Nematodes

By

Dr. Ahmed Osman

 General characters of nematodes
 elongated, unsegmented, cylindrical
 Separate sexes
 The body wall consists of three layers
 The body cavity contains body fluids in which lie
different systems as Digestive, genital system
 Life cycle is direct or indirect
 Male Female
Fertilization

Fertilized Female

Larviparous
Oviparous Ovoviviparous

lay immature eggs lay mature eggs lay larvae

 Strongyloides  Filariae
 Entrobius  Trichinella spiralis
Eggs
Hatch

1st larva

2nd larva

3rd larva
Moult 4 times

4th larva

5th larva

Adults
Classification of nematodes
 Ascaris lumbercoides

Giant intestinal round worm

 Ascariasis caused by Ascaris lumbricoides

 Ascaris lumbricoides infections : worldwide

 807 million–1.2 billion people in the world are infected with Ascaris

 Common in children

 Common in crowded rural areas with poor sanitation

 It is the largest nematode parasite in the human intestine

 Ascaris, hookworm, and whipworm are parasitic worms known

as soil-transmitted helminths (STH)

hosts: man

Habitat: small intestine

Life cycle direct

Infective stage: embryonated egg (egg containing L 2)

Diagnostic stage : egg

Granular
Fertilized egg Unfertilized egg
 Round in shape
 Immature (one cell fertilized ovum)  90 x45 um
 Size 60 μm x 45 μm  Elongated
 brown in color  Granular content
 Surrounded by thick shell with an outer
coarsely mammillated albuminous coat
 Morphology
Adult

Egg
 L2

Oviparous
 Pathogenesis and symptoms

1. Larval migratory phase

 Lung tissue damage (verminous pneumonia or Loffler's syndrome)
 Fever, dyspnea, cough with blood sputum, asthma , eosinophilia

2. Intestinal phase
 Colic, dyspepsia , diarrhea, epigastric pain , nausea
 Abdominal distension, peptic ulcer, vomiting
 Impaired digestion and absorption, stunted growth
3. Aberrant migration
 Pancreatic ducts pancreatitis
 Bile ducts cholangitis, cholecystitis
 Appendix appendicitis

4. Complications
 Products of worms
 Obstruction
 Perforation
 Diagnosis

 Stool examination: eggs, adult

 Sputum examination : larvae

 Serology: detection of antibodies Charcot Leyden crystal

 Molecular diagnosis: PCR on stool sample

 Imaging
 Chest X-ray
 Abdominal ultrasound
 Treatment

 Albendazole 400 mg PO x 1

 Mebendazole 500 mg PO x1

Drug of choice

 Surgical intervention in obstruction cases

Prevention

 Pure water supply

 Avoid eating raw vegetables.

 Personal hygiene

 Effective sewage disposal systems

 Pin worm
Entrobius vermicularis
Geographical distribution: World wide
Prevalent among groups of people e.g. families, schools
it most commonly occurs among children (5-10 year-old age group)

Host: man

Habitat: large intestine; caecum, colon, appendix

Diagnostic stage: mature egg

 Size: 50 x 25 um
 Shape: D shaped
 Shell: thick, with outer albuminous layer
 Color: translucent
 Content : 1st larva

Infective stage: egg containing L3

 Morphology

 White
 Double bulb shaped esophagus

Male
 5 mm
 Post. end curved
 One spicule

Female
 10 mm
 Long tapering tail
 Two sets of genitalia
 ovoviviparous
Infection may be acquired by

 Contaminated food or water or hands

 Autoinfection

 Exposure to eggs on cloths, bed linens

 Retroinfection
 Symptoms

 Itching of perianal areas (pruritis ani) at night………. Insomnia ,

restlessness, scratching of the anal area

 Aberrant vaginal infection : invasion of the female genital tract with

vaginal itching vulvovaginitis, vaginal discharges, urethritis, cystitis

 nocturnal enuresis

 Appenditictis

 Postmenopausal bleeding
Stool
 Treatment

 Mebendazole 100 mg

 pyrantel pamoate 11 mg/ kg in single dose

 Albendazole 400 mg

 Local ointment; white precipitate

 all household members should be treated at the same time.

 Treatment repeated after 2 weeks.

 Prevention

 Personal and community hygiene

 Frequent hand washing, finger nail cleaning , cut fingernails regularly,

 Avoid biting the nails and scratching around the anus

 Frequent washing of night clothes and bed linen.

 Boiling of internal clothes and bed linens

 Washing of toilet seats with disinfectants

 Health education