CHAN NICOLE B.

BSMLS 2A
CLINICAL PARA LECTURE 2
MORPHOLOGY, PATHOPHYSIOLOGY, LIFE
CYCLE, SPECIMENS USED FOR
IDENTIFICATION, DIAGNOSTIC FEATURES,
PREVENTION & CONTROL OF PHASMID
NEMATODES (PHASMIDEA)
PHASMIDS – sensory organ is located at
POSTERIOR ENDS.
1. Ascaris lumbricoides
- Most common intestinal roundworm
- COMMON NAME – Giant Intestinal
roundworm
- INFECTIVE STAGE – embryonated ova
- DEFINITIVE HOST – man (no intermediate
host needed)
- MAIN HABITAT – Lumen of the SI
- LIFE SPAN – 12-17 months
DEVELOPMENTAL STAGES
1. Ova/Eggs Types of eggs
A. Unfertilized: longer and narrower
2 layers of the eggshell
- Albuminous layer
- Chorionic layer of true shell
 Filled with an amorphous mass.
 Lack of the crescentic clear area.

B. Fertilized: broadly avoidal and thick 3

layers:
- Chorionic/true shell – chitinous layer; the
secretory product of the egg
- Vitelline layer – fertilization membrane; a
highly impermeable membrane that
protects the inner embryo.
- Protein coat/albuminous layer:
outermost.
 Embryonated – same as fertilized but
contains the larva of the embryo
 Decorticated – lacks the albuminous
mamillated shell; usually seen in old
specimens; it may be fertilized or
unfertilized.
CHAN NICOLE B.
BSMLS 2A
CLINICAL PARA LECTURE 2
Adult: white, creamy, or pinkish yellow when
freshly expelled and resembles earthworm
(lumbricus); the head is provided wt three
conspicuous lips which are finely denticulated;
each lip has minute twinned sensory papillae.
A. MALE
- 10-31 cm
- Usually shorter and slender
- Vertically curved posterior end with 2
spicules.
- Genitalia: composed of a single, long
tortuous tubule
B. FEMALE
- 35 cm long x 3-6 mm
- Straight posterior end
- Paired reproductive organs located in the
2/3 of the body.
- Oviparous
- Gravid uterus: 200,000 eggs
DISEASE: Ascariasis, dooryard or backyard
infection
PATHOLOGY
A. DUE TO LARVAL MIGRATION:
- ASCARIS PNEUMONITIS: Damage to the
pulmonary tissue (petechial hemorrhage)
when larvae break out of the lung
capillaries into the air sacs.
- Symptoms manifested: asthmatic type of
respiration, cough, bronchial rales
(abnormal respiratory sound), urticarial
rash (hives, vascular reaction of the upper
dermis. Eosinophilia in the circulatory
blood)
B. DUE TO ADULT WORMS
- Diarrhea, vague abdominal pain, nausea,
and loss of appetite
- Due to its erratic behavior, vomiting,
suffocation, intestinal obstruction,
appendicitis, acute pancreatitis, and
peritonitis. (Perforation of the bowel)
DIAGNOSIS
STOOL EXAMINATION – may give negative
results due to the ff:
- During the early stage of infection
- During larval migration through the
bloodstream – when only male worms are
present in the intestines.
PREVENTION:
- Sanitary disposal of human excreta
- Personal hygiene
- Avoid the use of night soil fertilizer.
- Thorough cooking of food particularly
vegetables and washing of fruits
- Washing solution: aqueous iodine solution
(200 parts/million)
- Kills infective egg and larva in 15 minutes.
CHARACTERISTICS OF HOOKWORM
DEFINITION
A. Necator americanus – semi-luna
cutting plate
B. Ancylostoma braziliense – 2 pairs of
teeth
C. Ancylostoma canicun – 3 pairs of
teeth
D. Ancylostoma duodenale – 2 pairs of
teeth
CHAN NICOLE B.
BSMLS 2A
CLINICAL PARA LECTURE 2
2. HOOKWORMS FEMALE – 9-13 mm by 0.35-0.6 mm
Huma Hookworms MALES – 5-11mm by 0.3-0.45m
a. Necator americanus
HOOKWOR BUCCAL COPULATORY BURSA
b. Ancylostoma duodenale
M SPP CAVITY
c. Ancylostoma ceylanicum
Animal Hookworms: N. - 1 pair - fused spicules, deep
americanus semilunar cleft
(Cause skin lesions or larval migrants in man)
cutting plates, - bipartite dorsal rays
d. Ancylostoma braziliense
dorsal
e. Ancylostoma canicum
median
DEVELOPMENTAL STAGES: tooth, deep
1. OVA – avoidal, colorless/hyaline and thin pair of
shelled; 56-60µ : 4-8 cell stage when triangular sub
passed in the feces (surrounded by a clear ventral
zone) lancets.
