Parasitic helminths

Live inside their host. They are worm-like organisms that

live and feed off living host receiving nutrients and
protection and causing weakness and disease.
Those which live inside the digestive tract are called
intestinal parasites.
Helminthology is the study of parasitic worms and their
effect on their host.
Parasitic worms are categorized into three groups;
trematodes, cestodes and nematodes.
All worm offspring are passed on through poorly cooked
meat (especially pork), wild fish, and beef, contaminated
water, feces, insects and, in general, areas of poor
hygiene and food regulation standards such as parts of
Africa, Central and South America and Asia.
 Worm eggs or larvae or even adults enter the
human body through the mouth, anus, nose or skin
with most species attaching themselves to the
intestinal tract.
With the presence of digestive enzymes, worm egg
shells are dissolved releasing a brand new worm;
unlike its egg shell, the parasitic worm is protected
from the body's powerful digestive enzymes by
producing a protective keratine or glycocalyx layer.
 Trematoda - flukes
Adult flukes are leaf-shaped, flattened
dorsoventrally and non segmented, vary in size
from a few millimeters to several centimeters in
length.
All adult trematodes have two suckers an oral
and the ventral one. The digestive system is
simple; the oral cavity is in the center of oral
sucker, and intestinal tract ends blindly in one or
two sacs. There is no anal opening and waste
products are regurigitated.
 They inhabit intestine or tissues of the host.
There are two types of flukes: one is
hermaphroditic; and the second are unisexual
Schistosomes, which live as adults in a blood
vessels. The body of male curves up along the
lateral edges and form a long chanel
(gynecophoral chanel) which wraps around the
female.
 GLOSSARY
Cercaria (pl. cercariae) - developmental stage of
fluke that develops from germ cells in a daughter
sporocysts or redia. This is the final
developmental stage in the snail host, consisting
of a body and tail that aids in swimming.
Metacercaria (pl. metacercariae) - the stage of
fluke life cycle occcuring when cercaria encysts
on water vegetations or in the second
intermediate host. Infective stage for human.
Miracidium (pl. miracidia) - ciliated first stage,
free swimming larva of trematode which
emerges from the egg and must penetrate
the snail in order to continue its life cycle.
Operculum - the lid or cap like cover on
some helminth eggs. Mostly characteristic for
trematodes and lower cestodes.
Redia (pl. rediae) - the second or third larval
stage which develops within a sporocyst.
Elongated, sacklike organisms with mouth
and gut. Many rediae develop in one
sporocyst. Rediae give rise to cercariae.
Schistosoma - a genus of trematodes commonly
called blood flukes. They have elongate shape,
separate sexes, and are found in blood vesses of
their definitive host.
Schistosomule - the immature schistosome in
human tissues after having lost the tail during skin
penetration.
Sporocyst - the larval form which develops from a
miracidium in the snail host. It forms a simple
sacklike structure containing germinal cells which
continue a process of larval multiplication,
producing rediae.
Tegument - body surface of platyhelminths
 Fasciola hepatica - fasciolosis
The large, leaf-shaped, trematode (up
to 3cm long) has oral and ventral
sucker at the first half of the body. May
be recognized by the presence of
numerous branches of intestine, testes
and vitelline glands.

