MEDICAL

BIOLOGY
Lesson 6 Nematoda
 Phylum Nematoda – Round worms
25,000 species have been described,
of which more than half are parasitic
• have a fusiform or thread-
like body
• have tubular digestive
system with openings at
both ends
• the head is radial symmetric,
while the body is bilateral
symmetric
• organ of excretion is either
primitive or absent
• mostly dioecious − have
separate male and female
individuals
 no segmentation
 no respiratory system
 no blood system
 no appendages
 no hard skeleton
Male nematode. 1 mouth
opening, 2 intestine, 3
cloacal opening, 4 organ of
excretion, 5 testis, 6
circumpharyngeal ring of
nervous system, 7 dorsal
trunk of nervous system, 8
ventral trunk of nervous
system, 9 excretion pore
 Philum Nematoda – Roundworms
Ascaris lumbricoides − Large human Ascaridiasis
round warm
Enterobius vermicularis − Pinworm Enterobiasis
Ancylostoma duodenale − Old World
Ancylostomiasis
hookworm
Necator americanus −New World Necatoriasis
hookworm
Trichuris trichiura − Whipworm Trichuriasis
Trichinella spiralis − Trichina worm, Pork Trichinosis
worm
Dracunculus medinensis −Guinea worm Dracunculosis
Wuchereria bancrofti - Bancroft’s filarial Lymphatic filariasis
worm Brugia malay, B. timori Wucheriasis
Dirofilaria conjunctivae, repens, D. immitis Dirofilariasis
Strongyloides stercoralis − Thread worm Strongyloidiasis
 Ascaris lumbricoides - Large
roundworm of man
DISEASE NAME: ascariasis
GEOGRAPHICAL DISTRIBUTION:
world wide, highest prevalence in
tropics and subtropics
HABITAT: small intestine
DEFINITIVE HOST: only man
INTERMIDIATE HOST: none
RESERVOIR HOST: none
INFECTIVE FORM: eggs
DIGNOSTIC FORM: eggs and adults
MODE OF INFECTION: ingestion

Diagnostic characteristics
include tapered ends and size
(length 15 - 35 cm; the females
tend to be larger).
 Ascaris lumbricoides

later stage with a larva

early stage with an embryo

fertilized eggs in a wet mount,

200× magnification.
Close-up of the anterior of an adult
A. lumbricoides. Note the three 'lips.'
Ascaris life cycle 1. Adult worms live in the lumen of the
small intestine. A female produces
approximately 200,000 eggs per day,
which are passed with the feces
2. Fertile eggs embryonate and
become infective after 18 days to
several weeks, depending on the
environmental conditions. 4. After
infective eggs are swallowed, the
larvae hatch, and 5, invade the
intestinal mucosa, and are carried via
the portal vein, then systemic
circulation to the lungs. 6. The larvae
mature further in the lungs (10 to 14
days), penetrate the alveolar walls,
ascend the bronchial tree to the
throat, and are swallowed. 7. Upon
reaching the small intestine, they
develop into adult worms 8. Between
2 and 3 months are required from
ingestion of the infective eggs to
oviposition by the adult female. Adult
worms can live 1-2 years.
 Clinical features of
ascaridiasis
the most common human nematode infection

discomfort and pain in the abdomen, diarrhea

inflammation of the bowel
When the worms are numerous, these symptoms
are intensified and may simulate those of gastric and duodenal ulcers and other
abdominal diseases. They also can block up the intestine.
Although their “home “ is the small intestine, the worms may then enter other
organs and cause serious problems, including:
enter and block the bile duct that brings the bile from the liver to the small
intestine
Enter the appendix and cause appendicitis;
Exceptionally, enter other locations, such as the ear or the genito-urinary
tract.
During the lung phase of larval migration, pulmonary symptoms can occur
(cough, dyspnea, hemoptysis, eosinophilic pneumonitis

In the cases of severe infection, bowel obstruction may put to death.

