 2 pairs of teeth
U. Stenocephala - cutting plates
fuse at their distal ends appearance of an irregular raised ◆ ALBENDAZOLE
track with erythema. ◆ IVERMECTIN
➔ Complications may develop such
as vesiculobullous lesions and
edema or rarely folliculitis.
➔ Less common disease
manifestations include
eosinophilic enteritis, ocular larva
migrans and diffuse unilateral
subacute retinitis (DUSN)

Trichinella spiralis But are also found in Australia, some areas of the Africa, the Caribbean, Hawaii Thorough cooking of food or thorough washing of vegetables when eaten raw
and Louisiana Proper hand washing utensils after preparing raw snails
Life Cycle (CDC) Outbreaks of human angiostrongyliasis have involve a few hundred of persons;
over 2,800 cases have been reported in the literature from approximately 30 Toxocara canis and Toxocara cati - paratenic host rangers for both species
1. After exposure to gastric acid and pepsin, the larvae are released from the encompass numerous species of mammals and birds
countries
cysts
2. Invade the small bowel mucosa where they develop into adult worms Dracunculus medinensis Some humans cases have been linked to consumption of undercooked beef,
3. Females are 2.2 mm in length; males 1.2 mm. The life span in the small bowel lamb, chicken, and duck meat (particularly liver)
is about four weeks. After 1 week, the females release larvae Life Cycle (CDC)
4. That migrate to striated muscles where they encyst Principle of TES - if the patient have antibodies against this antigen the
5. Diagnosis is usually made based on clinical symptoms, and is confirmed by 1. Following ingestion, the copepods die and release the larvae, which presence of the antigen and antibody will result to a reaction
serology or identification of encysted or non-encysted larvae in biopsy or penetrate the host stomach and intestinal wall and enter the abdominal
cavity and retroperitoneal space - detected through enzyme immunoassay
autopsy specimens.
2. After maturation into adults and copulation, the male worms die and the
Special Consideration in TES-ELISA - can detect asymptomatic and past
Dracunculus medinensis females (length: 70 to 120 cm) migrate in the subcutaneous tissues
infection of Toxocara
towards the skin surface
Prevention and Control: 3. Approximately one year after infection, the female worm induces a blister 1. The assay detects infections caused by both T. canis and T. cati
on the skin, generally on the distal lower extremity, which ruptures. When but cannot differentiate between the two.
● Use of properly treated water for consumption (boiling water)
this lesion comes into contact with water, a contact that the patient seeks 2. Evaluation of the true sensitivity and specificity of serologic test
● Prohibiting the practice of drinking and bathing the same water
to relieve the local discomfort, the female worm emerges and releases for toxocariasis in human populations is not possible.
● Ceasing the practice of allowing standing water to be ingested
larvae 3. When interpreting serologic findings, clinicians must be aware
● Filtering water using a finely meshed filter
4. The larvae are ingested by a copepod that a measurable titer does not necessarily indicate current
Angiostrongylus cantonensis - known as the multiple rat species as definitive hosts, 5. After two weeks (and two molts) have developed into infective larvae clinical Toxocara infection.
including black rats (Rattus rattus), brown rats (Ratus norvegicus), and cotton rats 6. Ingestion of the copepods closes the cycle.
(Sigmodon hispidus) Paired serum sample - demonstrating a significant rise in antibody level over
Angiostrongylus cantonensis time may be used to confirm active infection
- Gastropods (snail and slug) intermediate hosts are numerous that includes:
- parasitic nematode that can cause severe gastrointestinal or CNS Epidemiology:
● Achatina spp.
disease in humans
● Biomphalaria sp.
- prevalent in Southeast Asia and tropical Pacific islands T. canis and T. cati are cosmopolitan parasites of domestic dogs and cats.
● Bulinus spp.
- infection had been identified in other areas, including Africa, the While common globally, prevalence in both animals and people is highest
● Lymnaea sp.
Caribbean, and the US in developing countries. In developed countries, more infections are
● Promaecea spp.
- adult live in the pulmonary arteries and right ventricle of the normal detected among persons in lower socioeconomic strata.
- nematode roundworm with 3 outer protective collagen layers and a simple
definitive host
stomal opening with no lips or buccal cavity leading to a fully developed Cutaneous Larva Migrans
gastrointestinal tract Toxocara spp.
Bunostomum phlebotomum - cattle hookworm; capable of causing short-lived
Epidemiology Prevention and Control CLM in humans

● Most cases of infection are diagnosed in Southeast Asia and the Pacific Basin Education and awareness
Removing snails, slugs, rats found near houses and gardens
 The cycle in the definitive host is very similar to the cycle for the human
species, which involves tracheal migration to the small intestine.

Epidemiology:

● Ancylostoa caninum is broadly distributed in wild and domestic canids and

felids worldwide.
● A. braziliense occurs in the Southeastern US, Latin America, South America,
and Africa and has been reported spradically in the Australassian region.
● Uncinaira stenocephala is found in dogs and cats in cool-weather regions of the
Americas, Europe, Asia, Australia, and New Zealand.

Prevention and Control:

● Wearing shoes and taking protective measures especially when contact with
sand and soil
● Regular or routine veterinary care of dogs and cats
● Prompt and proper disposal of animal feces.