malina osman

Multicellular parasites: Helminthes

helminthes (annelida, nemathelminthes,
platyhelminthes)

A group of parasites : annelida, nematode and
flatworm
 Helminthes

Nemathelminthes Platyhelminthes Annelida

Intestinal Tissue Trematodes Cestodes

 Annelida

therapeutic use of leeches in medicine - 50 b.c.
and was cited by ancient authors.

Hirudo medicinalis, has been used by surgeons to
help salvage ischaemic tissues particularly in
replanted digits, ring avulsion injuries and in small
free flaps -

main therapeutic benefits are derived from the
anticoagulant and vasodilator contained in the leech
saliva
 Helminthes

Platyhelminth
Nemathelminthes Annelida
es

Intestinal Tissue Trematodes Cestodes

Ascaris lumbricoides
Trichuris trichiura
Necator americanus
Ancylostoma duodenale
Strongyloides stecoralis
Enterobius vermicularis

Nematodes (nemathelminthes) are elongated,
cylindrical unsegmented worms.



Divided into 2 (based on sites/ systemic
distribution in the host):
 Intestinal nematodes
 Tissue nematodes

Soil transmitted vs Non soil transmitted

helminths
Describe Basic Morphology
Life cycle
Diagnosis
Epidemiology and Mode of Transmission
Clinical manifestation
Treatment
Ascaris lumbricoides

White creamy worm – large size :

male – 10 to 31 cm, and female 22
to 35 cm

adult worms live in lumen of small

intestine (retention in the fold
of mucosa and pressure against
it);
a female worm – 200 000 to 250
000 eggs per day;
Eggs embryonate in the soil –
infective - ingested
Ascaris lumbricoides

Ingested, hatches in the

upper small intestine-
rhabditiform larva

Penetrate intestinal
wall- reach venule or
lymphatic

Reach lungs after 1-7

days
Break alveoli, migrate to
bronchioles and trachea

Pass to esophagus, small

intestine

Diagnosis
 Direct microscopy (wet mount ; saline and iodine)
 Kato Katz technique: in epidemiological study
• More common in warm
Oral ingestion;
countries, poor accidental ingestion
sanitation
of food contaminated
• Occurs at all ages,
particularly in children with worm eggs
• Incidence for both
Infective stage: Egg
sexes = same
Diagnostic stage: Egg
• Poor hygiene, poor
food preparation
• Unhygienic agri
practice - night soil
usage

Epidemiology Mode of transmission

Clinical manifestations
• No symptoms with small numbers of worms;
• Loeffler’s syndrome – allergic manifestations –
pulmonary infiltration; pneumonitis, asthmatic
like symptoms; Eosinophilia;
• Most frequent c/o – vague abdominal pain.
Others: LOA, fever, vomiting or diarrhea,
dyspepsia etc.
• Complications: intestinal obstruction – worm
bolus – common in smaller children; pancreatitis,
hepatic abscess, granulomatous peritonitis,
disseminated gastrointestinal infection,
malnutrition; ectopic migration

Albendazole, Mebendazole

Treatment
 Trichuris trichiura

The whipworm – thick

posterior part- the stock,
long thin anterior portion –
the lash;
Eggs produced by female :
3 000 to 10 000 per day
Trichuris trichiura

Embryonated egg is
ingested – activated
larva escape and
penetrate the intestinal
villus

Retained in the intestine

by anchorage with their
attenuation end-derives
its nourishment

Diagnosis
 Direct microscopy (wet mount ; saline and iodine)
 Kato Katz technique: in epidemiological study
• More common in warm
Oral ingestion;
countries, poor accidental ingestion
sanitation
of food contaminated
• Occurs at all ages,
particularly in children with worm eggs
• Incidence for both
Infective stage: Egg
sexes = same
Diagnostic stage: Egg
• Poor hygiene, poor
food preparation
• Unhygienic agri
practice - night soil
usage

Epidemiology follow A.l Mode of transmission

 Clinical manifestations
• Anterior end interlaced in the colonic mucosa –
damage;
• Appendicitis –blockage of the lumen;
• Heavier infections – abdominal pain, distension, a
bloody or mucoid diarrhea, tenesmus, weight loss
and weakness.
• Prolapse rectum common in malnourished children.
• Anemia due to blood loss and
• Moderate eosinophilia.
• No Loeffler’s syndrome

Albendazole,
Mebendazole

Treatment
Hookworms

Small, cylindrical,
fusiform, grayish white
nematode.