Worms leave dead corpse from the all openings possible (photo).
 Trichuris trichiura –
Whipworm (Trichocephalus trichuris)
DISEASE NAME: trichiuriasis
GEOGRAPHICAL DISTRIBUTION: worldwide,
prevalent in tropics
HABITAT: young – small intestine, adult -large
intestine
DEFINITIVE HOST: only man
INTERMIDIATE HOST: none
RESERVOIR HOST: none
INFECTIVE FORM: eggs
DIGNOSTIC FORM: eggs
MODE OF INFECTION: ingestion The anterior end is thiner
male 30-45 mm;
female 35-50 mm

Eggs are 50-55 by 20-25 µm, thick-

shelled and possess a pair of polar
“plugs” at each end.
Trichuris trichiura life cycle
 Trichuriasis distribution and clinical
features
The third most common roundworm
infecting humans. Distributed
worldwide, more frequent in areas with
tropical climate and poor sanitation
practices.
It is estimated that 800 million people are
infected worldwide; children being
most vulnerable.
Clinical presentation
Light infestations (<100 worms) are
frequently asymptomatic. Heavy
infestations may have bloody diarrhea
iron-deficiency anemia,
rectal prolapces,and vitamine A
deficiency Mechanical damage to the
mucosa may occur as well as toxic or
inflammatory damage to the intestines
of the host.
 Enterobius vermicularis − Pinworm
DISEASE NAME: enerobiasis
GEOGRAPHICAL DISTRIBUTION:
world wide
HABITAT: larva in the small
intestine, adults in the colon
DEFINITIVE HOST: only humans
male
INTERMIDIATE HOST: none
INFECTIVE FORM: eggs
DIGNOSTIC FORM: eggs, adults
MODE OF INFECTION: ingestion
(selfinfection, crossinfection);
retroinfection
Adult male is 0.1-0.2 mm wide; adult females
measures 8-13 mm long by 0.3-0.5 mm
wide. Adult males have a blunt tail with a single
spicule; females possess a long pointed tail. In
both sexes, there are cephalic expansions
posterior end of female
Enterobius vermicularis Eggs are deposited on perianal folds 1. Self-
infection occurs by transferring infective
life cycle eggs to the mouth with hands that have
scratched the perianal area 2. Person-to-
person transmission can also occur through
handling of contaminated clothes or bed
linens. Some eggs may become airborne
and inhaled. These could then be swallowed
and follow the same development as
ingested eggs. Following ingestion of
infective eggs, the larvae hatch in the small
intestine 3. and the adults establish
themselves in the colon 4. The time interval
from ingestion of infective eggs to oviposition
by the adult females is about one
month. The life span of the adults is about
two months. Gravid females migrate
nocturnally outside the anus and oviposit
while crawling on the skin of the perianal
area 5. The larvae contained inside the
eggs develop (the eggs become infective) in
4 to 6 hours under optimal
conditions. Retroinfection, or the migration
of newly hatched larvae from the anal skin
back into the rectum, may occur but the
frequency of this is unknown.
 Clinical features of enterobiasis
• One third of individuals with pinworm infection are totally asymptomatic. The
main symptoms are pruritus ani and perineal pruritus, i.e., itchingin around
the anus and around the perineum.The itching occurs mainly during the
night, and is caused by the female pinworms migrating to lay eggs around
the anus.
• The itching leads to continuous scratching of the area around the anus,
which further results in tearing of the skin and complications such as
secondary bacterial infection, including bacterial dermatitis.
• A considerable proportion of infected children suffer from anorexia (i.e., loss
of appetite), weight loss, irritability, emotional instability, and enuresis(i.e.,
inability to control urination).
• Pinworms in women may move into the vulva and into the vagina, from there
moving to the external orifice of the uterus, and onwards to the uterine
cavity, fallopian tubes, ovaries, and peritoneal cavity can cause
vuvlovaginatus.
• The pinworms can also enter the urethra, presumably with the risk of
carrying intestinal bacteria with them.
• The pinworm infection causes symptoms of appendicitis to become
apparent.
Ancylostoma duodenale,
Necator americanus – hook worms
DISEASE NAME: hookwarm infection
(ancylostomiasis, necatoriasis)
GEOGRAPHICAL DISTRIBUTION:
prevalent in moist warm climate
HABITAT: small intestine
DEFINITIVE HOST: man, some other
mammals
INTERMIDIATE HOST: none
RESERVOIR HOST: cats, dogs
INFECTIVE FORM: filariform larva
DIGNOSTIC FORM: eggs
MODE OF INFECTION: active penetration –
Necator, mainly ingestion - Ancylostoma
Typical geohelminths

