Phylum Nematoda  Body is usually tapered to a pointed

posterior end, and to a rounded

Morphology
anterior end
 The body is covered by a noncellular,
highly resistant coating “the cuticle”
 They have complete digestive system
with mouth, esophagus, midgut and
anus.
 All are non-hermaphroditic (separate
sexes); the female is usually larger
than the male.

Life Cycle

The life cycle of the individual nematodes

are similar but organism-specific. An
 Multicellular parasites that appear intestinal nematode infection may be
round in cross section initiated in several ways.
 Basic morphologic forms:
- Eggs (female sex cells after Pinworms- ingestion of the infected eggs
fertilization) vary in sizes and transmits the disease.
shape;
Hookworm larvae- burrow through the
- Juvenile worms known as
skin of the foot and make way into the
larvae; and
intestinal tract.
- Adult worms
The exact means whereby each organism
In the appropriate environment, developing
enters the host and migrated into the
larvae located inside fertilized eggs emerge
intestinal tract varies by species. The eggs
and continue to mature. These larvae are
or larvae, depending on the species,
typically long and slender. The growing larvae
continue to develop into adulthood. The
complete the maturation process, resulting in
resulting adult worms reside in the
the emergence of adult worms.
intestine, where they concentrate on
General Features obtaining nutrition and reproduction.

 Have elongated, cylindrical, smooth, Laboratory Diagnosis

unsegmented, flesh-colored bodies.
  May be accomplished by the recovery
of eggs, larvae, and occasional adult
worms.
 Specimen of choice vary by species
and include cellophane tape
preparations taken around the anal
opening, stool samples, tissue
biopsies, and infected skin ulcers.
 Serologic test methods are available
for the diagnosis of select nematode
organisms.
Pathogenesis and Clinical Symptoms
In general terms, three possible factors may
contribute to the ultimate severity of a
nematode infection:
(1) the number of worms present;
920 the length of time the infection persists;
and
(3) the overall health of the host.
Infections with nematodes
 Known to last for up to 12 months or
longer depending on the specific
species involved.
 Occurrence may increase the
infection time up to several years and
beyond; some remain asymptomatic
or cause minimal discomfort.
 Patients with heavy worm burden
with other health problems, are
probably more likely to experience
severe symptoms and/or
complications.
The life cycle of each of the nematodes
involves the intestinal tract.
Nematodes may cause intestinal infection
symptoms at some point during their
invasion of the host.
 Abdominal pain, diarrhea, nausea,
vomiting, fever, and eosinophilia
 Skin irritation, the formulation of skin
blisters, and muscle involvement may
also be present
Nematode Classification
Phylum (Nemathelminthes)
Intestinal Species (
Enterobius vermicularis,
Trichuris trichiura, Ascaris
lubricoides, Necator
americanus, Ancylostoma
duodenale, Strongloides
Class (Nematoda) stercoralis)
Interstinal-Tissue Species
(Trichinella spiralis,
Crancunculus medinensis)
Enterobius vermicularis
Introduction
 Enterbius vermicularis, commonly
known as pinworm or seatworm
 E. vermicularis is parasitic only to
humans
 Adults inhabit the ileocecus, that is
cecum and adjacent ascending colon
and distal ileum. The infection of E.
vernicularis may cause Enterobiasis
 World-wide distribution, it is
commonly found in kindergarten and
primary school students
 Most common worm parasite in the
U.S.
 Causes little disease
 Infects 30% of children and 16% of
adults in the U.S.
 Adults (females about 12mm long)
live in the large intestine and cecum
 Females migrate to anal region at
night and lay eggs -> causes itching
 Scratching anal region contaminants
hands and bedclothes
 Eggs develop rapidly and become
infective within 6 hours at body
temperature
 When swallowed, hatch in small
intestine and mature in large
intestine
Morphology
 Enterobius vermicularis Egg: Typical Characteristics at a
Glance
Parameter Description
Size 48-60 um long, 20-35 um wide
Shape Oval, one-side flattened
Embryo Stage of development varies; may be
unembryonated, embryonated, mature
Shell Double-layered, thick, colorless

Enterobius vermicularis
Adult: Typical Characteristics at a Glance
Characteristics Adult Female Adult Male

Length 7-14 mm 2-4 mm Life Cycle

Width Up to 0.5 mm ≤0.3 mm Disease: Enterobius vermicularis causes
Color Yellowish-white Yellowish-white inworm infection Enterobiasis

Tail Pointed; Life cycle:

Resembles
Pinhead
*Adult males are only rarely seen.
Laboratory Diagnosis
Diagnosis depends on finding the eggs
or the adult pinworms individual eggs are
invisible to the naked eye, but they can be
seen using a low-power microscope.
On the other hand, the light-yellowish
thread-like adult pinworms are clearly visually
detectable, usually during the night when
they move near the anus, or on toilet paper.
Transparent adhesive tape applied on
the anal area will pick up deposited eggs, and
diagnosis can be made by examining the tape
with a microscope.
 Microscopic identification of eggs
collected in the perianal area by
cellophane (Graham Scotch) tape
method or anal swabs. This must be
done in the morning, before
defecation and washing
 Detection of adult on anal skin
 The life cycle is confined to humans
 The infection is acquired by ingesting
the worm eggs
 The eggs hatch in the small intestine,
where the larvae differentiate into
adults and migrate to the colon
 The adult male and female worms live
in the colon, where mating occurs
 At night, the female migrates from
the anus and releases thousands of
fertilized eggs on the perianal skin
and into the environment
 Within 6 hours, the eggs develop into
embryonated eggs and become
infectious
 Reinfection can occur if they are
carried to the mouth by fingers after
scratching the itching skin
 When the eggs being ingested, it
hatch in the duodenum. The emerging
pinworm larvae grow rapidly to a size
of 140 to 150 micrometers in size, and
migrate through the small intestine
towards the color.
 The male and female pinworms mate
in the ileum whereafter the male
pinworms usually die, and are passed
out with stool. The gravid female
pinworms settle in the ileum, caecum,
appendix and ascending colon, where
 they attach themselves to the mucosa
and ingest colonic contents.
 Almost the entire body of a gravid
female becomes filled with eggs. The
egg-laying process begins
approximately five weeks after initial
ingestion of pinworm eggs by the
human host.
 The gravid female pinworms migrate
through the colon towards the
rectum. They emerge from the anus,
and while moving on the skin near the
anus, the female pinworms deposit
eggs either through.
1) Contracting and expelling the
eggs
Clinical Symptoms
2) Dying and then disintegrating,
or
3) Bodily rupture due to the host
scratching the worm
After depositing the eggs, the female dies.
The reason the female emerges from the anus
is to obtain the oxygen necessary for the
maturation of eggs.
Epidemiology
 Enterobius vermicularis, or pinworm,
is highly prevalent throughout the
world
o Infecting about 10% of
population in developed
countries, the infection rate in
children is even higher
o U.S: E. vermicularis is the
most common of all
helminthic infections (42
million cases in 1980s);
prevalence 15-50% in children
 Pinworm infection is particularly
common among:
o Children, institutionalized
groups, and households
o Not associated with
socioeconomic level
 One third of individuals with pinworm
infection are totally asymptomatic.
 The main symptoms are pruritus ani
i.e., itching in and around the anus.
 The itching occurs mainly during the
night, and is caused by the female
pinworms migrating to lay eggs
around the anus. Both the migrating
females and the clumps of eggs are
irritating. The intensity of the itching
varies, and it can be described as
ticking, crawling sensations, or even
acute pain.
 The itching lead to continuously
scratching the area around the anus,
which further results in tearing of the
skin and complications such as
secondary bacterial infections,
including bacterial dermatitis (I.e.,
skin inflammation) and folliculitis (i.e.,
hair follicle inflammation).
 General symptoms are insomnia and
restlessness. A considerable
proportion of children suffer from
anorexia, weightloss, irritability,
emotional instability, and enuresis.
 Pinworms cannot damage the skin,
and they do not normally migrate
through tissues. However, in women
they may move onto the vulva and
into the vagina, from there moving to
 external orifice of the uterus, and Ascaris lumbricoides Fertilized Egg: Typical
onwards to the uterine cavity, Characteristics at a Glance
fallopian tubes, ovaries, and Parameter Description
peritoneal cavity. This can cause Size 40-75 um by 30-50 um
 vulvovaginitis, i.e. an inflammation of Shape Rounder than nonfertilized version
the vulva and vagina. This causes
vaginal discharge and pruritus vulvae, Embryo Undeveloped unicellular embryo
i.e., itchiness of the vulva. Shell Thick chitin
Other May be corticated or decorticated
Treatment

 Pyatantel pamoate, albendazole,

mebendazole Ascaris lumbricoide Unfertilized Egg: Typical
 Secondary dose may be necessary Characteristic at a Glance
 Cure only after seven perineal smears Parameter Description
 Egg reduction rate are hard to Size 85-95 um by 38-45 um; size variations
determine because eggs are from possible
perineal area and not from feces Shape Varies
Embryo Unembryonated; amorphous mass of
 Contraindications to drugs: pregnancy
protoplasm
and hypersensitivity
Shell Thin
 Effects of drugs: gastrointestinal
Other features Usually corticated
disturbance, headache