Retained in the intestine

by oral attachment to
the mucosa
Hookworms

Eggs – mature rapidly –

release rhabditiform –
active filariform larvae
(infective stage)

Gain access thro’ skin

(bare foot)

Enter lymphatics – lungs

– trachea – small
intestine

Diagnosis
 Direct microscopy (wet mount ; saline and iodine)
 Kato Katz technique: in epidemiological study
 Harada Mori (culture in lab)
• More common in warm
Direct skin
countries, poor penetration by the
sanitation
filariform larva
• Occurs at all ages,
particularly in children
Infective stage: 3rd
• Incidence for both stage larva -
sexes = same filariform
• Poor hygiene, poor
Diagnostic stage: Egg;
food preparation larva
• Unhygienic agri
practice - night soil
usage

Epidemiology follow A.l Mode of transmission

 Clinical manifestations

• Cutaneous penetration – allergic reaction – ground itch;

• Hookworm attach to the intestinal mucosa. Maturation of
worms – marked diarrhea, vague abdominal pain, colic
nausea;
• Hookworm disease – Anemia – microcytic hypochromic
type – emaciation and mental and physical retardation
associated with this disease but ascribed to other factors
such as nutritional factors.
• Eosinophilia is variable.
• Loeffler’s syndrome

Albendazole,
Mebendazole

Treatment
Enterobius vermicularis

Small, cylindrical,
fusiform, grayish white
nematode.

Retained in the intestine

by oral attachment to
the mucosa
 Enterobius vermicularis

Ingestion – larvae hatch

in the duodenum

Mature to adult form in

jejunum and duodenum

Duration from ingestion

to the perianal migration
: 4 – 6 weeks

Diagnosis
 Direct microscopy (wet mount ; saline and iodine)
 Scoth tape for enterobiasis
  hand to mouth transmission,
inhalation/ airborne,
Human is the only known retroinfection
host
Widest geographical
Infective stage: Egg
distribution, children >>,
Diagnostic stage: Egg
institution centers

Epidemiology Mode of transmission

Clinical manifestations
 migration of female worms – pruritis ani;

 in small children – vaginitis; due to

hypersensitivity to the secretions and
excretions.

 Attachment to the intestinal wall produce

some inflammation; migration to appendix –
appendicitis; migration to female
reproductive system – granuloma around the
eggs or worms.

Albendazole,
Mebendazole

Treatment
Strongyloides stecoralis

Morphology : small,
colorless,
semitransparent
filariform nematode
(2.2 mm by 0.04 mm)

Maintain the position by

penetration of the
tissues
 Strongyloides stecoralis

3 types:
1. Follows hookworm
2. Larvae exposed to
environment – get
mature – adult – mating
– L 3 – direct skin
penetration
3. Autoinfection – L2
become L3 in the large
intestine – penetrate
intestinal mucosa or
perianal skin – follows
hookworm

Diagnosis
 Direct microscopy – larvae (rhabditiform,
filariform)
 Serology (Enzyme Immuno Assay )
 Harada Mori

Direct skin
Human is the only known
host
penetration by the
infective larvae (L3);
Tropical and subtropical autoinfection
areas, but cases also
occur in temperate
Infective stage: L3
areas Larvae
More frequently found
Diagnostic stage:
in rural areas,
institutional settings,
and lower socioeconomic
groups.

Epidemiology Mode of transmission

Clinical manifestations
• abdominal pain; nausea, vomiting, diarhea;
• Pulmonary symptoms (including Loeffler’s syndrome)
• Dermatologic manifestations include urticarial
rashes in the buttocks and waist areas.
• Blood eosinophilia

• heavy infections – weight loss and chronic

dysentry accompanied by malabsorption and
steatorrhea.
• Disseminated strongyloidiasis occurs in
immunosuppressed patients - abdominal pain,
distension, shock, pulmonary and neurologic
complications and septicemia, fatal outcome.

Albendazole,
Ivermectin

Treatment