Eggs are oval, gold-yellow and

operculated (DIAGNOSTIC STAGE).
 F. hepatica is the cosmopolitan parasite of
domestic and wild ruminants and man. Various
species of snails (Lymnea and Galba) are the
intermediate host.
This fluke is the so-called liver-fluke and cause
fasciolosis.
Adults locate in liver parenchyma and bile
ducts.
Transmission is by swallowing metacercariae
with water vegetations.
 Life cycle
Adult in bile duct
Eggs leave in feces (DIAGNOSTIC STAGE)
Miracidia develop and hatch in fresh water
Enter snai sporocyst redia I and II cercariae
Cercariae leave snail and encyst on water
plants as metacercariae (INFECTIVE STAGE)
Human eats metacercariae from uncooked
water plants (METHOD OF INFECTION)
Metacercariae excyst in intestinal tract and
juvenile migrate througs peritoneum and liver
tissue.
Method of diagnosis - recovery of eggs in feces.
Antibody detection tests are useful especially in the
early invasive stages
Diagnostic stage - operculated egg (150x90µm)
Disease names - fasciolosis, fascioliasis, sheep liver
rot
Major symptoms - headache, chills, fever, bile ducts
inflamation, hepatomegaly, jaundice, diarrhea and
anemia abdominal pain, hepatomegaly, vomiting,
eosinophilia. In the chronic phase biliary obstruction
and inflammation. Occasionally, ectopic locations of
infection (such as intestinal wall, lungs, subcutaneous
tissue, and pharyngeal mucosa) can occur.
Geographical distribution - cosmopolitan distribution in
sheep- and cattle-raising countries. The natural
definitive host is sheep therefore, infection of human is
 Prevention
Treatment of infected ruminants and
humans.
Elimination and control of the
intermediate hosts population
Avoiding of eating fresh uncooked
waterplants and drinking unboiled water.
Fasciolopsis buski - fasciolopsiosis, fasciolopsiasis
F. buski (large intestinal fluke) is largest fluke affecting
man (2-9cm) distributed in Asia and India, especially in
areas where people raise pigs and consume
freshwater plants. Oral sucker is smaller than the
ventral one.
Eggs (DIAGNOSTIC STAGE) are very similar to those
observed in Fasciola hepatica.
F. buski involves two hosts: the final host belongs to
mammals (dog, pig, rabbit, human) and snails
Planorbidae as intermediate hosts.
The adult lives in the duodenum of the definitive host.
Transmission to man is by eating waterplants
contaminated with metacercariae.
 Life cycle
Adult in small intesine
Eggs leave in feces (DIAGNOSTIC STAGE)
Miracidia develop and hatch in fresh water
Enter snai sporocyst redia I and II cercariae
Cercariae leave snail and encyst on water
plants as metacercariae (INFECTIVE STAGE)
Human eats metacercariae from uncooked
water plants (METHOD OF INFECTION)
Metacercariae excyst in intestinal tract
Method of diagnosis - Microscopic identification
of eggs, or more rarely of the adult flukes, in the
stool or vomitus.
Diagnostic stage - operculated egg (150x90µm)
Disease names - fasciolopsiasis, fasciolopsiosis
Major symptoms - mucosal ulcers, abdominal
pain, nausea, anemia, diarrhea, fever, intestinal
obstruction (in heavy infections), intoxication
can cause death.
Geographical distribution - Southeast Asia
 Prevention
Treatment of infected animals and
humans.
Elimination and control of the
intermediate hosts population
Avoiding of eating fresh uncooked
waterplants and drinking unboiled water.
 Schistosoma (blood flukes) -
schistosomiasis, schistosomosis
The three main species infecting humans
are Schistosoma haematobium, S.
japonicum, and S. mansoni. Two other
species are S. mekongi and S.
intercalatum.
In addition, other species of schistosomes,
which parasitize birds and mammals, can
cause cercarial dermatitis in humans
(swimmers itch).
 Schistosoma mansoni is found in parts of
South America and the Caribbean, Africa, and
the Middle East;
S. haematobium in Africa and the Middle East;
and S. japonicum in the Far East. Schistosoma
mekongi and S. intercalatum are found focally
in South-east Asia and Central-West Africa,
respectively.
Invasive form is furcocercariae actively
penetrating humans skin in water
environment.
Adult Schistosoma live in vessels of the intestinal
tract (S. mansoni, S. japonicum) and urinary
bladder (S. hameatobium).
They are dioecious and their body is elongated as
in nematodes. Smaller male has deep ventral
groove (gynecophoric canal) an the ventral side,
in which longer, slender female resides. Both oral
and ventral sucker are located neare the anterior
end.
Eggs (DIAGNOSTIC STAGE) are characteristic
for each species.
In S. japonicum cats, dogs, pigs cattle may be a
reservoir final hosts.
 Life cycle
Adults in veins around the intestinal tract (S.m.,
S.j.) and in veins around the urinary bladder (S.h.)
Eggs in feces S.m. and S.j. or in urine S.h.
(DIAGNOSTIC STAGE)
Miracidia hatch in fresh water
Enter snail sporocyst free swimming
furcocercaria (INFECTIVE STAGE) penetrates
skin, leaves tai behind (METHOD OF INFECTION)
Enters blood as schistosomule, goes througout
body via blood vessels and develop in appropriate
veins
Schistosoma mansoni
Method of diagnosis - Microscopic identification of
eggs in feces or urine (DS), antibody detection can
be useful in both in clinical management (e.g.,
recent infections) and for epidemiologic surveys.
Tissue biopsy may demonstrate eggs when
stool or urine examinations are negative.
Diagnostic stage - unoperculated egg with large
lateral spine (S.m); large terminal spine (S.h); small
lateral spine (S.j)
Disease names - schistosomiasis, schistosomosis,
bilhalziosis
S.m. - intestinal schistosomosis (bilharziosis)
S.h. - urinary bilharziosis
S.j. - oriental bilharziosis
S. mansoni S. haematobium S. japonicum
Major symptoms - fever, cirrhosis of liver, bloody
diarrhea, bowel obstruction, hypertension,
ulceration and necrosis of tissues, occlusions of
blood vessels, liver and spleen enlargmentand
toxic reactions due to granuloma around eggs in
liver and other tissues (S.h. is associated with
bladder cancer). Infection with furcocercariae
results in itching, skin rash.
Geographical distribution -
S.m. Africe, S and C America, West Indies
S.h. - Africa, Middle East
S.j. - Far East
 Prevention
Treatment of infected animals and
humans.
Protection of water reservoir from
contamination with urine and/or feces
Elimination and control of the
intermediate hosts population
Proper helth education
Other trematodes parasitizing man
Clonorchis sinensis - bile ducts - metacercariae in
uncooked fish
Paragonimus westermani -in lungs - metacercariae in
uncooked crab/crayfish
Heterophyes heterophyes - small intestine -
metacercariae in uncooked fish
Opisthorchis felineus and O. viverrini - bile ducts and
liver - metacercariae in uncooked fish
Dicrocoelium dendriticum - bile ducts - metacercariae
in ants at uncooked plants
 Cestodes - tapeworms
The body of cestodes consists of a scolex, neck and
ribbonlike stobila composed of segments known as
proglottids. They are vary in size. Scolex may be
equipped with suckers and armed with crown of
hooks. They have no digestive tract and all nutrition
occurs by the body surface. Most cestodes are
heteroxenous and hermaphroditic. Man may be a
final as well as intermediate host of cestdes.
Adult cestodes are intestinal parasites whlie the larva
inhabits tissues.
 GLOSSARY
Brood capsule - a structure within the daughter cyst
in E. granulosus in which many scolices grow.
Coracidium - a ciliated hecacanth (D.latum)
Cysticercoid - the larval stage of some tapeworm; a
small, bladderlike structure, containing little or no
fluid, in which scolex is enclosed (H. nana)
Cysticercus - a thin walled, fluid filled, bladderlike

Embryophore - one of the sub-layer of the inner

envelope in some cestodes (Taenia)
Hermaphroditic - having both male and female
reproductive organs within the same individual.
Hexacanth/oncosphere - a tapeworm larva having
six hooks. The motile, first-stage of certain
cestodes that infects first host.
Hydatid cyst - a vesicular structure formed by E.
granulosus larvae in the intermediate host;
contains fluid, brood capsules and daughter cysts
in which the scolices of potencial tapeworms are
formed.
Hydatid sand - granular material consisting of free
scolices, hooks, daughter cysts and amorphous
material. Found in fluid of older cysts of E.
granulosus.
Pleurocercoid - the larva in development of D.latum
that develops after the procercoid stage is ingested by
a freshwater fish. This form has the scolex at one end
and is infective if eaten by human.
Procercoid - larva of D.latum that develops in the body
of freshwater crustacean.
Proglottid - one of the segments of tapeworm. Each
contains male and female reproductive organs when
mature.
Rostellum - anterior protuberance of the scolex of
some tapeworms; may possess a crown of hooks
Scolex (pl. scolices) - anterior end of cestodes by
which attachments occurs; behind it neck (germinative
region) is localized
Cestodes parasitizing man may be divided
into two groups:

Intestinal Tissue tapeworms

tapeworms (in a (as a larva)
strobillar form)
Diphyllobothrium latum Echinococcus
Taenia saginata granulosus
Taenia solium Echinococcus
Hymenolepis nana multilocularis
Taenia solium
 Diphyllobothrium latum (broad fish tapeworm) -
diphyllobothriosis

Occurs in a few
developmental
stages:
operculaded egg
ciliated coracidium
developing in egg in water
envirnment
procercoid (in copepod)
pleurocercoid (in fish)
adult (in fish-eating animals
including man)
 D. latum distribution is limited to the regions
where freshwater fish are common part of diet.
(Baltic and Scandinaian countries, Asia and
North America). It is very long tapeworm (>
20m).
Eggs are operculated and unembryonated.
The source of invasion are fish containing
invasive stage pleurocercoid.
Different species of fish-eating mammals may
serve as final host for this tapeworm.
 Life cycle
Adult in small intestine of man
Undeveloped eggs passed in feces (DIAGNOSTIC
STAGE)
In water coracidium develops and hatches out
A copepod eats coracidium and procercoid develops
in copepod body cavity
Freshwater fish eats copepod, procercoid larva
penetrates the mucosa and moves to muscle in fish
Procercoid develops to pleurocercoid larva in fish
muscles (INFECTIVE STAGE)
Pleurocercoid ingested by man in row, smoked or
undercooked freshwater fish (METHOD OF
INFECTION)
Scolex of pleurocercoid attaches to mucosa and
Method of diagnosis - recovery of numerous eggs in
feces. Evacuated proglottids and scolices are also
rarely present in feces.
Diagnostic stage - operculated egg with terminal
knob opposite the operculum
Disease names - diphyllobothriosis,
diphyllobothriasis, dibothriocephalus anemia, fish
tapeworm infectin, broad fish tapeworm infection
Major symptoms - vomiting, diarrhea,
anorexiaabdominal pain, anemia (macrocytic type

utilization of dietary B12), intestinal obstruction, NS

disturbances due to B12 deficiency, weight loss and
weakness
 Geographical distribution -
temperate regions where fish are a
common part of the diet (the Great
Lakes region, alaska, Chile,
Argentina, Europe, Central Africa,
and parts of Asia.
Has a tendency to endemic
distribution.
 Prevention
Health education
Protection of water and fish farms
from contamination with feces
Treatment of infected persons
Eating well prepared fish (boild,
roasted, fried and hot smoked)

NO MORE SUSHI :)
 Taenia sp. - taeniosis
Among genus Taenia two species are worldwide distributed,
quite common parasites of man. In both cases the source of
infection is raw or undercooked meet of intermediate host

Taenia saginata - beef tapeworm Taenia solium - pork tapeworm

Strobillar form up to 10m
Scolex with suckers only
Gravid proglottids are longer
than wide with branched uterus
(more than 15 branches)
Embryophorated eggs with
oncosphere are infectous for IH
Bladder cysticercus (cysticercus
bovis) develops in cattle muscles
Strobillar form about 4m
Scolex with suckers and double
crown of rostellar hooks
Gravid proglottids are longer
than wide with branched uterus
(less than 15 branches)
Embryophorated eggs with
oncosphere are infectous for IH
Bladder cysticercus develops in
pig muscles man can also serve
as intermediate host
 Life cycle
Adults in small intestine of humans
Free egg or gravid proglottids passes in feces
(DIAGNOSTIC STAGE)
eggs eaten by intermediate host: cow T.sag, pig T. sol
oncosphere hatches, penetrates intestinal wall, carried
to tissue via blood
oncosphere develops to cysticercus larva in tissue
(INFECTIVE STAGE)
Cysticercus eaten by human in raw or undercooked
beef (T.saginata) and pork (T.solium) (METHOD OF
INFECTION)
Scolex everts and attaches to mucosa of small
intestine of human and larva matures to adult
Taenia saginata
Taenia solium
 Method of diagnosis - recovery of egg, gravid proglottid (or
scolex after treatment) in feces. In T. saginata proglottids
are passed individually and they can move, in T. solium
proglottids are passed in short tapes without independent
movement. For specific diagnosis T. saginta has 15-30
lateral uterine branches in the gravid proglottids and
scolex with only 4 suckes. T. solium gravid proglottids has
7-13 (15) branches, and scolex with 4 suckers and double
crown of hooks. The eggs of these two species are
identical. Antibody detection may prove useful especially
in the early invasive stages, when the eggs and proglottids
are not yet apparent in the stools.
TAKE EXTREME CARE IN PROCESSING THE SAMPLES!
INGESTION OF EGGS CAN RESULT IN
CYSTICERCOSIS!
Diagnostic stage - egg, prtoglottids, parts of strobila
Disease name - T. saginata - taeniarhynchosis,
taeniosis, taeniasis, beef tapeworm infection;
T. solium -taeniosis, taeniasis, pork tapeworm infection
Major symptoms - asymptomatic, abdominal pain,
diarrhea, weight loss, appendicitis, inflamation of the
small intesine. T. solium taeniasis is less frequently
symptomatic than T. saginata taeniasis. The main
symptom is often the passage (passive) of proglottids.
The most important feature of T. solium taeniasis is
the risk of development of cysticercosis.
Geographic distribution - both are cosmopolitan,
T.saginata is more common in beef-eating countries,
T. solium where pork is eaten and humans live in
close contact with pigs. T solium is more prevalent in
poorer regions is very rare in Muslin countries.
 Cysticercosis
Taenia solium (pork tapeworm) is
the main cause of human
cysticercosis. In addition, the larval
stage of other Taenia species (e.g.,
multiceps, serialis, brauni,
taeniaeformis, crassiceps) can infect
humans in various sites of
localization including the brain,
subcutaneous tissue, eye, or liver.
 Clinical Features:

The symptoms of cysticercosis are caused by the

development of cysticerci in various sites.
Cerebral cysticercosis (or neurocysticercosis),
can cause seizures, mental disturbances, focal
neurologic deficits, and signs of space-occupying
intracerebral lesions.
Death can occur suddenly.
Extracerebral cysticercosis can cause ocular,
cardiac, or spinal lesions with associated
symptoms. Asymptomatic subcutaneous nodules
and calcified intramuscular nodules can be
encountered.
 Diagnosis:

The definitive diagnosis consists of demonstrating

the cysticercus in the tissue involved.
Persons who are found to have eggs or
proglottids in their feces should be evaluated
serologically since autoinfection, resulting in
cysticercosis, can occur.
Antibody detection provides a useful adjunct in
specific diagnosis
 Prevention
Treatment of infected persons.
Systematic and careful meet inspection.
Temperature processing of meat before
consumption (prolonged cooking, deep
freezing).
Protection of animal farms from
contamination with human feces.
Hymenolepis nana (draft
tapeworm) - hymenolepiosis,
draft tapeworm infection

The smallest tapeworm (1-

6cm) parasitizing man
worldwidely.