2. RHABDITIFORM LARVA: A.duodenale 2 pairs of -Unfused spicules:
- Feeding stage, short and stout fused ventral shallow cleft
- Has a long narrow buccal cavity teeth -tripartite dorsal rays
- Flask shaped esophagus A.canicum 3 pairs of -bursa is supported by
- Very small genital primordium ventral teeth long, slender rays
3. FILARIFORM LARVA A.braziliense 1 pair of -Bursa is supported by
- Non-feeding larger outer short stubby rays.
- Infective stage teeth and 1
- Mouth is close with t=a protecting sheath pair of every
- Longer and slender with a pointed inconspicuous
posterior end. median tooth
DISEASE: Necatoriasis/Uncinariasis: Necator
americanus
Ancylostoma: Ancylostoma spp
PATHOLOGY
a. Due to larval stage:
1. Ground itch/Coolie itch/Dew itch
- Dermatitis at the site of entrance of
filariform HOOKWORM SPP
- Intense itching, edema and erythema, and
later papulovesicular eruption
2. Creeping eruption/Cutaneous larval
migrains/Plumber’s itch/ Duck Hunter’s
itch
- Due to the exposure of the skin to the
filariform larvae of A. braziliense and A.
canicum, occasionally of N. americanus
and A. duodenale.
- “Serpiginous tunnel” in the stratum
germinativum of the skin
4. ADULT HOOKWORMS
- Small, cylindrical, fusiform, grayish white
- Relatively stout with a cervical curvature
which appeared like a hook.
- With a well-developed buccal capsule
CHAN NICOLE B.
BSMLS 2A
CLINICAL PARA LECTURE 2
3. PULMONARY LESIONS: Wakana disease
- petechial hemorrhages with eosinophilic
and leukocytic infiltration the=at induces
cough and pyrexia
b. DUE TO ADULT WORM
1. Hookworm anemia
- Chronic blood loss due to continuous
mechanical suction of blood from the
intestinal mucosa and the presence of
bleeding areas left by the adult as they
transfer to new areas.
- Blood loss: “Mycrocytic Hypochromic
Anemia”
2. Hypoalbuminemia
- Loss of protein due to a combined loss of
blood and lymph and the protein loss is as
well in excess of the loss RBC.
DIAGNOSIS
A. Ground its and creeping eruption –
characteristics of the lesion and the
history of skin contrast with soil.
B. Recovery of eggs – DFS, J=KTS, Brine
flotation and FECT
C. Harada Mori culture technique
- Treatment – Mebendazole, Pyrantel
pamoate, oxantel
SEVERE ANEMIA – raise the hemoglobin level
to about 70-80 g/l, iron therapy.
(Ferrous sulfate, 200 mg 3x a day for 3
months)
PREVENTION
a. Sanitary disposal of feces
b. Avoid sites where infected dogs and
cats may defecate.
c. Eradicating the infection in dogs and
cats by periodic antihelminthic
treatment
d. Personal hygiene such as use of shoes
or slippers
e. Avoiding ingestion of raw vegetables
Strongyloides stercoralis
COMMON NAME – Theadworm
DEFINITIVE HOST – man
HABITAT – upper small intestine (duodenum)
- 2 spp: S. stercoralis, S. fuellerboni
DEVELOPMENTAL STAGES
1. OVA
- Avoidal thin-shelled, transparent,
resembles a Chinese lantern.
- Not found in feces except in diarrhea and
hyperistalsis
- Contains a fully developed embryo.
2. Rhabditiform larvae – Flask-shaped &
stout esophagus
- Short buccal activity
- Conspicuous genital primordium
3. Filariform larvae
- Non-feeding stage with a long and
delicate esophagus
- Forked or notched tail.
1. Parasitic
- Inhabits the intestine of host
- Female is a delicate filiform worm
- Esophagus: occupies 1/3 of the anterior
part (longer)
- Parthenogenetic
2. Fee-living
- Exists in the environment.
- Buccal cavity: slightly larger than parasitic
male worm
- Adult female: shorter, smaller
- Shorter esophagus
MOT – skin penetration, autoinfection
DISEASE – Cochin-china diarrhea,
Strongyloidiasis, Strongyloidosis
PATHOLOGY AND SYMPTOMS
1. Skin: allergic, raised red blotches at
the site of larva; penetration
2. Migration of larvae: bronchial
verminous pneumonia
3. Intestine: abdominal pain, diarrhea,
and constipation, vomiting, weight
loss, variable anemia, eosinophilia,
protein-losing enteropathy
4. Death in immune-compromised px
due to heavy autoinfection or larval
migration throughout the body.
CHAN NICOLE B.