A. duodenale female – 9-15mm, N. americanus – 7-13mm; maile -7-10, 5-10 mm,

respectively. Oval egg with a thing shell is 57-76 µm by 35-47 µm. Ancylostoma
lives 4-5 years, Necator – 10-15 years.
Ancylostoma
duodenale
Necator americanus
 Ancylostoma duodenale,
Necator americanus
• The second most common human helminth
infection (after ascariasis)
• Geographic Distribution: Worldwide, mostly in
areas with moist, warm climate. Both N.
americanus and A. duodenale are found in
Africa, Asia and the Americas. Necator
americanus predominates in the Americas and
Australia, whilst only A. duodenale is found in
the Middle East, North Africa and southern
Europe.
Hookworm life cycle
 The Human Hookworms

On the ground
The life cycles of Ancylostoma duodenale and Necator
americanus are similar with some exceptions:

A. duodenale N. americanus

live on average 1–3 years 3–10 years

can infect by ingestion as only through the

well as via the skin
skin
Migrating larvae no grow and
develop in the
lungs
 Clinical Features of hookworm infection

• Iron deficiency anemia (caused by blood loss at the site

of intestinal attachment of the adult worms) is the most
common symptom of hookworm infection, and can be
accompanied by cardiac complications.
• Protein deficiency leads to dry skin, edema and potbelly
- gastrointestinal and nutritional/metabolic symptoms.
• Local skin manifestations ("ground itch") can occur
during penetration by the filariform (L3) larvae, and
respiratory symptoms can be observed during pulmonary
migration of the larvae.
Philippa C. Matthews 2012. TROPICAL MEDICINE NOTEBOOK
 Strongyloides
stercoralis. Rhabditiform
larva in stool.

Methods of infection
Filariform larvae enter skin in contact with soil
• Following direct larval development
• Following free-living cycle in the soil
Filariform larvae develop before leaving patient
• Following deposition on the soil, enter exposed
skin
• Enter perianal skin and initiate autoinfection
• Enter intestinal mucosa, migrate to lung and
initiate autoinfection
Cook_Zumla (eds.) 2008 Manson's Tropical Diseases 22nd Edition
Toxocara spp.
Symptoms Fever + eosinophilia
are non-human-derived • Hepatosplenomegaly
ascarids that are capable • Bronchospasm resembling asthma
• Hypergammaglobulinaemia
of undergoing limited • Myocarditis
development in the • Nephritis
human host. • Fits, neuropsychiatric symptoms, encephalopathy

Geographic Distribution Worldwide.

Philippa C. Matthews 2012. TROPICAL MEDICINE NOTEBOOK

 Trichinella spiralis − Trichina worm
DISEASE NAME: trichinosis (=trichinellosis)
GEOGRAPHICAL DISTRIBUTION: worldwide,
especially in pork-eating countries
HABITAT: small intestine, cysts in striated
muscles
DEFINITIVE HOST: man, rodents, bears, foxes,
dogs, cats, some marine mammals
RESERVOIR HOST: rodents, bears etc. Female 3-4 mm, male
INFECTIVE FORM: encysted larvae 1.4-1.6 mm long
DIGNOSTIC FORM: encysted larvae
MODE OF INFECTION: ingestion of
undercooked meat

Viviparous (=ovoviviperous, live-bearing)

species

Larva encysts in a single muscle cell,

modified according to its own requirements
 Trichinella spiralis − Trichina worm

Geographical distribution of
Simon Brooker and Donald A. P. Bundy. Ch. 85. Cook_Zumla (eds.) 2008
Manson's Tropical Diseases 22nd Edition
All the Trichina
life stages
develop in one
host

Larvae excyst in
small intestine,
burrow in intes-
tinal mucosa,
mature and
reproduce new
larvae. The
newborn larvae
migrate to striated
muscles and
encyst. To
complete the life
cycle, encysted
larva should be
eaten by a new
host
 Diagnosis of trichinosis
• Based on clinical symptoms and eosinophilia, can be confirmed by
specific diagnostic tests, including antibody detection, muscle biopsy
and microscopy.
• Clinical Features:
– Light infections may be asymptomatic. Intestinal
invasion leads to gastrointestinal symptoms
(diarrhoea, abdominal pain, vomiting).
– Larval migration into muscle tissues (one week after
infection) can cause periorbital and facial edema,
conjunctivitis, fever, hemorrhages, rashes and blood
eosinophilia.
– Myocarditis, central nervous system involvement, and
pneumonia. Larval encystment in the muscles
causes myalgia and weakness
– Eventually leads to death due to heart failure,
respiratory complications or kidney malfunction.
 Secondary biohelminth