Scolex with 4 suckers and

single ring of hooks.
Oval or spherical eggs with
hexacanth are immediately
infective and possess 4-8 polar
filaments.
H. nana is the most common cause of all
cestode infections, and is encountered
worldwide.
Human become infected by swollowing the
eggs, mainly by oral route (from hand to
mouth).
In human intestinal mucos cysticercoid
developes and give rise to strobillar form.
 Life cycle
Adults in intestine
Embryonated eggs released from disintegrating gravid
proglottids
Infective eggs in feces (DIAGNOSTIC STAGE)
Egg infective when released (INFECTIVE STAGE)
Egg is eaten by human (METHOD OF INFECTION)
Egg hatches in small intestine and oncosphere
invades intestinal villus
Cysticercoid larva forms
Emerges into lumen; scolex evaginates and attaches
to mucosa; matures comletely.
Autoendoifection occurs when egg hatches in GI tract
Method of diagnosis - The diagnosis depends on
the demonstration of eggs in stool specimens.
Concentration techniques and repeated
examinationsis recomended.
Diagnostic stage - egg with colorless shell and
filaments
Disease name - hymenolepiosis, draft
tapeworm infection
Major symptoms - asymptomatic, abdominal
pain, diarrhea, hedache, dizziness, vomiting,
weakness, anorexia. Autoinfection is common.
Geographic distribution - worldwide, especially
in children. Most common human tapeworm in
US.
 Prevention
High level or personal and social
sanitation and hygiene.
Treatment of the infected
individuals

NEVER EAT FLEA AND BUGS

Cestodes parasitizing human tissues
and organs

Echinococcus granulosus - dog

tapeworm, hydatid tapeworm
Echinococcus multilocularis
Taenia solium
Human echinococcosis is caused by the larval stages of
E. granulosus causes cystic echinococcosis
(hydatiddisease, hydatid cyst, hydatidosis),
E. multilocularis causes alveolar (multilocular)
echinococcosis;
Man become infected (unspecific intermediate host)
when infective eggs are eaten. And then cestode larva
develops in human tissues.
E. granulosus occurs worldwide. E. multilocularis occurs
in the northern hemisphere (central Europe, northern
Europe, Asia, North America).

(E. vogeli causes polycystic echinococcosis; and E. oligarthrus is an extremely

rare cause of human echinococcosis. E. vogeli and E. oligarthrus occur in
Central and South America.)
Echinococcus granulosus
Small (2-6mm) worldwide
distributed tapeworm of dogs
Scolex with 4 suckers and
double hook crown.
Strobila consists of three
proglottids: immature,
mature and gravid.
Infective eggs are surrouned
by embryophore and are very
similar to Taenia eggs.
Large (more than 20cm in
diameter) bladder unilocular
hydatid cysts develops in
intermediate host tissues
(sheep, deer, pig, other
herbivores, human).
 Life cycle
Adults in intestine of dog or other wild canines
Eggs in feces (INFECTIVE STAGE)
Infect sheep, pig (other herbivores) and form hydatid
cyst in an organ especially liver or lungs
Human (accidental intermediate host) ingests eggs by
close contact with infected dog or sheep fleece
(METHOD OF INFECTION)
Hydatid cyst in liver, lungs, or other organs. These
cyst must be surgically removed (DIAGNOSTIC
STAGE)
Viscera of infected animals eaten by dogs
Cyst digested in the canine intestine, and each
protoscolex develops to an adult tapeworm
Hydatid cyst possesses external
laminated acellular cyst wall and
inner germinal layer from which
the daughter cysts and brood
capsules derive. Inside the
capsules protoscolices develop.
This cyst is encapsulated by host
connective tissue layer
Method of diagnosis - ultrasonography and/or other imaging
techniques (X-ray, CT, MR), serologic tests, ultrasound
guided fine needle biopsy, molecular tests.
Diagnostic stage - hydatid cyst,
Disease name - echinococcosis, hydaid disease,
hydatidosis
Major symptoms - vary according to cyst location. If
in liver or lungs no symptoms until cyst gets large.
- Hepatic involvement: abdominal pain and bile ducts
obstruction.
- Pulmonary involvement: chest pain, cough.
- Rupture of the cysts produce fever, urticaria, eosinophilia,
and anaphylactic shock, as well as cyst dissemination.
In addition to the liver and lungs, other organs (brain, bone,
heart) can also be involved, with resulting symptoms. Growth
can result in death.
Geographic distribution - E. granulosus
occurs practically worldwide, and more
frequently in rural, grazing areas where dogs
ingest organs from infected animals.
Cysts developing and those Degenerated or partially or totally
larger than 2.0 cm are often calcified cysts. Very unlikely to
fertile contain viable protoscoleces