BSMLS 2A
CLINICAL PARA LECTURE 2
ENTEROBIUS VERMICULARIS
Synonym: Oxyuris vermicularis
Common name: pinworm, seat worm
Main habitat: cecum and appendix
Definitive host: man
Reservoir host: dogs and cats
Infective stage: embryonated egg
DEVELOPMENTAL STAGES
1. OVA
- Double lined chorionic shell, transparent
& colorless, elongated and ovoidal wt one
side flattened.
- With inner embryonated layer and outer
albuminous shell
- Embryonated when laid at the perianal
area.
- Remain viable up to 13 days, rarely seen
in stool.
2. Adult
- Small, spindle-shaped, relatively stout
with dorsoventral bladder-like expansions
of cuticle called the “cephalic alae” or
“lateral wings”.
- Have an oral end and three lips,
hourglass-shaped esophagus.
a. Male: 2-5 mm long, strongly curved
pointed tail which is used for
copulation, spicule is conspicuous
b. Female: 8-13 mm in length by 0.4mm;
posterior end is sharply pointed; vulva
found in the middle third; paired
genital organs.
DISEASE: Enterobiasis, Oxyuriasis
MODE OF TRANSMISSION
- By anus to the mouth via contaminated
fingers and fomites
- Through contaminated food and drinks
especially if the food handler is the carrier
- Via inhalation: viable ova can float in the
air.
- Retro infection: gravid female after laying
their eggs in the perianal area goes back
through the anus to the large intestine.
The larvae upon hatching migrate back to
the large intestine.
PATHOLOGY & SYMTOMATOLOGY
- Some are asymptomatic: rarely causes
serious lesion.
- Other symptoms
 Nocturnal perianal itching
 Vulva irritation: vulvovaginitis, salpingitis
 Cardinal feature: hypersensitivity
 Mild nausea or vomiting
 Loss of sleep, irritability
 Slight irritation to intestinal mucosa
CONTROL & PREVENTION: extremely difficult
once sets in the household.
- Home and community sanitation
- Better personal hygiene: fingernails
should be cut short.
- Use showers rather than bath tubs
- Infected persons should sleep alone
DIAGNOSIS
a. Graham scotch tape
technique/cellulose acetate technique
b. NIH Swab Technique
c. Schuffner and Swelling Rebel Method
TOXOCARA SPP
Toxocara canis & Toxocara cati
- Synonyms: Ascaruis mystax/Belascaris
cati
 Can infect humans and damage of the
visceral organs.
MORPHOLOGY: adult female
- L: 10-12 cm
- Passes numerous eggs into their host’s
feces
CHAN NICOLE B.
BSMLS 2A
CLINICAL PARA LECTURE 2
DISEASE: there are two major forms of
toxocariasis:
1. Ocular larva migrans (OLM)
- Toxocara infections can cause OLM, an
eye disease that can cause blindness.
2. Visceral larva migrans (VLM)
- Heavier, or repeated Toxocara infections,
while rare, can cause VLM, a disease that
causes swelling of the body’s organs or
central nervous system
- Liver lesions: gray, elevated,
circumscribed.
- Diameter: 4mm
- Granulomatous lesions: eosinophils,
lymphocytes, epitheloid cell and giant
cells of foreign-body type
- Larvae: liver, brain, eye, spinal cord, lungs,
cardiac muscle, kidney and lymph nodes.
SYMPTOMS: due to the inflammatory
reaction at the site of infection
- Benign: 20-80% eosinophilia and
hepatomegaly
- Severe: intermittent pain., dermatitis and
neurologic disturbances, pneumonitis.
Liver and spleen enlargement, skin rashes
on the lower extremities
- Larvae: liver, brain, eye (blindness-most
serious), spinal cord, lungs, cardiac
muscle, kidney and lymph nodes.
TREATMENT: Mebendazole to eliminate the
worm: prednisone for inflammatory
symptoms.
PREVENTION: avoidance of infected dogs and
cats
DIAGNOSIS:
- Clinical s/s: a triad of marked eosinophilia,
hepatomegaly & hyperglobulinemia
- History of exposure to dogs, cats and dirt
eating
- ELISA; EIA
Gnasthostoma spp
1st IH – copepods
2nd IH – fish and amphibians
Diagnosis – migratory lesions, eating raw fish.
LENGTH – 2-3 cm long and rust-colored
LARVA
- Four rows of hooklets extruding from the
surface of the cephalic bulb
- Tiny, cuticular spines run along the length
of their bodies.
- Twi types of papillae extend from the
worm, a cervical papilla off the main body
and two labial papillae on the cephalic
bulb
- Four sac-like openings in the cephalic bulb
EGGS/OVA
- Ovular with a mucus plug at one end
- Approximately 40 micrometers to 70
micrometers
 May cause a VLM like syndrome
(southeast Asia) the larvae may migrate
through subcutaneous tissues, causing
transient swelling, and deepen tissues,
eventually invading the CNS.
