APHASMID NEMATODES (ADENOPHOREA)

CAPILLARIA PHILIPPINENSIS

Describe in Philippines in 1963 after the death of first human case

Epidemic occurs: 1967-1968 more than 1000 cases were reported and 100 individuals
died.
Descendant of Trichuridae: tiny nematodes that reside in the small intestine of humans
and the esophagus have rules of secretory cells called "stichocytes" and the entire
esophageal structure is called stichosomes.
• Common name: Pudoc worm
Disease caused:
- Capillariasis or Mystery disease
- Malabsorption syndrome: flattening of the villi

• Infective stage: 3rd stage larva

• Intermediate host: glassfish, “bagsit”, “bagsang”, “ipon”
•Definitive Host: Man and birds
• Main Habitat: L.I. & S.I. (large and small intestine
Laboratory Diagnosis:
- Direct Fecal smear
- Sedimentation techniques

Diagnostic stage:
- Fertilized ova

*Parasites can also be recovered through duodenal aspirate

• Distribution: Philippines & Thailand

• Developmental stages
1. OVA
✓ Color: Pale yellow
✓ Size: 42x20 µ (microns)
✓ similar to that of T. trichiura
✓ smaller & more striated shells
✓ Flattened plugs
✓ Peanut shape
Passed in the feces and embryonate in soil and water, and must reach the water in
order to be ingested by small species of freshwater.

2. FEMALE
✓ size: 2.4 – 4.3 mm
✓ Divisions:
- Anterior – esophagus and esophageal glands
- Posterior – intestine and reproductive organs
*Vulva located on the junction of the anterior and the middle third of the body

❖ Atypical female
- uterus lined with 2-3 rows of eggs
- Larviparous
- causes internal auto-reinfection
❖ Typical female
- uterus lined with 1 row of egg
- oviparous

3. MALE
✓ size: 2.3 – 3.17mm
✓ caudal alae; long, non-spiny sheath
Spicule 230-300 um

• Disease caused: Capillariasis or Mystery disease

• Predominant Symptoms
✓ borborygmi "gurgling of stomach"
✓ abdominal pain
✓ Diarrhea (chronic)
✓ Untreated:
✓ weight loss; malaise
✓ vomiting; dehydration
✓ anorexia
✓ pneumonia, heart failure and cerebral edema
✓ Death: 2 – 8 weeks after these are seen

*Causes flow electrolyte level specifically potassium and high level IgE during
capillariasis
*Death can be seen 2-8 weeks after these are seen

TREATMENT
1. Albendazole
✓ drug of choice
✓ 400 mg/day for 10 days
✓ destroys larvae readily

2. Mebendazole
✓ 200mg twice a day for 20 days or 400 mg/day for 20 days depending on severity of
infe tion

3. Electrolyte replacement therapy and high protein diet (electrolyte and protein
loss)
• Prevention: Thorough cooking of fish
• Laboratory Diagnosis: DFS & Concentration technique
• Mode of Transmission: eating infected fish
Relapses may occur if treatment regimen is not strictly followed for both Alben and
Meben
 TRICHURIS TRICHIURA

• Synonyms: Trichocephalus trichiurus, Trichocephalus dispar

• Common name: whipworm
• Infective stage: embryonated ova
• Principal host:
● man, but has been also found in:
● hogs
● monkeys
● cattle
● dogs
● mice
• Main habitat: cecum & appendix
• Life span: 5-10 years
•Disease cause: Trichuriasis, Trichocephalus, Whipworm infection

• Developmental stages
1. OVA
✓ Barrel/football-shaped, Japanese lantern
✓ 50 µmX25µm in size
✓ 3 layers:
✓ undeveloped, unicellular embryo
✓ outermost layer – smooth, bile-stained
✓ Hyaline/Mucus plug
According to Brown: it is lemon shaped, plugged like translucent potatoes prominences
has yellowish outer and transparent inner shell

2. ADULTS
✓ flesh – colored
✓ anterior three-fifths is attenuated (whiplike)
✓ stichosome type of esophagus

a) MALE
- 30-45 mm
- posterior portion: coiled ( greater than or equal to 360°c)
- lanceolate spicule protruding through a refractile pineal sheath

b) FEMALE
- 35-50 mm
- bluntly rounded posterior end
- 3,000-10,000 eggs per day

Trichocephaliasis
✓ Whipworm infection
- Slight infection – asymptomatic
- Heavy infection – surface of colon matted with worms

• Pathology & Symptomatology

✓ Asymptomatic for light infections
✓ Heavy infection: surface colon is matted with worms : TRICHURIASIS
- Bloody or mucoid diarrhea
- Weight loss and weakness
- Abdominal pain and tenderness
- Increased peristalsis and rectal prolapse
- Obstruction and inflammation of the appendix (appendicitis)
- Hypoalbuminemia and IDA
- Extreme cachexia (weakness of the body, seen with fatal infections hundreds to
several thousands of worms present.