Cysts starting to degenerate,

but usually still contain viable protoscolices
 Prevention
Health education
High hygiene
Household dogs and sheepdogs should
be regularly de-wormed
Feeding of doggs with cooked viscera
Avoidance of dogs, sheep, eating
uncooked vegetbles, especially in
endemic regions
Echinococcus multilocularis - alveolal (multilocular)
echinococcosis
Small (1-4mm) distributed in
northern hemisphere tapeworm
of carnivores.
Scolex with 4 suckers and
double hook crown.
Strobila consists of four
proglottids: 2 immature, mature
and gravid.
Infective eggs are surrouned by
embryophore and are very
similat to Taenia eggs.
Alveolar cysts develop in
intermediate host tissues (rodents
human) and resembles cancer
changes.
 Life cycle
Adults in intestine of fox, cat or other wild canines
Eggs in feces (INFECTIVE STAGE)
Infect rodents (human) and form hydatid cyst in an
organ especially liver or lungs
Human (accidental intermediate host) ingests eggs
contaminated with fox feces by eating forest friuits,
plants or water (METHOD OF INFECTION)
Alveolar cyst in liver, or other organs. These cyst must
be surgically removed (DIAGNOSTIC STAGE)
Viscera of infected animals eaten by foxes, cats.
Cyst digested in the canine intestine, and each
protoscolex develops to an adult tapeworm
Alveolar cyst does not contains
daughter cysts and brood capsules and
is not covered by host connective tisue.
It forms a net of intumescences
extending throughout affected organ
(liver), with growing protoscolices at
the end of each branch.
Method of diagnosis - immunoenzymatic, immunological,
histo-pathological, serological, antibody detection and
molecular methods.
Diagnostic stage - alveolar (multilocular) cyst,
Disease name - echinococcosis, alveolar (multilocular)
echinococcosis
Major symptoms - vary according to cyst location.
- hepatic involvement may mimic hepatic carcinoma, lesions
in liver tissue, abdominal pain and bile ducts obstruction,
necrosis and death,
- Pulmonary involvement cause chest pain, cough.
- Rupture of the cysts produce fever, urticaria, eosinophilia,
and anaphylactic shock.
- Peripheral parts of the cyst may detach and, like carcinoma,
transfer via blood or lymphatic vessels and form metastases
in other tissues.
E. multilocularis affects the liver as a slow
growing, destructive tumor, with abdominal
pain, biliary obstruction, and occasionally
metastatic lesions into the lungs and brain. E.
vogeli affects mainly the liver, where it acts as
a slow growing tumor; secondary cystic
development is common.

Geographic distribution - E. multilocularis

occurs in the northern hemisphere, including
central Europe and the northern parts of
Europe, Asia, and North America
 Prevention

Similar to E. Granulosus

REMEMBER FOREST FRUITS MAY

BE CONTAMINATED WITH E.
MULTILOCULARIS EGGS
 Other cestodes infecting human
Hymenolepis diminuta - stobillar form in the intestine -
cysticercoid in flea or grain beetle
Dipylidium caninum - stobillar form in the intestine -
cysticercoid in flea
Taenia multiceps - coenurus in CNS - eggs with
oncosphere
Spirometra mansonoides - causes sparganosis larva
(spargana) in human tissue - infected copepod of raw
flesh of the second intermediate host.
 NEMATODA - roundworms
Elongated, round in cross section, unsegmented dioecious
(the male smaller than female) and vary is size (from few mm
to over a meter).
The male frequently has a curved or coiled posterior end
with copulatory spicules and bursa.
The adult anterior end may have oral hooks, teth, or plates
in the buccal capsule, for the purpose of attachment.
The exterior surface is called cuticle below it muscle layers
are.
The organ systems include a complex nerve core, digestive
system (buccal capsule, esophagus, gut, anus), and
reproducitive organs. The female can produce from several
hundrets up to millions of offspring.
 Man is the definitive host for the roundworms of
medical importance.
The adult female produces fertilized eggs or
larvae, which may be directly infective, may
require a period of development in the soil, or
may be transmitted to another host by an insect.
Infection of human by nematodes may be by
ingestion of the infective egg or larva, by larval
penetration through the skin or via transmission
of larva by the bite of an insect.
About half resides as adult in the intestinal tract;
the others are found in variuos human tissues.
 Most nematodes are monoxenous, however,
some have complex life cycles

The pathogenicity of intestinal nematodes may be

due to migration of larvae through body tissues,
piercing of the intestinal wall, bloodsucking
acivities, or allergic reactions to substancecs
secreted by parasite.

Pathogenicity induced by the tissue rounworms is

primarily due to host responses to the parasite
secretions and excretions.
 Glossary
- a disease
caused by the migration of larvae of Ancylostoma under
the human skin. It is marked by thin, red papular lines of
erution.
Cuticle - resistant to digestion surface of nematodes.
Filaria (pl.filariae) - a nematode worm which requires an
arthropod intermediate host for transmission.
Incubation period - from initial infection to clinical
symptoms
Microfilaria - an embryo of filaria, usually in the blood or
tissue of humans: must be ingested by the arthropod
intermediate host.
Prepatent period - the time between initial infection and
reproduction by the parasite
Rectal prolapse - weakening of the rectal musculature

whipworm infections)
Tropical eosinophilia - syndrome associated with high level
of eosinophils, coughing and asthma. Caused by zoonotic
filarial infections with no microfilaria circulating in blood.
Visceral larva migrans - a disease caused by the migration
of T. cati/canis through the liver, lungs etc., characterised
by hypereosinophila, hepatomegaly and pneumonitis;
larvae can invade ocular space and cause retinal
damages
Ascaris lumbricoides-large
intestinal roundworm
Ascaris lumbricoides is the largest
nematode parasitizing the human
intestine (females: 20-35 cm; adult
male: 15-30 cm).

Eggs unoperculated, oval covered

with thick mamillated, yellow-
brown outer shell.

Man is the only host of this

rounworm and become infected by
swallowing infective eggs.
Ascaris lumbricoides is the largest and most common
human helminthic parasite (1300000000 people are
the carriers) with, highest prevalence in tropical and
subtropical regions as well as areas with inadequate
sanitation.

The main source of infection for man are vegetables

(lettuce) and soil contaminated with human feces
containing infective eggs (oral route of infection)

Coexists with T. trichiura. The eggs of these two

require the same soil conditions for development, and
infection for both is by ingestion of infective eggs.
 Life cycle
Adult in small intestine
Undeveloped eggs in feces (Diagnostic
stage)
Eggs develop in soil for few weeks
(INFECTIVE STAGE)
Infective eggs containing larvae eaten by
humans (METHOD OF INFECTION)
Larvae hatch out of eggs in the small intestine
Larvae penetrate intestinal wall, then enter
blood vessels
Migrate to liver
Travel to blood via blood
stream
Larvae break out of lung Liver-lung
capillaries into alveoli migration
Travel to bronchioles,
coughed up to pharynx,
swallowed, return to intestine

Larvae mature to adult intestinal form

 Method of diagnosis - recovery of fertile and infertile
eggs in feces. Larvae can be identified in sputum or
gastric aspirate during the pulmonary migration phase.
Adult worms are occasionally passed in the stool or
through the mouth or nose and are recognizable by
macroscopic characteristics.
Fertilized - with embryo
inside, thick yelowish chitin
shell and coarse, mamillated
albuminous covering