Prevention and Control

Laboratory Diagnosis
 Washing hands with soap & water
Stool
(after using toilet, before eat)
 Trimming nails regularly & avoid  The specimen of choice for the
biting the nails recovery of A. lumbricoides eggs.
 Avoid scratching anal area.  Adult worms may be recovered in
 Showering every morning and several specimen types, depending on
washing the anal area (to remove the the severity of infection, including the
eggs) small intestine, gallbladder, liver, and
 Do not co-path with infected people appendix. In addition, adult worms
 Cleansing bathroom & toilet may be present in the stool, vomited
up, or removed from the external
nares, where they may attempt to
Ascaris lumbricoides escape.
 An enzyme-linked immunosorbent
Morphology assay (ELISA) is also available.
Ascaris lumbricoide Adults: typical Characteristics at Egg detection
a Glance
Characteristics Female Adult Male Adult  Both fertilized and unfertilized eggs
can be detected by stool examination.
Size (length) 22-35 cm Up to 30 cm
Color Creamy white Creamy white Larva detection
pink tint pink tint
Other features Pencil lead Prominent  During the early pulmonary migratory
thickness incurved tail phase, larvae can be found in sputum
 or gastric aspirates before the eggs Clinical Symptoms
appear in the stool.
The main symptoms include the following:
Adult worm detection
 Low grade fever
 Adult worms may be detected in stool  Cough and bloody sputum
of the patients by naked eye.  Wheezing
 X-ray of the GIT may demonstrate the  Abdominal cramping and
adult worm in the intestine. discomfort
Life Cycle  Nausea
 Vomiting worms
 Anorexia
 Diarrhea and passing worms in
stool
 Small bowel obstruction (mainly
in children)
 Pancreatitis (worm migration)
 Appendicitis (worm migration)

Asymptomatic:

 Patients with a small number of

worms (5 to 10)
 Patients usually ingest only a few
eggs. They may only learn of their
infection if they happen to notice an
adult worm in their freshly passed
feces or if they submit a stool for a
routine parasite examination.

Epidemiology Treatment

 Agent and life cycle- Ascaris  Requires treatment consist of

lumbricoides lives in small intestine of medications deigned to rid the body
humans. of parasitic worms. These include
 Egg production is very heavy about albendazole and mebenazole.
2,400,000 eggs per day. Prevention and Control
 These become embryonated in
external environment and infective in The way to prevent ascariasis is to always:
2-3 weeks.
 Avoid ingesting soil that may be
 On ingestion they hatch in small
contaminated with human feces,
intestine and move to liver and then
including where human fecal matter
lungs via blood. In lungs they moult
(“night soil”) or wastewater is used to
twice, break alveoli and reach
fertilize crops.
bronshile where they are coughed up
 Handwashing
and swallowed
 Wash, peel, or cook all raw
 On reaching intestine, mature in to
vegetables and fruits before eating,
adults in 60 to 80 days. Average life
particularly those that have been
span is 6 to 12 months.
 grown in soil that has been fertilized Pathogenesis and Laboratory Diagnosis
with manure.
Pathogenesis & Clinical Findings
Transmission of infection to others can be
 Although adult Trichuris worms
prevented by:
burrow their hairlike anterior ends
 Not defecating outdoors. into the intestinal mucosa, they do
 Effective sewage disposal systems. not cause significant anemia, unlike
the hookworms
 Trichuris may cause diarrhea, but
Trichuris trichiura (whip worm) most infections are asymptomatic
 Trichuris may also cause rectal
Morphology
prolapse in children with heavy
Eggs are lemon shaped with plug-like infection
translucent polar prominences 50-54um
Laboratory Diagnosis
Trichuris trichiura Egg: Typical Characteristics at a Glance  Diagnosis is baed on finding the
Parameter Description typical eggs, i.e., barre;-shaped
Size 50-55 by 25um (lemon-shaped) with a plug at each
Shape Barrel, football; hyaline polar plug at each end, in the stool
end
Embryo Unicellular; undeveloped Life Cycle
Shell Smooth; yellow-brown color because of bile
contract

The worm is divided into a thin whip-like

anterior part measuring 3/5 of the
worm and a thick fleshly posterior
part of 2/5 the length.

Male: The male measures 3-4.5 cm in length.

Its posterior end is coiled and possess
a single cubicle.