Gnasthostomiasis (Gnasthostoma
spinigerum)
- Food-borne parasitic infection that results
from the human ingestion of the third-
stage larvae.
OTHER TERMS – Choko-fushu Tua chid or
chokofishi (Japan)
- Consular disease (Nanjing)
- Shanghai rheumatism
- Tau-cheed (Thailand)
- Woodbury bug (Australia)
- Yangtze River edema
MODE OF TRANSMISSION
- Eating undercooked or raw freshwater,
eels, frogs, and reptiles
- Contaminated water
- In rare instances, larvae can directly
penetrate the skin of individuals who are
exposed to contaminated food sources or
freshwater.
SIGNS & SYMPTOMS
- Migratory swelling under the skin
- Increased levels of eosinophils in the
blindness
- Rarely, the parasite can enter other
tissues such as the liver, and the eye,
vision loss or blindness.
- It can also affect the nerves, spinal cord,
or brain, resulting in nerve pain, paralysis,
coma, and death.
CHAN NICOLE B.
BSMLS 2A
CLINICAL PARA LECTURE 2
Trichostrongylus spp
Zoonotic infection (herbivores)
- Human infection:
 T. colubriformis
 T. orientalis
 T. axei
 T. brevi
 T. tenuis
- They infect poultry and other birds
worlwide
- T. axei – the stomach hairworm, infects
cattle, sheep, goats, pigs, and horses, and
many wild mammals. Found worldwide
other less frequent app are T. probolurus
and T. vitrinu
- HABITAT – small intestines: eggs – larvae-
ingestion by DF
- DISEASE: light & asymptomatic; heavy
infection may produce abdominal pain
and diarrhea, usually with eosinophilia.
Trichostrongylosis or Trichostrongyliasis
- Worms damage the lining of the small
intestine or the stomach – enteritis,
gastritis, and sometimes anemia.
- Typical signs are diarrhea (mucous and/or
hemorrhagic) or constipation – general
weakness and wasting
- Loss of appetite
- Reduced weight gains or even weight loss,
etc.
- Acute severe infections in young animals
may be fata.
- Eggs resemble those of hookworms
(78-98μm by 40-50μm) slightly tapered at
one end.
DIAGNOSIS
- Detection of characteristics eggs in the
feces
- Determination of the spp requires post
mortem examination of adult worms after
necrops.
LIFE CYCLE
 DIRECT LIFE CYCLE
- Adult females lay eggs in the large
intestine of the host that are shed with
the feces. Once in the environment the
eggs release the L1-larvae that complete
development to infective L3-larvae in
about 5 days by suitable weather (hot and
humid), significantly longer by cold
weather. These infective larvae can
survive in the environment and remain
infective for up to 6 months.
Angiostrongylus cantonensis
Synonym – Pulmonema cantonensis
Common name – rat/rodent lungworm
Definitive host – rats
Main habitat – lungs
Disease – Human Angiostrongylosis
MOT – ingestion of larvae in raw or
undercooked snails or other verctors, or
contaminated water and vegetables
Infective stage – 3rd stage larva
DEVELOPMENTAL STAGES
1. OVA
- Elongated, ovoidal with a delicate hyaline
shell – 46-48 to 74 microns
2. 1st stage larva
- Has a distinct dorsal minute notch near
the tip of the tail.
3. 3rd stage larva
- With 2 well developed chitinous rods with
expanded knob-like tips at the anterior
end
4. Adult worms
- Filiform worms wt a length of 17-25mm
a. FEMALE – the milky white uterine
tubules are spirally wound around the
blood-filled intestine and can be seen
through transparent cuticle as a
“barbers pole” pattern
b. MALE – has a well developed caudal
bursa which is kidney-shaped and
single lobed
PATOLOGY & SYMPTOMATOLOGY
- Confusion, incoherence, disorientation
and impairment of memory of profound
coma
DIAGNOSIS
- Brain dyscrasia – moderate to high
eosinophilic counts in the spinal fluid
- History of the px as to ingestion of snails,
crabs or leafy vegetables
- Autopsy to make thorough gross and
microscopic examination of the brain and
spinal cord
CHAN NICOLE B.
BSMLS 2A
CLINICAL PARA LECTURE 2
TRANSMISSION
- Ingestion of raw mollusks containing the
3rd stage larva
- Ingestion of raw leafy vegetables
contaminated with mucus secretions of
the mollusks containing the 3rd stage
larva.
- Drinking water contaminated with the
infected larva.
- Ingestion of paratenic hosts such as
freshwater pawns and crabs containing
the infective larva.

PREVENTION & CONTROL

- Thorough cooking of prawns and crabs
- Through washing of leafy vegetables
- Avoidance of ingestion of raw Achatina
fulica
- Elimination of the snail and eradication o
rodents