Nonfertilized - with
amorphous mass of
protoplasm, heavy
albuminous coating and thin
shell
Disease names - ascariosis, ascariasis,
roundworm infection
Major symptoms - (1) pneumonia, cough (blood
stain sputum), low-grade fever and eosinophilia,
dyspnea, hemoptysis, eosinophilic pneumonitis
(2) intestinal obstruction and perforation of
intestinal wall by adults in heavy infections; (3)
vomiting, symptomatic occlusion of the biliary
tract and abdominal pain due to adult migration.
Each developmental stage may cause allergic
reaction. Invasion of Ascaris may cause death in
children.
Geographic distribution - worldwide, prevalent in
warm climate and areas of pood sanitation
 Prevention
Education
High level of hygiene
Do not use human feces as
manure/fertilizer in agricultural
production
Well food preparation
Treatment of infected persons
Enterobius vermicularis
- pinworm, seatworm
Trichuris trichiura -
whipworm

These species are

cosmopolitan, worldwide
distributed monoxenous
parasites of human colon.

Infective egg must be

ingested to cause disease.

Characteristic eggs in
feces are the diagnostic
stage.
Enterobius vermicularis - pinworm, seatworm

Adults are small (female up to 13mm). Eggs

are ovoid and flattened on one side and may
be embryonated or invasisve.
Sources of invasion are the infected people,
bedding, towels, toys, tools and dust
contaminated with pinworm eggs.
The way of infection is usually hand-to-mouth.
 Life cycle
Adults live in colon
Gravid female migrates to anus peripheral
region to lay eggs (DIAGNOSTIC STAGE)
Eggs develop to infective stage in 3-8h
(INFECTIVE STAGE)
Eggs distributed in air, house, environment
Eggs are ingested - mainly hand-to-mouth
transport (METHOD OF INFECTION)
Eggs hatch in small intestine
Larvae mature to adults
Method of diagnosis - recovery eggs from perianal
region with cellophane tape preparation. This must
be done in the morning, before defecation and
washing, by pressing transparent adhesive tape

the tape placed on a slide. Alternatively, anal swabs

(a paddle coated with adhesive material) can also be
used. Eggs can also be found, but less frequently, in
the stool. Adult worms are also diagnostic, when
found in the perianal area, or during ano-rectal or
vaginal examinations.
Diagnostic stage - thick-walled, colorless flattened on
one side egg, sometime adults in feces and perianal
region.
Disease names - enterobiosis, enterobiasis,
oxyuriosis, pinworm infection

Major symptoms - asymptomatic, other symptoms are

associated with the noctural (night) migration of
female: slight irritation to intestinal mucosa, mild
nausea or vomiting, loss of sleep, irritability (nails
biting), anorexia, abdominal pain, perianal itching
which may lead to bacterial superinfection.

Geographuc distridution - Worldwide (more prevalent

in temperate regions than in tropics), infections are
more frequent in children and in crowded conditions.
 Prevention
High level of hygiene
Food and water protection from dust
Prevention
Treatment of all members of the group
simultaneoulsy
 Trichuris trichiura - whipworm
Adults (female up to 5cm) are
whip-shaped. Unembryoneted
eggs are brown, barrel-shaped
with two polar hyaline plugs.

Sources of invasion are the

foodstafs, water and soil (dust)
contaminated with whipworm
eggs (oral route of infection)
 The third most common monoxenous
round worm of humans. Worldwide, with
infections more frequent in tropical areas
and poor sanitation practices, and among
children.
It is estimated that 800 million people are
infected worldwide.
T. trichiura parasitizing human large
intestine.
 Life cycle
Adults in colon; anterior portion embeds in
mucosa by spearlike projection
Undeveloped eggs in feces (DIAGNOSTIC
STAGE)
Eggs embryonate in soil by few weeks
(INFECTIVE STAGE)
Infective eggs containing larvae eaten by human
(METHOD OF INFECTION)
Larvae hatch in small intestine, penetrate and
develop in intestinal villi
Return o lumen and go to caecum
Larvae mature
Method of diagnosis - recovery of characteristic eggs
(occasionally adults) in feces. Concentration
procedure is recommended.
Disease names - trichurosis, trichuriasis, whipworm
infection
Major symptoms - asymptomatic (slight infection),
bloody or mucoid diarrhea, colitis, vomiting, anemia,
weight loss and weakness, abdominal pain and
tenderness, rectal prolapse, intestinal obstruction
and possibly growth retardation. May provide
subsequent entrance of bacteria resulting in
inflamatory processes. May increase probability of
cancer.
Geographic distibution - worldwide, prevalent in
warm and humid climate.
rectal prolapse
 Prevention

Similar to Ascaris lumbricoides

Toxocara canis/cati - dogs/cats large intestinal
rounworm
Cosmopolitan intestinal parasite
of (young) dogs and cats.

