INTRODUCTION TO

NEMATODES
College of Medical Laboratory Science
Our Lady of Fatima University
PARA 311

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 METAZOANS
Nematoda
Intestinal Ascaris lumbricoides Strongyloides stercoralis
Capillaria philippinensis Trichuris trichiura
Enterobius vermicularis
Hookworm
Extraintestinal Angiostrongylus cantonensis
Filarial worms
Trichinella spiralis
Cestoda
Cyclophyllidea Dipylidium caninum Railientina garrisoni
Echinococcus spp. Taenia saginata
Hymenoplepis diminuta Taenia solium
Hymenoplepis nana
Pseudophylilidea Diphyllobotrium latum
Spirometra
Trematoda
Clonorchis sinensis Heterophyids
Echinostoma ilocanum Opistorchis spp.
Fasciola gigantica Paragonimus wetermani
Fasciola buski Schistosoma spp. 2
 GENERAL CHARACTERISTICS OF NEMATODES

1. Elongated worms, cylindrical

2. Not segmented
3. Have a complete digestive system
4. Have separate sexes (though some maybe parthenogenic)
5. Presence of sensory organs (with exceptions)
6. Mostly are intestinal parasites

CLASSIFICATION OF NEMATODES

A. Presence or Absence of Chemoreceptors

1. Phasmid nematode – minute receptor organs
2. Aphasmid nematode – without chemoreceptors

Ex: Trichuris trichiura, Trichinella spiralis, Capillaria philippinensis

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B. Habitat
1. Intestinal
a. small intestines: Ascaris, hookworms, Strongyloides, Capillaria
b. large intestines: Trichuris, Enterobius

2. Extraintestinal
a. Lymph nodes/vessels: Wuchereria and Brugia
b. Eyes and meninges: Angiostrongylus
c. Muscles: Trichinella

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C. Infective stages and Modes of Transmission

1. Ingestion of embryonated eggs – Ascaris, Trichuris, Enterobius

2. Ingestion of infective larva – Capillaria, Trichinella, Angiostrongylus
3. Skin penetration of L3 – hookworms and Strongyloides
4. Vector-borne – Wuchereria and Brugia
5. Autoinfection – Strongyloides and Enterobius
6. Transmission through inhalation – Enterobius and Ascaris

DEVELOPMENTAL STAGES
1. Egg
2. Larva
a. L1 : rhabditiform larva
b. L2 :
c. L3 : filariform larva
3. Adult
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 Ascaris lumbricoides
Common name : Giant intestinal/round worm
Final Host : man
Habitat : small intestine
Diagnostic stage : fertilized and unfertilized egg
Infective stage : embryonated egg
Source of ex. to inf. : soil-transmitted helminth
MOT : Ingestion
Pathology : Ascariasis
Diagnosis : Stool Exam, Concentration technique
Drug of choice : Albendazole
(Mebendazole and Pyrantel Pamoate)

Ascaris suum – Ascaris of Pigs

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 MORPHOLOGY

MALE FEMALE Trilobate lips with

sensory papillae
10-31 cm 22-35 cm
Ventrally curved Straight end
posterior with 2
spicules

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 MORPHOLOGY

Corticated, Corticated,
Unfertilized egg Fertilized egg

Decorticated, Embryonated
Fertilized egg egg

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 MORPHOLOGY

Corticated, Corticated,
Unfertilized egg Fertilized egg

Decorticated, Embryonated
Fertilized egg egg

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LIFE CYCLE

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 PATHOLOGY
A. Due to larva
*Ascaris pneumonitis or Loeffler’s Syndrome
- occurs during lung migration resulting in allergic reactions
such as lung infiltration, asthmatic attacks and edema of the
lips, similar symptoms of pneumonia, vague abdominal pain
* Eosinophilia is present

B. Due to adult worm

- worm bolus causing bowel obstruction
- diarrhea
- abdominal pain

Erraticity: if worm migrates to ectopic sites (gallbladder, hepatobilliary tree,

appendix and pancreas) à maybe regurgitated and vomited, may escape
through the nostrils or inhaled to the trachea.

- Maybe due to medication, spicy-diet and fever 11

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 DIAGNOSIS
A. Stool Examination
1. Direct Fecal Smear
2. Kato-thick
3. Kato-katz
B. Concentration Technique
1. FECT
2. MIFCT
3. Brine floatation
4. Zinc sulfate floatation technique
C. X-ray (extra-intestinal ascariasisàlungs)
D. CBC (demonstrate eosinophilia)