Female: The female measures 4-5 cm in

length. Its posterior end in straight

Infective stage and mode of infection:

Infection is by ingestion of eggs containing

larvae with contaminated raw Epidemiology
vegetables.  800 million people infected
worldwide
Trichuris trichiura Adults: Typical Characteristics at a
 Children living in poverty in the
Glance
Parameter Description tropics and subtopics
Size 2.5-5 cm long; ,males usually smaller than  It is most common in poor rural
females communities and areas in which
Anterior end Colorless; resembles a whip handle; sanitary facilities are lacking and
contains a slender esophagus hands, food, and drink are easily
Posterior Pinkish-gray: resembles whip itself; contains contaminated
end digestive and reproductive systems; males
possess prominent curled tails.
  Many people harbor infections with
both Trichuris and Ascaris
 In up to 10% of patients in endemic
areas worm burden may be high (up
to 200 worms/pts) and suffering from
disease
 Genetic studies: 25% of the variation
in susceptibility to infection with T.
Trichiura is due to genetic factors
Clinical Symptoms
Asymptomatic
 Patients who suffer from a slight
whipworm infection often remain
asymptomatic.
Decreases whipworm ATP production,
causing energy depletion,
immobilization, and death.
Prevention and Control
 Prevent contamination of soil with
human feces
 Construction of latrines
 Washing hands before eating
(children, soil worker).
 Washing vegetables & fruits
 Do not use the night soil as fertilizer
Trichinella spiralis
Morphology