Man may be infected by ingestion

of invasive egg with food, water,
soil contaminated with animal
feces (children are more
frequently infected).
Toxocara never completes its life
cycle in human and disease is
caused by migration of larvae
(cutaneous/ocular larva migrans
viscelaris, larva migrans
viscelaris)
 Toxocarosis (toxocariasis) belongs to
zoonoses.
Zoonoses are parasitic infections in which the
normal host is animal, but which can produce
disease in humans if they accidentaly become
infected (some protozoans, tapeworms,
nematodes and arthropodes). These parasites
usualy do not develop to the adult stage in
human.
 Life cycle
Adult in dog/cat small intestine
Undeveloped eggs in feces (DIAGNOSTIC STAGE)
Eggs embryonate in soil by two weeks (INFECTIVE STAGE)
Infective eggs eaten by humans (animals) (METHOD OF
INFECTION)
IN HUMAN: after ingestion,
eggs hatch and larvae penetrate the intestinal
wall
carried by the circulation to a wide variety of
tissues (liver, heart, lungs, brain, muscle, eyes).
While the larvae do not undergo any further
development in these sites, they can cause
severe local reactions that are the basis of
toxocariasis. The two main clinical presentations
of toxocariasis are visceral larva migrans (VLM)
and ocular larva migrans (OLM). (DIAGNOSTIC
STAGE)
Method of diagnosis - Since the larvae do not develop
into adults in humans, a stool examination would not
detect any eggs and making a correct diagnosis is
very difficult. A diagnosis rests on clinical signs,
history of exposure to puppies, laboratory findings
(including eosinophilia), detection of antibodies,
biopsy for detection of granuloma surrounding larvae.
Diagnostc stage - In animals: eggs and adults; In
human larvae.
Disease names - toxocarosis, toxocariasis, visceral
larva migrans (VLM) and ocular larva migrans (OLM)
Geographic distribution - Worldwide
Major symptoms - asymptomatic, eosinophilia.
- In VLM the larvae invade multiple tissues
(liver, heart, lungs, brain, muscle) and cause:
fever, anorexia, weight loss, pulmonary
inflamation cough, wheezing, rashes,
hepatosplenomegaly, and hypereosinophilia.
Death can occur rarely, by severe cardiac,
pulmonary or neurologic involvement.
- In OLM - ophthalmologic lesions (may be
misdiagnosed as retinoblastoma) resulting in
surgery. OLM may leads to blindness.
Prevention De-worming of animals
Secuing of food, water
and playgrounds from
dogs and cats feces
Cleaning after dogs
 Trichinella spiralis - trichinosis
The smallest cosmopolitan
roundworm infecting man
(females up to 5 mm).

Human is the accidental host.

Transmission occurs by ingesting

spirally coiled infective larvae
licalized in striatted muscles of
many species of animals.

Most of the parasite life cycle take

place in one host. Two types of
life cycle may be distinguished
synantropic and sylvatic
Humans are accidentally infected. The source of infection
for man is consumption of meat with infective larvae.
Rats and rodents are responsible for maintaining the
endemicity. Carnivorous/omnivorous animals (pigs or bears),
feed on infected rodents or meat from other animals.
Different animal hosts are implicated in the life cycle of the
different species of Trichinella.
 Life cycle
Adults in small intestine
Female releases larvae (up to 2500) which penetrate
intestinal wall and disseminate via blood
Larvae encyst and form a capsue in striated muscles
(DIAGNOSTIC STAGE) encysted larvae may remain
viable for several years. They show predilection for
muscles reach in vessels (diaphragm, tongue, larynx, neck
and intercostal)
Ingestion of improperly processed meat (or eating food
contaminated with such meat) containing encysted larvae
(METHOD OF INFECTION and INFECTIVE STAGE)
Tissue digested and larvae freed in intestine
Rapidly mature to adults
Method of diagnosis - based on clinical
symptoms and eosinophilia, can be confirmed
by antibody detection, fluorescent antibody
latex flocullation, bentonite flocculation, indirect
heagglutinationmuscle biopsy, and
microscopy.
Diagnostic stage - larva encysted in a muscle
cell (the so-called nurse cell). Cyst becomes
calcificated over time.
Disease names - trichinellosis, trichinosis
Gographic distribution - worldwide among
meat-eating populations.
Major symptoms - asymptomatic.
- Intestinal invasion: nausea, diarrhea, gastroenteritis,
abdominal pain, vomiting, headache.
- Larval migration (one week after infection): allergic
symptoms, muscle pain, periorbital and facial edema,
fever, rashes, and blood eosinophilia, bloody effusion
under nail and conjunctivitis, blurred vision, acute local
inflamation with edema of the musculature.
Occasionaly myocarditis, central nervous system
involvement, and pneumonitis as well as nephritis.
Larval encystment in the muscles causes myalgia and
weakness.
Trichinellosis may leads to death.
 Prevention
Avoiding consumption of undercooked or
raw meat
Meat inspection (not only pork)
The smoking, curing and drying of meat
are not reliable method of prevention.
Education
 Filariasis
Caused by nematodes that inhabit the
lymphatics and subcutaneous tissues. Eight
species infect humans.
Wuchereria bancrofti and Brugia malayi
cause lymphatic filariasis, and Onchocerca
volvulus causes onchocerciasis (river
blindness). The other five species are Loa
loa, Mansonella perstans, M. streptocerca,
M. ozzardi, and Brugia timori.
 Adults live in various human tissue.
All require an arthropod intermediate host
Adult female living in the body tissues deposit
larvae (microfilariae) into lymphatics, blood, skin.
When taking a blood meal, the arthropod ingests
microfilariae which after moulting inside arthropod
become infective.
These larvae are injected into the new host during
blood sucking.
The entering larvae migrate to appropriate tissue
site and develop to adult.
 Loa loa

Onchocerca volvulus

Wuchereria bancrofti
 Life cycle
Adults in lymphatics (W. bancrofti) or in subcutaneous
tissue (L. loa and O. Vulvulus)
DIAGNOSTIC STAGE microfilariae in: blood (W.b and
L.l) or in subcutaneos nodule (O.v)
Microfilariae ingested with blood by: mosquito (W.b.),
Chrysops fly (L.l) or Simulium fly (O.v)
Infectious stage in arthropod (INFECTIVE STAGE)
Infective larvae enter skin at arthropod feeding site
(METHOD OF INFECTION)
Larval migration and development in tissues
Some microfilariae exhibit diurnal (Loa loa) and
nocturnal (Wuchereria bancrofti) occurence in
blood due to a time of intermediate host feeding
strategy.
Method of diagnosis microfilariae in stained blood
smear. It is important to time the blood collection with
the known periodicity of the microfilariae. For
increased sensitivity, concentration techniques can be
used. Antigen detection. Molecular diagnosis using
PCR. Identification of adult worms during
subcutaneous biopsies or worm removal from the eye
(loiasis). Antibody detection is not recomended
because of cross reactivity between filaria and other
helminths
Diagnostic stage - microfilariae
Disease name filariosis, filariasis
Major symptoms asymptomatic, localized
subcutaneous edema, especially around eye due to
the adult worm migration
Geographic distribution - Africa
Method of diagnosis SIMILAR TO LOA LOA
Disease name filariosis, filariasis
Diagnostic stage - microfilariae
Major symptoms asymptomatic, lymphatic
dysfunction, lymphedema and elephantiasis
(frequently in the lower extremities), febrile
lymphangitis may occur. Persons who have newly
arrived in disease-endemic areas can develop afebrile
episodes of lymphangitis and lymphadenitis. An
additional manifestation of filarial infection, mostly in
Asia, is pulmonary tropical eosinophilia syndrome,
with nocturnal cough and wheezing, fever, and
eosinophilia.
Geographic distribution Worldwide, tropical and
subtropical
Onchocerca volvulus
Method of diagnosis microfilariae in tissue scraping or
snips of nodule. Skin snips must be incubate in saline or
culture medium, and then examined for microfilariae.
Antigen detection. Molecular diagnosis.
Identification of adult worms is possible from tissue
samples collected during nodulectomies. Antibody
detection is not recomended.
Diagnostic stage - microfilariae
Disease name filariosis, filariasis
Major symptoms asymptomatic, dermatitis,
onchocercomata (subcutaneous nodules), and
lymphadenopathies. The most serious manifestation
consists of ocular lesions that can progress to
blindness.
Geographic distribution Central America, Africa
 Strongyliodes stercoralis (threadworm)