PREVENTION AND CONTROL

1. Sanitary disposal of human feces 4. Avoid using night soil
2. Health education 5. Proper food preparation
3. Mass chemotheraphy 13
 Integrated Helminth Control Program (DOH)
Targets and Doses
1. Children aged 1 year to 12 years old
For children 12 – 24 months old
Albendazole - 200 mg, single dose every 6 months. Since the preparation is 400mg, the tablet is halve and can be chewed by the
child or taken with a glass of water
Or
Mebendazole - 500 mg, single dose every 6 months
For children 24 months old and above
Albendazole - 400 mg, single dose every 6 months
Or
Mebendazole - 500 mg, single dose every 6 months
Note: If Vitamin A and deworming drug are given simultaneously during the GP activity, either drug can be given first.
2. Adolescent females
It is recommended that all adolescent females who consult the health be given anthelminthic drug
Albendazole 400 mg once a year
Or
Mebendazole 500 mg once a year
3. Pregnant women
It is recommended that all pregnant women who consult the health be given anthelminthic drug once in the 2nd trimester of
pregnancy.
In areas where hookworm is endemic:
Where hookworm prevalence is 20 – 30%
Albendazole 400 mg once in the 2nd trimester
Or
Mebendazole 500 mg once in the 2nd trimester
Where hookworm prevalence is > 50%, repeat treatment in the 3rd trimester
4. Special groups, e.g., food handlers and operators, soldiers, farmers and indigenous people
Selective deworming is the giving of anthelminthic drug to an individual based on the diagnosis of current infection. However, certain
groups of people should be given deworming drugs regardless of their status once they consult the health center.
Special groups like soldiers, farmers, food handlers and operators, and indigenous people are at risk of morbidity because of their
exposure to different intestinal parasites in relation to their occupation or cultural practices. 14
For the clients who will be dewormed selectively, treatment shall given be anytime at the health centers.
 Trichuris trichiura
Common name : Whipworm
Final Host : man
Habitat : large intestine
Diagnostic stage : egg
Infective stage : embryonated egg
Source of ex. to inf. : soil-transmitted helminth
MOT : Ingestion
Pathology : Rectal prolapse, IDA, diarrhea
Diagnosis : Stool Exam, Concentration technique
Drug of choice : Mebendazole
(Albendazole as alternative drug)

* Usually observed occuring together with Ascaris lumbricoides

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 MORPHOLOGY

MALE FEMALE
30-45 mm 35-50 mm
Coiled posterior with a single Rounded/blunt posterior
spicule and rectractile sheath
Attenuated anterior 3/5– slender, hairlike, transversed by a narrow
esophagus resembling “string of beads” – used for attachment
Robust posterior 2/5 – contains the intestines and single set of
reproductive organs 16
 MORPHOLOGY

Lemon shaped/barrel-shaped/football shaped/ Japanese

lantern with plug-like translucent polar prominences a.k.a
“mucoid bipolar plugs”

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LIFE CYCLE

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 PATHOLOGY
1. Rectal prolapse
- a condition in which the rectum
(the lower end of the colon,
located just above the anus)
becomes stretched out and
protrudes out of the anus.
Weakness of the anal sphincter
muscle is often associated with
rectal prolapse at this stage,
resulting in leakage of stool or
mucus.
2. Appendicitis and granulomas due to irritation and
inflammation brought by the worms
3. Blood streaked diarrheal stools, abdominal pain,
tenderness, anemia and weight loss 19
 DIAGNOSIS
A. Stool Examination
1. Direct Fecal Smear
2. Kato-thick
3. Kato-katz

B. Concentration Technique
1. FECT
2. MIFCT
3. Brine floatation
4. Zinc sulfate floatation technique

PREVENTION AND CONTROL

1. Treatment of infected individuals
2. Sanitary disposal of human feces àconstruction of toilets
3. Washing of hands
4. Health education (sanitation and hygiene)
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5. Proper food preparation practices
 Enterobius vermicularis
Common name : Pinworm, Seatworm, Society worm*
Final Host : man
Habitat : (cecum) large intestine
Diagnostic stage : ova
Infective stage : embryonated egg
Source of ex. to inf. : contact-borne
MOT : Ingestion, inhalation
Pathology : Enterobiasis or oxyuriasis
Diagnosis : Scotch tape swab
Drug of choice : Pyrantel pamoate
(Mebendazole and Albendazole as
alternative)
* Familial disease

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 MORPHOLOGY
“Cephalic alae”
– lateral wing or
cuticular alar
expansions at the
anterior end

Prominent
posterior
esophageal bulb or
“bulbus”

MALE FEMALE
2 to 5 mm 8-13 mm
Curved tail and has a single long pointed tail
spicule
*rarely seen because they die
after copulation 22
MORPHOLOGY
Gravid Female

Cephalic Alae
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 MORPHOLOGY

D-shaped eggs of E. vermicularis

Asymmetrical, with one side flattened and the other side is convex
Translucent shell – triple albuminous outer layer for mechanical protection
and inner embryonic lipoidal layer for chemical protection

Ovum develops into a “tadpole-like embryo”

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MORPHOLOGY

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LIFE CYCLE

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 PATHOLOGY
1. Mild catarrhal inflammation of the intestinal mucosa
2. Nocturnal Pruritus ani – “perianal itching” which may
lead to secondary bacterial infection and lack of sleep
3. Other complications: appendicitis, vaginitis, endometritis
and peritonitis.
4. Poor appetite, weight loss and abdominal pain

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 DIAGNOSIS

1. Graham’s scotch adhesive tape

swab (Perianal cellulose tape swab)
- provides the highest percentage of
(+) results

PREVENTION AND CONTROL

1. Personal cleanliness and hygiene are essential
2. Hand washing
3. Boiling of linen and clothing
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 REFERENCES
Belizario, V. and De Leon, W. (2015). Philippine Textbook
of Medical Parasitology. Third Edition. University of the
Philippines Manila. Ermita, Manila.

Mikhail A. Valdescona, RMT, MPH. PAR313 Lecture.

Our Lady of Fatima University. Valenzuela City.

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