• Diagnosis: Direct Fecal Smear, Kato Thick Smear, Concentration techniques

• Treatment: Mebendazole (500mg) , Albendazole (400 mg) & Oxantel-pyrantel
• Prevention
- Sanitary disposal of feces
- Thorough washing of hands
- Thorough washing and cooking of food
- Avoid using human feces as fertilizer

CLASS PHASMIDIA (with caudal receptors)

Enterobius vermicularis

● Also known as Oxyuris vermicularis

● Commonly known as Pinworm, Seatworm because of its pin-like appearance at
the end of the tail or its characteristic or morphological structure
● Cylindrical
● Has a cuticle with 3 main outer layer that is made of collagen and other
compound that secreted by epidermis
● Cuticle layer's main function protects the nematode so that when it invades the
digestive tract of animals the E.vermicularis will be protected.
● Worm will molt (sheds) 4 times.
○ 1st 2 shedding happens before hatching and before adult stage
● Disease associated with Enterobiasis, Oxyuriasis
● Adult worm has a disease characteristic of: spindle shaped and has a hourglass
shaped esophagus and cephalic alae.

MORPHOLOGY
MALE: 2-5 mm long
● strongly curved pointed tail (copulation)
● spicule is conspicuous (it is obvious and can be seen and labeled in
Diaphragm)
● found at the end pointed tail of male and primarily function of focculation

FEMALE: larger 8-13 mm long × 0.4mm

 ● pointed tail of the female gives a pin shape tail.
● distinguish by alae and winge like appendage
● posterior end has sharply pointed end
● VULVA can be seen in middle third
● Paired genital organs
● UTERUS is distended when filled with eggs

OVA: 50-60 mm×20-30mm

● D shaped appearance
● Embryonated within 4-6 hours
● Elongate, Flattened
● Eggs actually have 5 membranes:
○ 1 inner
○ 3 middle layer(membrane lucida)
○ 1 outer (albuminous membrane coats the egg, this makes the egg sticky;
one that makes the egg stick to the rectum or anus). Important in the life
cycle of vermicularis.
○ Will lay its egg on rectum or anus of the host usually during night time.
○ 4,672 to 16,888

Main habitat: cecum and appendix

Definitive host: man
Reservoir host: dogs and cats
Infective stage: embryonated egg
Life cycle:
Autoinfection: night time the child will put her/his fingers in anus then when it will
Mode of transmission:
● anus to mouth - the source of ova comes to anus and indirectly goes to the
fingers and the child will thumb suck.
● Contaminated food and drinks
● Inhalation - a viable ova can float; because it can drop the ova or egg may drop
or probably from sheets of clothes of another then you can inhale.
● Retroinfection - when the gravity male migrates to the anus and lays egg then
goes back to the large intestines after laying eggs. And then the larvae that will
hatch into the rectum will migrate back to l.intestines.

PATHOLOGY
⅓: asymptomatic (do not javelin signs and symptoms and unconscious infected)
Other symptoms:
● cardinal feature
● puritus an itching in rectum
● Mild nausea and vomiting
● Loss of sleep or irritability (anus is itchy at night time and the child will have
difficulty in sleeping).
 ● Slight irritation to intestinal mucosa because of the migration.
● Vulva irritation because of itchiness

LABORATORY DIAGNOSIS
Scotch Tape method/cellophane slide sample
- sticky part is the one that is outside then stick to the anus or rectum then going to
put that on top of slide. Serve as coverlip and observe at microscope. Double
sided.