Trichuriais (whipworm infection) 1. Adults: 1.5mm, 3-4mm, both have a

single set of reproductive organs.
 Heavy infection of 500 to 5000 worms 2. Juvenile (larva): 124x6um, one or
produce a wide variety of symptoms. more coil in a cyst in the skeletal
 The conditions that a whipworm muscle fibers
infection may simulate vary with the
age. An infection of as few as 200 Trichinella spiralis Encysted Larva: Typical
worms may cause a child to develop Characteristics at a Glance
chronic dysentery, severe anemia, Parameter Description
and possibly growth retardation Average juvenile size 75-120 um long, 4-7 um wide
 Increase rectal prolapse and Average mature size Up to 1 mm in length
peristalsis are common in infected Appearance Coiled
children. Encysted in Nurse cells of striated muscle
 Infected adults experience symptoms Notable features Inflammatory infiltrate
that mimic those of inflammatory present around nurse cell
bowel disease.7
 Common symptoms found in infected Trichinella spiralis Adult: Typical Characteristics at a
persons include abdominal Glance
tenderness and pain, weight loss, Characteristic Adult Female Adult Male
weakness, and mucoid or bloody
diarrhea Size 4 by 0.5 mm 2 by 0.04 mm
Treatment Notable Blunt, round Curved posterior
features posterior end; end with two
 Mebendazole (Vermox) single ovary rounded
Causes worm death by selectively and with vulva in appendages
irreversibly blocking glucose uptake anterior fifth of
and other nutrients in the susceptible body
adult intestine where helminths Common to Both Adult Males and Females
dwell. Thin anterior end
 Albendazole (Albenza) Small mouth
Long slender digestive tract
Laboratory Diagnosis
 Examination of the affected skeletal
muscle is the method of choice for
recovery of the encysted larvae.
 Serologic methods are also available.
 Other laboratory findings such as
eosinophilia and leukocytosis may
also serve as indicators for disease.
 Elevated serum muscle enzyme levels,
such as lactate dehydrogenase,
aldolase, and creatinine
phosphokinase, may also aid in T.
spiralis diagnosis.
It is important to note that several tests
may be required to confirm the presence
of T. spiralis.
Life Cycle
Epidemiology
 In general the incidence of trichinous
is less in the tropics and subtropics
than in the temperate zones, chiefly
owing to lower consumption of pork
products.
 Religious bans on cating pork explain
the absence of the infection in certain
countries and races.
 Trichinosis shows seasonal
fluctuations, reaching its peak during
the winter months when there is
greatest consumption of pork.
 The incidence of infection in cadaver
increase with age. A high rate is found
at autopsy in the older age group and
a relatively low rate in the younger
age groups and in Negroes.
Clinical Symptoms
 Larvae infect animals that eat flesh of
other animals.
 Humans eat the meat (often pork),
and larvae mature to adult forms
 Adult reproduce, and larvae exit GI
tract & migrate to striated muscles.
Skeletal muscles- Encyst and calcify.
Treatment
 Patients are instructed to get plenty
of rest, supplemented by adequate
fluid intake, fever reducers, pain
relievers.
 Patients with severe infections that
may be potentially life-threatening
are usually treated with prednisone.
 Thiabendazole may also be given,
even though research to date
indicated that the effectiveness of this
medication is questionable.
 Mild cases
o Supportive treatment like
bedrest, analgesics and
antipyretics
 Moderate cases
o Albendazole (400mg BID for 8
day) or
o Mebendazole (200-400 mg TID for
3 days, then 400 mg TID for 8
days)
 Severe Cases
 o Add glucocorticoids like
prednisolone to albendazole or
mebendazole
Prevention and Control
1. Proper Cooking of pork
2. Regulate inspection by Trichiniscopy
3. Freeze of Pork meat at -15C for 20
days to Kill larvae
4. Control of Rodents
Dracunculuc medinensis (Guinea Worm
Disease)
 Guinea Worm- a white worm
emerging from a skin lesion.
 Its length is between 60cm-120cm
(=1m)
 Infection occurs when a person drinks
contaminated water containing water
fleas (Cyclops) infected with guinea
worm larvae
Morphology
Dracunculus medinensis First-Stage Larva: Typical
Characteristics at a Glance
Parameter Description
Average size 620 by 15um
Tail characteristics Consume one third of body length;
culminates in a point
Dracunculus medinensis Adults: Typical Characteristics at
a Glance
Characteristics Adult Female Adult Male
Size 840 by 1.5mm 21 by 0.4mm
Other features Prominent rounded Anterior end coils
anterior end itself at least once
Larvae. There are two larval stages. The
diagnostic stage, also known as the first stage
or rhabditiform larvae, is relatively small. The
third-stage larvae, which reside in an
intermediate host, have not been well
described.
Adults. Considered as one of the largest adult
nematodes. The rarely seen adult male is
smaller than the female, measuring only 21 by
0.4 mm.
Laboratory Diagnosis
 Blister Formation
 The skin outline of worm under the
skin
- Enhanced by reflected light
 Detection of Adult Worm:
- Gravid female worm appears
at the surface of skin
- After death may become
calcified detected radiological
 Detection of Larva
- Contact with water- Large
amount of larva discharges
- Microscopic examination
 Serology
- Antibody seen in serum by
ELISA & Fluorescents antibody
test
 Skin test
- Antigen is injected
intradermal to see wheal
reaction
Life Cycle
Epidemiology
In 1986, there were an estimated 3.5
million cases of Guinea worm in 20 endemic
nations in Asia and Africa. The number of
cases has been reduced by more than 99% to
3,190 in 2009, 3,185 of them in the four
remaining endemic nations of Africa: Sudan,
Ghana, Mali and Ethiopia
Clinical Symptoms
 Disease- Drancunculosis
 Clinical features develop a year afyer
infection following the migration of worm
to the subcutaneous tissue of the leg
 Blister formation- rupture of blister when
in contact with water
 Ulceration- release of larvae by adult
female worm
 Secondary bacterial infection of ulcer
 Symptoms of dracunculiasis occur as
worms migrate under the skin
 Female releases metabolic wastes that
cause toxemia that causes a rash, nausea,
diarrhea, and dizziness
 The adult female produces a substance
that causes inflammation, blistering, and
ulceration of the skin, usually of the lower
extremities. The inflamed papule burns
and itches, and the ulcer can become
secondarily infected.
 No s/s until about 1 year after infection
 A few hours before worm emerges,
person may develop fever, swelling, and
pain in area
 >90% of worms come out at legs and feet
 Wound can develop secondary bacterial
infection
Treatment
 Removal of Worm
o By twisting it around
o Take weeks to months
 Metronidazole, Niridazole, Mebendazole
are sometimes used to limit inflammation
and facilitate worm removal.
 Surgical removal of worm
 Worms that have emerged from skin may
be successfully removed by wrapping the
worm around a small stick. This process
often lasts a few weeks to months.
Occasionally it may take only a few days
 There is no successful drug treatment,
although some drugs may be used to treat
symptoms
 Worms may also be surgically removed
before ulcer formation
 Analgesics (aspirin and ibuprofen) are
used to reduce swelling
 Antibiotic ointment may be used to
prevent bacterial infections
 Wet compressions relieve discomfort.
Prevention and Control
 The main way to prevent infection is
through education
 Educate individuals in areas prone to
infection to:
- Drink water from underground
sources free from contamination
- Do not enter drinking water
sources with an ulcer
- Use a filter for drinking water to
remove copepods
 Unsafe water can be boiled or treated
with an approved larvicide to kill
copepods
 Drink water only from protected water
bodies free of contamination
 Teach villagers to cook their fish properly
 Encourage dog owners to keep out
infected dogs