Philippa C. Matthews 2012. TROPICAL MEDICINE NOTEBOOK

 Dracunculus medinensis -
Guinea worm
DISEASE NAME: drucunculiasis, guinea worm
disease
GEOGRAPHICAL DISTRIBUTION: initially in
wide range of tropical and subtropical
countries of Africa nad Asia, now in a marrow
belt of African countries and Yemen
HABITAT: abdominal cavity and
retroperotoneal space
DEFINITIVE HOST: mainly man, now also dogs
ITERMIDIATE HOST: copepods (small
crustacean)
RESERVOIR HOST: none
INFECTIVE FORM: stage 3 larvae
DIGNOSTIC FORM: adult female
MODE OF INFECTION: ingestion of copepods female 70-120 cm,
male only 4 cm
Ovoviviparous (larva develops in egg that is
retained in female’s body)
Dracunculus medinensis life cycle
Dracunculus medinensis life cycle
 Life Cycle
• Humans become infected by drinking unfiltered water containing
copepods (small crustaceans) which are infected with larvae of D.
medinensis.
• Following ingestion, the copepods are killed and release the larvae,
which penetrate the host stomach and intestinal wall and enter the
abdominal cavity and retroperitoneal space.
• After maturation into adults and copulation, the male worms die and
the females (length: 70 - 120 cm) migrate in the subcutaneous
tissues towards the skin surface (mainly in legs under knee, but also
in the other parts of the body)
• Approximately one year after infection, the female worm induces a
blister on the skin (generally on the distal lower extremity), which
ruptures.
• When this lesion comes into contact with water (a contact that the
patient seeks to relieve the local discomfort), the female worm
emerges and releases larvae into the water.
• The larvae are ingested by a copepod and after two weeks (and two
molts) have developed into infective larvae.
• Ingestion of the copepods closes the cycle.
• Clinical features. Female worms elicit allergic reaction
during blister formation causing an intense, burning pain. It
produce rashes, nausea, diarrhea, dizziness, and localized
edema. Upon rupture of the blister, allergic reactions
subside, but skin ulcers form, through which the worm can
protrude. Death of adult worms in joints can lead to arthritis
and paralysis in the spinal cord.
Only when the worm is removed is healing complete. The
procedure may take several days. No active antihelminthic
treatment is available
 ,

eastern Mali Chad WHO

During the mid-1980s an estimated
Southern western 3.5 million cases of dracunculiasis
Sudan Ethiopia occurred in 20 countries worldwide
(1), 17 countries of which were in
Africa. The number of reported
cases fell to fewer than 10 000
cases in 2007, dropping further to
542 cases (2012), 148 (2013), 126
(2014), 22 (2015), 25 (2016). In
2017, only 30 cases were
reported globally. In March 2018,
South Sudan, which reported
human cases until 2016,
announced it has succeeded in
interrupting transmission of the
disease.
 FILARIASIS
Eight main species infect humans

Three of these are responsible for most of the

morbidity due to filariasis: Wuchereria bancrofti and
Brugia malayi cause lymphatic filariasis,
Onchocerca volvulus causes onchocerciasis (river
blindness)

The other five species are Loa loa, Mansonella

perstans, M. streptocerca, M. ozzardi, and Brugia
timori (The last species also causes lymphatic
filariasis)
 Wucheria bancrofti - Bancroft’s filarial
worm
DISEASE NAME: wucheriasis (lymphatic
filariasus)
GEOGRAPHICAL DISTRIBUTION: tropical
and subtripical regions
HABITAT: adult - lymphatic system, larva –
mainly peripheral blood and lymph vessels
DEFINITIVE HOST: mostly man, some other
mammals
INTERMIDIATE HOST: mosquitoes
RESERVOIR HOST: none
INFECTIVE FORM: larvae
DIGNOSTIC FORM: larvae, adults
MODE OF INFECTION: specific inoculation
female 60-100 by
300 mm; male 40 by
100mm with curved
Ovoviviparous (larva develops in egg that tail
is retained in female’s body)
 Microfilaria of Wuchereria bancrofti collected by filtration with a Nucleopore
membrane and using Giemsa stain. The pores of the membrane are visible.