TREATMENT
1. piperazine salts
2. pyrvinium pamoate (problem: it has side effects like
a. headaches
b. dizziness
c. vomiting
d. abdominal pain
e. diarrhea
f. increased SGOT
3. pyrantel pamoate: has the same side effects like pyrvinium pamoate
4. mebendazole: commonly used for E.vermicularis but cannot be used by
pregnant women

PREVENTION
1. Home and community sanitation
2. Better personal hygiene
3. Fingernails should be cut short
4. Use showers rather than bath tubs
5. Infected persons should sleep alone
6. Underwear, night clothes, blankets-boiled and laundered
 Ascaris lumbricoides

● reported in more than 150 countries across the globe: tropic,

subtropical,temperate regions.
● Approximately 1.4 billion people worldwide that are infected.
● In the U.S 4 million are infected with A.lumbricoides.
● Highly durable egg can remain dormant in soil for 10 years and may be resistant
to many adverse conditions.
● Common name: Giant Intestinal Roundworm (largest intestinal nematode
affecting man measuring 15-25 cm in length specially during adulthood.
● Lumbricus means (earthworm)
● with smooth, finely striated cuticle
● Head is provided with three conspicuous lips

MORPHOLOGY
MALE: 10-35 cm
● coiled and slightly curve end
● obvious and conspicuous spicule at the end
● Ventrically curved posterior end has 2 spicules
● Genitalia: Composed of single, long torous(twisted)tubule

FEMALE: 35 cm long×3-6mm
● pointed end
● Larger and longer to male
● Straight posterior end
 ● Paired reproductive organs located at ⅔ of the body
● Oviparous (lays ova)
● Gravid uterus: 200,000 eggs
● Roundworms lack a circulatory system and its digestive, excretory, nervous and
reproductive systems are suspended within PSEUDOCOELOM
● A.lumbricoides lack the circular muscle and the only muscle buns being
longitudinal and the worms only use muscular activity, this muscular activity helps
A.lumbricoides to remain in the intestinal lumen of the host.
Picture yellow: open intestine containing ascaris lumbricoides (looks like
spaghetti and palabok)

OVA / EGGS 2 types:

1. UNFERTILIZED
- Longer and narrower as compared to Fertilized eggs
- Elongated and larger thinner shell with irregular protein of albumin
- Released by unfertilized females or early stage of ovipositions of
Fertilized female
- Completely filled with amorphous mass of protoplasm with refractile
granules
- Unfertilized eggs are usually difficult to identify and lack the cresentic
clear area.
- Do not see the larva inside unlike your Fertilized egg
2. FERTILIZED
- Broadly avoidal and thick
- 3 layers:
1. Chorionic/true shell:
- Secretory product of egg
2. Vitelline layer
- Fertilization membrane
3. Protein coat/Albuminous layer
- Contains mass of coarse, lecithin granules

● EMBRYONATED OVA
- same as Fertilized ova
- contains larva

● DECORTICATED OVA
- occur in old specimen
- outer mammillated shell is absent
- eggs may or may not be fertile

Picture *Fertilized eggs sometimes may lack the outer albuminous layer and are colorless. Has
smooth core outer layer.
FACTS
1. Eggs are susceptible to desiccation (although they are more resistant compared
to trichuris eggs.
2. Suitable environment: moist, loose soil with moderate shade (dryness is
unfavorable for the survival of A.lumbricoides)
3. Eggs are destroyed by direct sunlight (within 15 hours and they are killed at
temperature 40°C, perishing within hour at 50°C)
4. Exposure to -8 °C to -12 °C has no effect to Ascaris eggs (but this Tempe range
is fatal to Trichuris eggs)
5. Eggs resistant to chemical disinfectants and can withstand temporary immersion
in strong chemicals
6. They survive for months in sewage or night soil (because this areas are suitable
environments for the survival of A.lumbricoides.

Definitive host: man

Main habitat: small intestine
Infective stage: embryonated ova/egg
Worm produces PEPSIN inhibitor to prevent host enzymes from digesting it, productive
mechanism, and uses muscular activity to avoid being excreted. Usually found in
Jejunum
Disease: Ascariasis, Dooryard or Backyard infection

PATHOLOGY
1. pneumonia, cough (can migrate to the lungs causing A.pneumonitis), low grade
fever and eosinophilia, Loeffler's syndrome; 1-2 weeks after ingestion of eggs
Allergic reaction may occur with reinvention
2. Intestinal or appendix Obstruction
Specially if many
3. Vomiting and abdominal pain due to adult migration
4. Protein malnutrition in children with heavy infections and poor diet (because
A.lumbricoides will get nutrition from children or host)
5. Some patients can be asymptomatic ( Diagnosed: in Routine fecalysis)

PATHOGENESIS
2 phases in ascariasis
1. The blood-lung migration Phase of the larvae:
● During the migration through the lungs, the larvae may cause pneumonia.
(Symptoms: low fever, cough, sputum may be blood pinch)
 ● Large numbers of worms may give rise to allergic symptoms. (Have
eosinophilia)
● These clinical manifestations are also called Loeffler's syndrome.
2. Intestinal Phase of adults
● Vague abdominal pains or intermittent colic(kabag), especially in children
● A heavy worm burden can result in malnutrition
● Wandering adults may block the appendix lumen or the common bile duct
and even perforated the Intestinal wall
Complications of ascariasis:
● Intestinal Obstruction
● appendicitis, biliary ascariasis (most common complication),
● perforation of the intestine, cholecystitis, pancreatitis and peritonitis, etc.,
may occur.