Adult
parthenogenetic
females (2,5mm)
are the intestinal
parasites of
human.

Rhabditiform
larvae are
released with
feces.
 Life cycle
Adult in small intestine only pathenogenic females
Eggs hatch in intestine
First-stage noninfective rhabditiform larva in feces
(DIAGNOSTIC STAGE). May develop to infective stage in
intestine.
Lives in soil and develops to non parasitic adults
Eggs, rhabditiform larvae
Infective third-stage filariform larvae (INFECTIVE STAGE)
Larvae penetrate skin, enter lymphatics or blood
(METHOD OF INFECTION)
Migrate to lungs via blood stream, break out of lung
capillaries into alveoli
Travel to bronchioles, coughed up to pharynx, swallowed,
return to intestine and mature to adult
Method of diagnosis recovery and identification of
rhabditiform larvae in feces (0.7mm). Examination of serial
samples may be necessary, because stool examination is
relatively insensitive. The duodenal fluid can be examined
as well. Larvae may be detected in sputum.
Diagnostic stage rhabditiform larva
Disease name strongyloidosis, strongyloidiasis,
threadworm infection
Major symptoms asymptomatic; Skin: raised, itchy red
blotches at the site of larval penetration; Migration of
larvae: bronchial pneumonia; Intestinal: abdominal pain,
diarrhea, constipation, vomiting, weight loss, anemia,
eosinophilia. May cause death in
immunosupressedpersons.
Geographic distribution Warm areas, worldwide.
 Ancylostoma duodenale( Old World hookworm),
Necator americanus (New World hookworm)
Adult monoxenous
nematodes (8-13mm)
are the intestinal
parasites of man.

Ovoid eggs are

released with feces.

In heavy infections
they may cause
significant loss of
blood and decreasing
in the number of
erytrocytes.
 Life cycle

Adult in small intestine

Eggs in feces (DIAGNOSTIC STAGE).
Embryo develop rapidly to rhabditiform larva and
hatches in soil
Molts twice and develops to infective third-stage
filariform larva (INFECTIVE STAGE)
Larvae penetrate skin, enter lymphatics or blood
(METHOD OF INFECTION)
Migrate to lungs via blood stream, break out of lung
capillaries into alveoli
Travel to bronchioles, coughed up to pharynx,
swallowed, return to intestine and mature to adult
Method of diagnosis recovery and identification of
hookworm eggs in feces.
Diagnostic stage egg with thin, smooth colorless shell,
two to eirght cell stage of cleavage
Disease name ancylostomosis, necatorosis, hookworm
infection
Major symptoms asymptomatic; anemia (caused by
blood loss at the site of intestinal attachment of the worms)
is the most common symptom of hookworm infection, and
can be accompanied by cardiac complications. Skin:

Migration of larvae: mild pneumonia with cough, sore

throat, bloody sputum and headache; Intestinal: abdominal
pain, enteritis, weight loss, loss of strength, eosinophilia.
Geographic distribution N. Americanus US, Africa
A. Duodenale Europe, S. Am.
 Prevention

Proper social and personal sanitation

Avoidance of walking barefoot, soil and
water contaminated with human feces
Treatment of infected individuals
(particularly immunosupressed)
Health education
 Anisakis sp. anisakiosis, anisakiasis
Anisakiosis is caused by the
accidental ingestion of larvae of
Anisakis simplex and
Pseudoterranova decipiens.
They are present in the oceans and
see of northern hemisphere.
The 3rd stage invasive larva
(INVASIVE STAGE) is present in
different fish species mainly in
heerings and mackerels and are
infectious for fisheating mammals.
Human may be accidental host and
larvae may produce symptoms
similar to peptic ulcer. Additionally
allergic reaction is present at site of
worm attachment place.
Method of diagnosis - diagnosis is made by
gastroscopic examination (2 cm larvae are visualized
and removed), or by histopathologic examination of
tissue removed at biopsy or during surgery.
Diagnostic stage larvae attached to
stomach/intestinal wall
Major symptoms - within hours after ingestion, violent
abdominal pain, nausea, and vomiting may
occur. Occasionally the larvae are coughed up and
may pass into the bowel and severe eosinophilic
granulomatous response.
Geographic distribution - worldwide, with higher
incidence in areas where raw fish is eaten (e.g.,
Japan, Scandinavia, South America, the Netherlands).
 Prevention

Avoidance of eating raw, cool

smoked or salted fish
 Others
Ancylostoma braziliense dog/active penetratiof of larvae
- cutaneous larva migrans
A.caninum dog/active penetratiof of larvae - cutaneous
larva migrans
Angiostrongylus cantonensis ingestion of snail -
meningoencephalitis
Baylisascaris procyonis, a roundworm of raccoons, has
been reported to cause similar VLM and OLM syndromes
in humans
Brugia malavi mosquito lymphatics
Brugia timori mosquito lymphatics
Capillaria philippinensis raw fish - small intestine
Dirofilaria spp. insects - tropical eosinophilia
 Dracunculus medinensis copepod -
subcutaneous tissue, painful ulcer of the skin
Mansonella streptocerca - dermis and
subcutaneous tissue - midge
M. ozzardi - subcutaneous tissues - midge
M. perstansin - body cavities and
surrounding tissues midge
Trichostrongylus spp. small intestine
infective larvae at plants