PARASITOLOGY : LESSON 2- EXTRAINTESTINAL NEMATODES 1st SEM 2020-2021

EXTRAINTESTINAL NEMATODES:
Trichinella spiralis
Characteristics:
1. Commonly referred to as “pork muscle roundworm or trichina worm”.
2. Adult female is viviparous or larviparous.
3. Infective stage is encysted larva which maybe acquired through ingestion from inadequately cooked pork.
4. Adult worm lives in the small intestine while larva encyst on striated muscles.
Life cycle:
Trichinosis is acquired by ingesting meat containing the encysted larva. After exposure to gastric acid and pepsin, the larva is released
from the cyst and invade the small bowel mucosa where they develop into adult worms. Life span in the small bowel is 4 weeks. After 1 week, the
female releases a larva that migrate to the striated muscles where they encyst. Encystment is completed in 4-5 weeks and the encysted larva may remain
viable for several years. One female worm produces approximately 1500 larva. Man is the terminal host. The reservoir includes most carnivorous and
omnivorous animals.

Pathogenesis: T. spiralis can cause Trichinosis or Trichinelliasis

a. intestinal involvement __________________________________________
b. larval migration ________________________________________________
c. muscle encystment _____________________________________________

Morphology:
Adult worms are whitish in color. Male measures 1.5 mm x 0.04 mm. Female measures 3.5 mm x 0.06 mm. Larva measures 80-120 u, x 5-6 um.
and with spear like burrowing anterior tip.

Laboratory Diagnosis:
At the diarrhoeal stage, adults and larva maybe found occasionally in feces.
1. Muscle biopsy- maybe used during the encysment stage
2. Skin test / Intradermal test
3. Biochemical test ( CPK, LDH, Myokinase )
4. Serologic tests ( CF test. Latex agglutination test,Hemagglutination, Fluorescent Antibody test )
5. Animal Inoculation

BLOOD AND TISSUE NEMATODES

General characteristics:
1. ___________________________________________________
2. Arthropod transmitted __________________________________
3. Infective stage to man __________________________________ infective to vector______________________________
4. Mode of transmission _____________________________________
5. Specimen for diagnosis __________________________________ diagnostic stage ____________________________

Specie Common name Habitat Mode of Arthropod vector Periodicity

Transmission
Wuchereria Bancroft’s Filaria Lower lymphatics Mosquitoes ( Aedes, Culex, Nocturnal periodic
bancrofti Anopheles and Mansonia )
Brugia malayi Malayan Filaria Upper lymphatics Mosquitoes Nocturnal sub-periodic
( Mansonia spp. )
Loa loa Eyeworm Subcutaneous Skin Inoculation Chrysops fly/ Deerfly/ Mango fly Diurnal periodic
tissues
Onchocerca Convoluted Simulium fly/ Black fly
volvulus Filaria
Dipetalonema Persistent Filaria Body cavities Culicoides fly Non-periodic
perstan
Mansonella Ozzard’s Filaria
ozzardi

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PARASITOLOGY : LESSON 2- EXTRAINTESTINAL NEMATODES 1st SEM 2020-2021

Mansonella streptocerca
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________

Dirofilaria immitis
Common name: Dog heartworm
A filarial worm of dogs, can produce peripheral nodules in the lungs referred to as “Coin Lesions”
________________________________________________________________________________

General Life cycle of Filarial Worms:

Microfilaria ingested by arthropod vector. Microfilaria penetrates the midgut and passes through the thoracic muscles. Microfilaria develops into
first, second and third stage larva ( L1 , L2, and L3). After 6-20 days , third stage larva ( L3 ) force their way out of the muscles and migrate toward
mosquito’s head. Third stage larva injected to man through bites. Third stage larva develops into maturity in the lymphatics, tissues and body
cavities. Adult female give birth to a larval embryo which is known as Microfilaria. Microfilaria appears in the blood one year after infection.
Microfilaria goes to the peripheral blood depending on its periodicity.
Host Requirement:
1. Definitive host _________________________________________________
2. Intermediate host ______________________________________________

Two Important Properties of Microfilaria:

1. It exhibits periodicity ( rhythmical appearance of microfilaria in the peripheral blood )
Classification of Microfilaria according to periodicity
a. periodic -
 if there is a required time for the microfilaria to appear in the peripheral blood
1. nocturnal periodic - night
2. diurnal periodic - day
b. sub-periodic
 if microfilaria can be recovered both at day and night time
1. nocturnal sub-periodic - if the peak count is at night
2. diurnal sub-periodic - if the peak count is at day
c. non-periodic
 if the count in both night and day are the same.
2. Microfilaria may be sheathed or unsheathed

Morphology of Microfilaria
Specie Possession of Sheath Distinguishing feature
Wuchereria bancrofti Nuclei do not extend to the tip of the tail
Brugia malayi SHEATHED With two distinct terminal nuclei
Loa loa Nuclei extend to the tip of the tail
Onchocerca volvulus Nuclei do not extend to the tip of the tail and microfilaria
does not appear in the peripheral blood.
Dipetalonema perstans UNSHEATHED Nuclei extend to the tip of the tail
Mansonella ozzardi Nuclei do not extend to the tip of the tail