Laboratory diagnosis:
Identification of microfilariae by microscopic examination of blood samples (the blood
should be taken during their diurnal migration to peripheral blood, 10 p.m. to 2 a.m
Antigen detection, molecular diagnosis
Ultrasonography can detects the movements and noises caused by adult worms
Dead, calcified worms can be detected by X-ray examinations
 From Cook G.C. 2007. TROPICAL MEDICINE: AN ILLUSTRATED
HISTORY OF THE PIONEERS

Manson had seen a good deal of

elephantiasis as well as scrotal disease
(which he operated upon), caused by both
Wucheraria bancrofti and Brugia
Patrick Manson malayi.
(1844–1922)

Timothy Lewis, who had

demonstrated ‘embryos’ (microfilariae) of
W. bancrofti in both urine and peripheral
blood, as well as adult nematodes in an
elephantoid scrotum

Timothy Lewis (1841–86)

 Lymphatic filariasis Wuchereria bancrofti

Elephantiasis -presentation of lymphatic filariasis

W. bunckrofti inhabit the lymphatic and subcutaneous tissues, leading to an
inflammatory thickening of their walls, and associated tissues. Affected
tissues drastically increase in size.
 Elephantiasis -
presentation of
lymphatic
filariasis

W. bunckrofti
inhabit the
lymphatic and
Wuchereria bancrofti subcutaneous
tissues, leading to
an inflammatory
thickening of their
walls, and
associated
tissues. Affected
tissues drastically
increase in size.
 Clinical features of wucheriasis
Asymptomatic phase.
Inflammatory (acute) phase. The worms in the
lymph channels disrupt the flow of the lymph, This
results in fever, chills, skin infections, painful
lymph nodes, and tender skin of the lymphe-
dematous extremity. The syptoms often lessen in
5-7 days. Other symptoms include orchitis
(inflammation of the testes).
Obstructive (chronic) phase is marked by lymph
varicies, lymph scrotum, hydrocel, lymph in urine,
skin sickening and elephantiasis. Microfilariae are
not normally present in this phase. A key feature
of this phase is scar formation from affected
tissue areas. Elephantiasis affects men mainly in
the legs, arms, and scrotum. In women, the legs,
arms, and breasts are affected

Prevention
mosquito control, public education, screening.

Therapy: cleansing the skin, surgery, or the use of therapeutic drugs

 Geographical distribution of lymphatic filariasis

and onchocerciasis
(river blindness or Robles
disease). Most infections
occur in sub-Sahara Africa
Onchocerca volvulus causes
sucutaneous nidules. They
often get into the eye and
penetrate in all tessures. It is
not the nematode but its
endosymbiont bacteria,
Wollbachia pipientis, that
causes the severe inflamma-
tory response that leaves
many blind When the worms
die, their Wolbachia symbionts
are released, triggering a host
immyne system response that
can cause severe itching, and
can destroy optical tissue in
the eye. Humans are the only
Onchocerca definitive host
The intermediate host or
vector is the black fly
Simulium. The normal adult
worm lifespan is up to fifteen
years
Onchocerciasis:
depigmentation and leopard skin lichenified
Papules on skin
eczematoid
dermatitis of the
body and arms

Cook_Zumla (eds.) 2008 Manson's Tropical Diseases 22nd Edition

Skin microfilaria of O. volvulus. microfilariae of O.

volvulus in
subcutaneous tissue.
Males/females Onchocerca volvulus
The burden of onchocerciasis: children leading blind adults in Africa
 Loaosis)
• Disease agent Loa loa (30-70 мм)
• Specific vector – horse flies
Chrysops. Adult worms parasitize
in the subcutaneous tissue, under
the conjunctiva of the eye and
under serous membranes;
microfilariae (larvae) in the blood
vessels.
Philippa C. Matthews 2012. TROPICAL MEDICINE NOTEBOOK

Loa loa microfilariae in blood

FROM Garcia, L.S. 2007.
Diagnostic medical parasitology.
CLINICAL SYNDROMES

1 Subcutaneous migration
» • Pain, itching
» • Calabar swellings: limb oedema
» • Granulomatous reaction to adult worms ±
secondary bacterial infection
2 Eyes
» Visible worms migrating beneath conjunctivae
(usually last < 1 hour)
 Dirophilariasis
Dirofilaria (from Latin) – evil thread
• Dirofilaria immitis - in hart,
pulmonary arteria
Vectors – mosquitoes from genera
• Dirofilaria repens ( adults 10–17. Aedes, Culex, Anopheles,
cm) – subcutaneous tissue
• Main hosts – dogs, sometimes
cats and other mammals
• People are occasional hosts.

In dogs
In humans