DIAGNOSIS
1. Routine fecalysis/stool examination
● recovery and identification of fertile or infertile eggs in feces
● Looking for ova
2. Sedimentation techniques
● recommend than flotation
3. ELISA serologic test

TREATMENT
1. Mebendazole (500mg)
2. Pyrantel pamoate (10 mg/kg maximum of 1g)
3. Albendazole (400mg)

PREVENTION
1. Sanitary and proper disposal of human excreta/feces
2. Personal hygiene
3. Avoid the use of night soil fertilizer
4. Thorough cooking of food particularly vegetable and washing of fruits
washing solution: aqueous iodine solution (200 parts/million) it can kill infected
eggs and larva in 15 minutes.
 Strongyloides stercoralis

● The only species naturally pathogenic to man that is charac by free living ravidiform and
parasitic stages.
● Commonly known: thread worm

ADULT
● Well-developed buccal capsule
● No teeth, no cutting plates
● But bears a crown of chitinous, leaf-like processes
2 phases of development:
1. Parasitic stage
● Inhabits the intestine of host

● Begin when pilariform larva infects human through skin

● Female delicate filiform worm
● Length: 2.2 mm
● Esophagus: occupies ⅓ of the anterior part (longer)
● Parthenogenetic: natural form of asexual reproduction, in which growth
and development of embryos can occur without actual fertilization.

2. Free-living stage
● Found in the soil
● Exists in environment
● Buccal cavity: slightly larger that of the parasitic male worm
● Adult female: shorter, smaller
● Shorter esophagus
● Begin with rhabditiform larva and develop which is Infective to man

OVA
● Thin shelled, transparent, resembles a Chinese lantern
● Contains fully developed embryo
● Not found in feces except in cases of diarrhea and hypertalsis
 Definitive Host: man
Main habitat: duodenum of man
Infective stage: filariform larvae
Disease: cochin-china diarrhea, Strongyloidiasis, Strongyloidosis

SIGNS AND SYMPTOMS

Asymptomatic in light infection
1. Skin: allergic, raised red blotches at the site of larval penetration (typical symptoms)
2. Migration of larvae: bronchial verminous pneumonia
3. Intestine:
● abdominal pain
● diarrhea and constipation
● vomiting
● weight loss
● variable anemia
● eosinophilia (high number of eosinophil sue to presence of parasite)
● protein losing enteropathy
4. Can cause death in immuno-compromised patients
Due to heavy autoinfection or larval migration throughout the body. Bacterial infections
and intestinal leakage.

3 PHASES OF INFECTION
1. invasion of the skin
2. Migration of larva through the body (lungs destroyed causing lobar infection with
hemorrhage)
3. Penetration of the intestinal mucosa by the adult worm (greatest number in
duodenal and upper jejunal regions)

DIAGNOSIS
1. Recovery and identification of rhabditiform larvae in feces (differentiate
2. Enterotest: presence of hookworm like eggs in duodenal drainage fluid
3. ELISA
4. Filter paper/Harada Mori filter paper technique

TREATMENT
1. Thiabendazole - OVICIDAL (can kill ova) and LARVICIDAL (can kill larva)
2. Albendazole- 400 mg/day for 3 days

PREVENTION
1. Treatment of infected individual
 2. Sanitary disposal of feces
3. Avoid sites where infected cats and dogs may defecate
4. Personal hygiene: use of shoes/slippers
5. Avoiding ingestion of raw vegetables

Strongyloides stercoralis : FILARIFORM

Infective, third-stage filariform larvae (L3) of Strongyloides stercoralis are up to 600 µm long.
The tail is notched and the esophagus to intestine ratio is 1:1, which helps distinguish it from
hookworm filariform larvae (which have a short esophagus and pointed tail).

Strongyloides stercoralis : RHABDITIFORM

They may also be found in soil and cultured fecesThe first-stage rhabditiform larvae (L1) of
Strongyloides stercoralis are 180—380 µm long, with a short buccal canal, a rhabditoid
esophagus (divided into three sections) extending 1/3 of the body length, and a prominent
genital primordium.