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PARASITOLOGY : LESSON 2- EXTRAINTESTINAL NEMATODES
Specie Geographic Distribution
Wuchereria bancrofti Indigenous throughout the
warmer regions of the globe.
It is hyper- endemic in South
East Asia and the Polynesian
Islands.
Brugia malayi Found only in South East
Asia
Loa loa Indigenous in Central and
West Africa.
Onchocerca volvulus Occurs in equatorial Africa,
with the exception of the east
coast; and in Guatemala and
Southern Mexico.
Prepared by : DR. MA. CRISTINA LIWANAG
Morphology of Adult
Adults are long, female 8-10
cm x 0.25 mm being larger
than male 4 cm x 0.1 mm.
Adult worms are 2-5 cm x 0.1-
0.2 mm.
Adults range in size from 3-7
cm x 0.3- 0.5 mm. , the
female being slightly larger
than the male.
Adult worms are long, female
being markedly larger ( 30-50
cm x 0.3-0.4 mm ) than male (
2-4 cm. x 0.1-0.2 mm. )
1st SEM 2020-2021
Pathogenesis
Bancroftian filariasis. Adult worms provoke
inflammatory and obstructive changes
particularly in the lymph glands. Inflammation
results in toxemia , fever and local pain.
Obstruction of the lymph channels results in
stagnation of the lymph and and dilatation of
the vessels with following hyperthrophy and
fibrosis of the affected tissues, leading
eventually to elephantiasis, especially of the
limbs and scrotum. . Those infected may
produce Milky urine
Tropical Pulmonary eosinophilia/ Occult
filariasis
Malayan Filariasis. The elephantic lesions are
more frequent in the upper limbs and are rarely
observed in the lower limbs or scrotum.
Temporary inflammatory swellings (
Calabar or Fugitive swelling ) are provoked
by migratory adults. They cause pain, and
inconvenience, especially when in the
neighborhood of the eyes or the bridge of the
nose
Onchocerciasis or Blinding Filariasis. Adult
worms in the subcutaneous tissues give rise to
local inflammatory reaction and fibrotic
nodules, each of which generally contains a
male and female worm. The characteristic
nodules are not usually painful unless situated
over a joint, but they may be intensely pruritic.
Much more serious are the ocular lesions
which results from invasion of the eye by
microfilaria and their death therein, giving rise
to inflammatory reaction. Blindness not
infrequently follows.
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PARASITOLOGY : LESSON 2- EXTRAINTESTINAL NEMATODES 1st SEM 2020-2021

Dipetalonema perstans
Mansonella ozzardi
Widely distributed in the
tropical areas of Africa and
Central and South America
Occurs extensively in South
America and the West Indian
Islands.
The adult worms are slightly Infection is essentially symptomless.
larger than the adults of Loa
loa. Inhabits the connective
tissue of the mesenteries and
the peritoneal cavities; more
rarely they occur in the
pericardial and pleural
cavities.
Adult worms are similar in
size to those of D. perstans.

Laboratory Diagnosis of Filariasis

1. Examination of Peripheral Blood Smear
2. Knott’s Concentration Technique
3. Filtration using Nucleopore filter.

Reasons why Microfilaria may not be demonstrable in the peripheral blood in Chronic Infections:
1. low intensity of infection
2. dead worms
3. obstructed lymphatics

Dracunculus medinensis
Characteristics:
1. Commonly known as Guinea worm/ serpent worm or dragon worm.
2. It inhabits the subcutaneous tissues.
3. It can cause Dracontiasis. The mode of transmission is through ingestion of the infective larva from infected copepods. Migration of the gravid
female causes allergy and eosinophilia. Local lesions develops into ulcers with discharge of embryos and some fibrosis. There is often
secondary bacterial infection, and sometimes arthritis of the knee and ankle.
4. Recovery of larva after placing a drop of water on skin ulcers is the usual means of detection. Adult female can be removed from the ulcer by
winding it slowly onto a stick.
5. Infective stage : third stage larva / diagnostic stage : first stage larva\

Life Cycle:
Larva from infected copepod ingested by man. Larva digested out in the stomach, penetrates the intestinal wall and develops into adult worm in
the body cavities. Adult worm goes to the skin and produce blisters. In water, from open blisters, adult discharges larva. Larva in water ingested by
copepods.

Angiostrongylus cantonensis
Characteristics:
1. Commonly known as Rat Lung Worm Definitive Host : ____________________ Intermediate Host _____________
2. Lives in the pulmonary arteries of rats
3. Can cause Eosinophilic meningoencephalitis in man which can be diagnosed through CSF examination, CT scan, and serologic tests.

Life cycle involving man:

Adult worm in pulmonary arteries of rats, adult female produces egg. Egg embryonates in blood stream and after 6 days, first stage larva
hatches from the egg. First stage larva expelled in feces of rats. Larva is then ingested by a Molluscan which acts as the intermediate host or the
larva may gain access thru penetration. In the mollusk, first stage larva undergoes two molts to reach the infective third larval stage. Man ingest third
stage larva, passes through the stomach. Third stage larva enters circulatory system and migrate to the brain or the spinal cord. Larva undergo two
molts before they reach maturity. After the final molt, adult migrate to the pulmonary arteries to complete their development. After 2 weeks, adult
female start to lay eggs.

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PARASITOLOGY : LESSON 2- EXTRAINTESTINAL NEMATODES 1st SEM 2020-2021

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